JUSINDO, Vol. 7 No. 1, Januari 2025

p-ISSN: 2303-288X, e-ISSN: 2541-7207

Jurnal Sehat Indonesia: Vol. 7, No. 1, Januari 2025 |382

Analysis of Inpatient Registration Information System on The Timeliness of

Inpatient Services at Hamba Regional Hospital

Qurrota 'Aini

, Yuyun Yunengsih

, Johni S. Pasaribu

Politeknik Piksi Ganesha, Bandung, Indonesia

1,2,3

Email: [email protected]

, [email protected]

ABSTRACT

Keywords: Registration;

Hospitalization; Fishbone

Diagram; Timeliness

This research aims to evaluate the inpatient registration

information system at RSUD Haji Abdoel Madjid Batoe. This

research is a descriptive qualitative research with the research

respondents being inpatient registration admission officers at

RSUD Haji Abdoel Madjid Batoe. This research is a

qualitative research using the scrum method. Findings from

interviews with admissions officers showed several factors

affecting the timeliness of registration, including human

resource shortages, delays in procurement of materials,

suboptimal procedures, slow computer systems, and limited

funding. The analysis resulted in recommendations for

improvement, additional staff, improved technological

equipment, material and fund management, and consistent

implementation of SOPs. In addition, regular training and

evaluation for staff is required to ensure that procedures are

followed correctly and efficiently.

Correspondent Author: Qurrota 'Aini

E-mail: [email protected]

Articles with open access under license

Introduction

A hospital is an institution that provides complete individual health services, including

inpatient, outpatient, and emergency services (Permenkes, 2019). One of the services provided

is inpatient care, which provides medical services to patients in less than 24 hours. The inpatient

registration place is a front-line service unit and is the responsibility of medical records in each

hospital, starting from registration to recording patient document data. Therefore, medical

records are documents containing patient identity data, examinations, treatments, patient

actions, and other services that have been provided to patients (Permenkes, 2022). In today's

information era, information plays an important role in decision-making by individuals and

government agencies. Information is now easier to obtain, more diverse in form, and its

usefulness is increasing. With the rapid development of technology, the need for information

has become very important so that it must be accessible anytime and anywhere. This facilitates

fast and accurate access to information, thereby reducing unwanted errors and including

important information related to patient data (Rusman & Suwardoyo, 2022).

The system is a unit of procedures that are combined and created to record and supervise

the implementation of activities related to one of the fields in a hospital or company. In the

hospital there are inpatient services. According to Endang Sutisna (2022, p. 322) inpatient

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services are services for patients for observation, diagnosis, treatment, nursing, medical

rehabilitation by staying in an inpatient room at a health facility with a place of care that due to

illness the patient must stay in the hospital. The hospital has an inpatient registration system

that aims to register patients to manage patient data who are treated until they are discharged

from the hospital (Ripriyanti & Hidayati, 2021).

Hospitals are part of social and health organizations that provide curative and preventive

services, and function as centers for health training and medical research (Tanjung et al., 2023).

Hospitals also have an important role in providing health services evenly, prioritizing healing

and health recovery, and supporting health worker education and research, in accordance with

Article 1 paragraph 1 of the Indonesian Minister of Health Regulation No. 159 of 1988. To

carry out its duties, hospitals have several main functions (Article 4 of Law No. 44 of 2009).

These functions include: 1) providing standard treatment and health recovery services, 2)

maintaining and improving individual health through second and third level health services

according to medical needs, 3) organizing education and training for human resources to

improve their ability to provide health services, and 4) conducting research and development

of technology in the health sector by paying attention to scientific ethics (Haryanti et al., 2024).

Medical records are files containing notes and documents about patient identity,

examinations, treatments, actions, and other services that have been provided to patients at

health facilities. These files include anamnesis, diagnosis, examinations, and medical actions

given to patients both in inpatient, outpatient, and emergency services (Amran et al., 2022).

Medical records aim to provide information about patients to all parties providing care or

treatment. According to Minister of Health Regulation Number 269/ MenKes/Per/III/2008,

medical records are divided into two types: 1) Conventional Medical Records, which are paper

files with contents according to applicable regulations, and 2) Electronic Medical Records,

which use electronic information technology and are regulated by separate regulations (Putri et

al., 2024).

