# Telemedicine Adoption for Managing Chronic and Rare Diseases in Indonesia During and Beyond the COVID-19 Era: Qualitative Study

## TL;DR

This study explores how telemedicine was adopted in Indonesia during the pandemic to manage chronic and rare diseases, highlighting its benefits and ongoing challenges.

## Contribution

The study provides new insights into telemedicine adoption in a geographically and socioeconomically diverse country like Indonesia.

## Key findings

- Telemedicine adoption in Indonesia was limited before the pandemic but accelerated rapidly afterward.
- Telemedicine improved access to specialists and reduced costs for patients in remote areas.
- Challenges include lack of physical examination and infrastructure, as well as physician burnout.

## Abstract

Telemedicine has emerged as a valuable tool for improving health care delivery, especially in low-resource and geographically isolated regions. In Indonesia, the COVID-19 pandemic highlighted the need for digital health solutions to manage chronic diseases and improve access to specialists.

This study aimed to examine the rapid adoption of telemedicine in Indonesia, focusing on its role in managing chronic and rare diseases and highlighting both its benefits and challenges to long-term viability during and post pandemic.

A qualitative study was used, following the Consolidated Criteria for Reporting Qualitative Research 32-item checklist and guided by established theories and frameworks. Recruitment followed a systematic multistage procedure suited to the context of Indonesia, an upper-middle-income country and Group of Twenty member characterized by wide regional and socioeconomic disparities. Data were collected through 15 semistructured interviews conducted between October and December 2024. The interviews were divided into 2 phases: first with physicians from various medical specialties and 6 out of 7 regions within Indonesia, and then with patients diagnosed with autoimmune diseases. All interviews were audio-recorded, transcribed verbatim, and analyzed inductively to identify recurrent themes and subthemes.

Before the COVID-19 pandemic, telemedicine adoption in Indonesia was limited, with many physicians recalling its nonexistence before 2015. The pandemic accelerated the adoption of virtual platforms, which became essential for patient consultation, follow-ups, and medication management. Though its use decreased after the pandemic, telemedicine remains valuable, particularly for chronic and rare disease management in remote areas with limited access to specialists. At least three overarching themes were identified: (1) acceleration and normalization of telemedicine (the pandemic catalyzed the integration of virtual consultations into routine care, transforming initial skepticism into broad acceptance); (2) accessibility and cost efficiency (telemedicine reduced financial and travel burdens, especially for patients in remote areas, with several reporting cost savings from hybrid consultation models); and (3) limitations of virtual care (physicians highlighted constraints related to the absence of physical examination).

The findings reveal that telemedicine has become a valuable tool in Indonesia for managing chronic and rare diseases, particularly for follow-up care and medical specialist access across diverse geographical areas. While telemedicine has improved health care accessibility and demonstrated significant cost benefits by reducing transportation and consultation costs, challenges such as limited infrastructure and physician burnout remain. Long-term success will depend on the development of sustainable regulatory frameworks, continued investment in digital infrastructure, and a focus on optimizing cost-effectiveness in health care delivery.