A system is a collection of subsystems, components, or procedures that interact with each

other to achieve certain goals and produce the desired output. This system is an integrated

network of procedures to carry out the main activities in a company, organization, or hospital.

Within the system there are procedures and components that involve people and are designed

to ensure the handling of transactions in companies, organizations, and hospitals. System

components include: system components that interact to form a whole, system boundaries that

separate the system from its external environment, the external environment that affects system

operations, connections between components for resource flow, input as processed data, output

that is useful as input for other subsystems, processing to convert input into output, goals and

objectives that direct the system, and feedback to control deviant processes. Systems can be

classified as abstract and physical systems, natural and man-made, certain and uncertain, and

closed and open systems (Irianto et al., 2021).

Inpatient care is an individual health service that includes observation, diagnosis,

treatment, nursing, medical rehabilitation, with an overnight stay in an inpatient room at a

hospital health facility where for medical reasons the patient must stay overnight. There are

four types of inpatient care in hospitals: 1) Emergency care for patients who need immediate

assistance, 2) Complete inpatient care that provides comprehensive health services according

to patient needs, 3) Referral services for patients referred by other health facilities for diagnosis

or therapy, and 4) Outpatient surgery services that perform surgery with patients being

discharged on the same day (Haryanto et al., 2023).

According to the KBBI, analysis is an investigation of an event (an essay, action, etc.).

To find out the actual situation (cause, cause, problem, etc.). According to Goverde (2017, p.

111) punctuality means that the implementation of services in the community can be completed

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within a specified time period. Increasing punctuality can be done if there is synergy between

regulators and operators with a good planning system, setting operational standards.

Addressing these issues is crucial to improving hospital service delivery. This study aims

to evaluate the inpatient registration information system at Haji Abdoel Madjid Batoe Regional

Hospital, focusing on identifying factors influencing timeliness and providing actionable

recommendations for system improvement.

Research methods

The research design in this study uses qualitative descriptive. The subjects in this study

were officers at the inpatient registration and inpatients. And the objects in this study were

inpatients. The variables in this study were divided into 5 elements, namely man, material,

method, machine, and money. The instruments in this study were interviews and observations.

The location of the study was carried out at the inpatient registration at the Haji Abdoel Madjid

Batoe Regional Hospital in Rengas Condong, Muara Bulian, Batang Hari Regency, Jambi. The

data in this study were primary data obtained from interviews and observations and secondary

data obtained or collected by researchers from various existing sources or research data

obtained indirectly. The stages in qualitative descriptive research are as follows:

1. Determining research objectives

2. Selection of research subjects.

3. Identification of research variables

4. Selection of research location

5. Data collection.

Furthermore, this research also uses data collection techniques which are divided into:

1. Semi-structured or structured interviews were conducted with inpatient registration

officers and inpatients. Questions were designed to explore information about the

predetermined research variables (man, material, method, machine, and money).

2. Participatory or non-participatory observation, where the researcher observes the situation

and records everything relevant to the research variables.

3. Collect data from existing documents, reports, or records related to the inpatient

registration process at Haji Abdoel Madjid Batoe Regional Hospital.

4. Literature study, begins with the process of searching for information related to the

creation of web applications through research journals, articles, and books so that in the

application design process, strategic steps can be planned in the application creation

process.

Fishbone diagram, also known as cause-effect diagram, is a quality improvement tool

developed by Dr. Kaoru Ishikawa in 1915. This diagram systematically depicts the path leading

to the root cause of a quality problem. The steps in creating it include defining the problem,

brainstorming potential causes, drawing the diagram with main categories such as raw

materials, methods, people, machines, measurements, and environment, placing the causes in

the appropriate category, finding the root cause, and developing collective action based on the

analysis results. The advantages of this diagram include identifying the root cause, generating

solution ideas, further investigating the facts, creating desired results, discussing the issue

comprehensively, and generating new ideas (Coccia, 2020).

The inpatient registration system using the fishbone method includes elements of man,

material, method, machine, and money. Man refers to the involvement of human resources that

affect the medical record system, including health workers such as doctors and nurses. Material

includes the infrastructure needed, such as computers and HVS paper. Method is the registration

procedure or workflow. Machine involves equipment such as printers and barcode machines to

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support operations. Money refers to the funds needed to support the medical record system and

other operations, including purchasing equipment and paying salaries to workers (Anggryani et

al., 2024).

Results and Discussion

Results

From interviews with the head of the room and admissions officers at Haji Abdoel

Madjid Batoe Hospital, information was obtained regarding the inpatient registration process.

Patients who require hospitalization must first obtain an inpatient order (SPRI) from a doctor

in the ER or polyclinic. Furthermore, the patient's family brings this letter to the admissions

department to complete the administrative data and search for a room. After the room is

available, the admissions department contacts the room that will receive the patient. If the

patient has been placed in a room, the responsibility is transferred to the nurse. The archives

of patients who have been discharged are returned to the medical records unit. The data

required for inpatient registration include KTP, Family Card, and BPJS card or other health

insurance. This process involves recording the identity of the person in charge of the patient

and completing the administrative files in the hospital system. Socialization regarding the

inpatient registration process has been carried out and followed by the ER admissions officers.

SOPs regarding inpatient registration also exist, and their benefits are recognized as important

by officers to speed up the process and make work easier. The registration process can be seen

in the following image:

Figure 1. Patient Registration Flow

Source: Research data, 2024

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Then, behind that, there are still some obstacles in the implementation of inpatient care.

Problems that often occur in the implementation of inpatient registration include errors in

writing data, slow computer systems, and lack of manpower in the admissions department.

Admissions officers often have to go back and forth because of incomplete SPRI such as the

absence of the name of the doctor in charge. The timeliness of inpatient services is generally

good but sometimes constrained by a slow system. This causes the waiting time for the patient's

family to be longer. Lack of staff also results in less than optimal service.

Discussion

By using the fishbone diagram method, the analysis of the inpatient registration information

system at Haji Abdoel Madjid Batoe Hospital includes five main elements, namely man,

material, method, machine, and money. From the results of interviews with related officers, the

following results were obtained.

1. Man (Human Resources)

Human resources in the admissions department play a crucial role in inpatient

registration. Interviews with admissions officers 1 and 2 showed that understaffing slowed

down the administration process and reduced service delivery. Additional staff and continuous

training are needed to improve efficiency and reduce errors in data entry. The performance of

superiors was also considered quite good by admissions officers in directing and disciplining

staff. The provision of SOP training was also very helpful in ensuring that procedures were

followed correctly.

2. Materials (Materials and Infrastructure)

The materials used include hardware such as computers, scanners, and printers.

Interviews showed that problems often arise when there is a delay in the procurement of

necessary materials, such as paper or printer ink. The provision of sufficient and timely

materials must be ensured for smooth administrative processes. Admissions officers stated that

materials that are not available quickly can cause delays in the patient registration process.

Therefore, management needs to improve the procurement system to ensure that operational

needs are met.

3. Method (Procedure and Workflow)

Clear SOPs and workflows have been in place and socialized. Interviews with ward heads

and admissions officers indicated that consistent implementation and regular evaluation are

needed to ensure that all procedures are followed correctly. This will help reduce patient waiting

times and increase their satisfaction with hospital services. Officers also suggested that SOPs

be updated regularly to keep up with technological developments and hospital needs. Regular

evaluation and feedback from field officers are also important to ensure that the implemented

SOPs are truly effective.

4. Machine (Equipment and Technology)

Slow computer system constraints often hamper the registration process. Interviews

indicated that investment in better equipment and technology and regular maintenance are

needed to speed up the administration process and reduce patient waiting times. Admissions

officers 1 and 2 also stated that the system often experiences errors that hinder their work.

Improving the quality of the network and hardware can help overcome this problem. In addition,

training on the use of technology for officers is also needed to improve efficiency.

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5. Money (Funds)

The availability of adequate funds for operations is very important. Funds are used to

purchase equipment, materials, and labor salaries. Interviews with officers showed that good

financial management will ensure that all operational needs are met and support the smooth

running of the inpatient registration process. Management needs to ensure that the budget for

purchasing equipment and procuring materials is always available and sufficient. In addition,

investment in technology and staff training also requires adequate financial support to improve

the quality of hospital services. Based on the discussion of the 5 elements of the fishbone

diagram above, the following is a fishbone diagram that illustrates the factors that influence the

timeliness of inpatient registration at Haji Abdoel Madjid Batoe Hospital.

Figure 2. Fishbone Diagram of Inpatient Registration

Source: Research data, 2024

Program Creation Needs

There are server device requirements and user device requirements (users) used in

running the inpatient registration information system program, among others:

Server device requirements used:

1. CPU: 4 Core

2. RAM: 4 GB

3. Storage: 120 GB

4. PHP, MySQL, NodeJs, Git

5. Programming Language: PHP, JavaScript

6. Framework: Laravel, Filament

7. Library Styling: Tailwind

8.Database: MySQL

The timeliness of inpatient

registration at Haji Abdoel

Madjid Batoe Regional

Hospital is influenced by a

lack of staff, delays in

procurement of materials

MAN

Lack of staff in the

admissions section, lack of

training in the use of SOPs,

and incomplete human

resources.

MATERIAL

Delays in procurement of

materials such as paper and

printer ink, as well as low

quality equipment and

technology.

METHOD

Inconsistency of procedures

with field needs and lack of

periodic evaluation and

updating of SOPs.

MACHINE

Slow computer systems and

errors in hospital computer

systems.

MONEY

Budget constraints for

system maintenance and

upgrades.

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User device requirements that are used:

1. CPU: 2 Core

2. Ram: 4 GB / 1 GB Free

3. Storage: 64 GB / 10 GB Free

4. Web Browser (Chrome, Mozilla, Firefox, Edge, Safari)

5. Keyboard, Mouse, Monitor

6. OS (Win 7 and above, Mac OS 10.10 and above, Ubuntu 18 and above)

System implementation

1. Login Menu

The login menu is the first page that will appear when the application website is run. The

email and password, the display will return to the login menu.

Figure 3. Login Menu

2. Dashboard View

Dashboard view is a visual display that presents various types of data in one centralized

place. In the dashboard there is a menu of the total number of stored patients, the total handling

of igd patients, the total hospitalization of patients and the total number of outpatients.

Figure 4. Dashboard view

3. Registration form

Registration form is a collection of patient identification data in the form of administrative

data in medical records containing identities that will facilitate the process of searching for

patient medical record data. On the website page select new registration to register a patient,

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fill in all patient identity data except the medical record number and then create. if the data is

successfully saved, a patient display will appear on the registration menu.

Figure 5. Registration form

4. handling display

The handling display is a process of action taken in providing services in an emergency

such as an igd. On the handling page, select the patient's name that has been registered, fill in

the doctor's name and other data then click create. If successfully saved, the data will appear on

the handling menu.

Figure 6. handling display igd

5. hospitalization form

The hospitalization form is a form that contains the identity of patients who have been

registered and treated in the IgD section. Patients who need special care and must stay overnight

at the hospital. On the hospitalization page, select the patient's name, fill in the room and class

type, pay type, admission date and time, discharge date and time, return status then click create.

If the data is successfully saved, the patient will appear in the inpatient menu.

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Figure 7. hospitalization form

6. outpatient form

The outpatient form is a form that contains the identity of patients who have registered

with the admissions department without the patient having to stay overnight. On the outpatient

page click the patient's name, date of admission, doctor's name and poly unit and patient status

then create. Patient status is filled in if the patient needs treatment and the data will move to

inpatient care. If the data is successfully saved, the patient data will appear in the outpatient

view.

Figure 8. outpatient form

Conclusion

Based on the results of the analysis, it can be concluded that the inpatient registration

information system at RSUD Haji Abdoel Madjid Batoe still needs improvement in several

aspects. To evaluate and improve the inpatient registration information system at RSUD Haji

Abdoel Madjid Batoe, it is recommended to increase the number of staff in the admission

section based on workload and patient volume to ensure faster and more efficient service.

Procure and maintain the necessary technological equipment to support a faster and more

accurate registration process. Optimize the use of materials and funds to support daily

operations, ensuring availability and consistent service quality. Implement existing SOPs

consistently to improve service standards and reduce errors in the registration process. Conduct

regular training and evaluation for officers to ensure they understand and apply procedures

correctly and efficiently, and stay up-to-date with the latest technological developments and

service methods.

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