Education Excellence and Innovation Management: A 2025 Vision to Sustain Economic Development during Global Challenges

Puskesmas, The Third Level of Indonesia Healthcare:

Current Electronic Medical Record (EMR) Status and
Readiness in Meeting Industry 4.0 Challenges
Faisal SYAFAR

Computing and Information Systems Research Centre, Department of Electronics, Universitas

Negeri Makassar, Makassar, Indonesia, email: faisal.syafar@unm.ac.id

Misita ANWAR

Computing and Information Systems Research Centre, Department of Electronics, Universitas Negeri
Makassar, Makassar, Indonesia, email: misita.anwar@unm.ac.id

Halimah HUSAIN

Department of Chemistry, Universitas Negeri Makassar, Makassar, Indonesia, email:

halimah.husain@unm.ac.id

Sutarsih SUHAEB

Computing and Information Systems Research Centre, Department of Electronics, Universitas

Negeri Makassar, Makassar, Indonesia, email: sutarsih.suhaeb@unm.ac.id

Sofyan SYAFAR

Politeknik, STIA-LAN Makassar, Department of Public Administration, Makassar, Indonesia, email:

sf_syafar@yahoo.com

Abstract

The current world of health is inseparable from computer technology and information technology.
The processing of medical data that used to be done manually is now made automatic with
information systems to speed up the work process of doctors in obtaining medical data. In hospitals,
of course many have "Electronic Medical Record (EMR) Information System (IS)" but there are still
many Puskesmas (the third level of Indonesian healthcare institution) that do not have such a system
in Makassar City. Patient medical data at the health center at this time in the city of Makassar, is done
manually or using a computer but has not been supported by the information system. The number of
problems that often occur due to recording medical records is done by recording on the medical
record card, resulting in human errors, searching medical records data that takes a long time and
recording disease reports that are sometimes inaccurate. In addition to the patient's medical data, the
illnesses suffered by patients vary greatly and the drugs recommended for each patient are also, in
many cases, not the same between patients with the same disease. Based on the description above, it
is considered very urgent to design and design an EMR information system at one of the Puskesmas
in Makassar that can be used as a reference by other Indonesian’s Puskesmas.

Introduction

To find out the level of accuracy of a drug for each patient, a system is needed to handle this
problem, namely by creating an information system to make it easier for doctors to enter patient data,
search for patient data, medical record data and others quickly. So it is expected that with a
computerized information system for recording medical records that can facilitate the process of

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recording medical records, search for patient data that checks at the health center. According to
Bjering et al. (2018) The use of computers for electronic medic record services in public health
services, especially for data processing in the patient registration section, recording medical records
and patient examination sites is very appropriate, because it can provide several advantages and
conveniences in patient services including: speeding up service, more accurate information, and
faster data searching and searching.

Based on the description above, it is considered very urgent to design and design an EMR
information system at one of the Puskesmas in Makassar that can be used as a reference by other
Puskesmas. With the design of this system, it is expected to make it easier for doctors to find out
patient information, diseases, drugs, know the level of influence of certain drugs on certain patients
and get reports clearly and quickly and can make it easy for patients to find out personal data
information, and check data.

Research Problems

1. What is the real condition (status) of the data management of road patient medical records at the
Makassar City Health Center at this time?
2. How to design a patient's integrated EMR information system at the Puskesmas in Makassar
City?

Research Objectives

1. Knowing the current status of patient data management to determine the EMR information
system that suits your needs.
2. Analyzing and documenting the draft of the information system design of the target Puskesmas
EMR in Makassar City.

Research Limits

1. Designing a web-based and also android-based EMR Information system (only for the doctor
module), this is done so that the distribution and publication of information is quickly conveyed
to those in need, so that health services are carried out properly and efficiently.
2. Information system which includes entering medical record supporting data such as patient,
doctor, laboratory assistant, reference letters and also medical reports.
3. The patient queue process is also used to check whether the patient data that want to check
already exists or not at the target health center.

Research Importance

Data management in all Puskesmas in Makassar City is one of the important components in realizing
an EMR information system, where data management is still manual even though it is already using a
computer (not based on information systems) has many weaknesses, besides requiring a long time,
less accurate, so the possibility of error is very large. With the support of current information
technology, the work of managing data manually can be replaced with an information system that is
not only faster and easier, data management is also more accurate.

The increase of both inpatient and outpatient patients in all Puskesmas causes difficulties for staff in
registering patients, both old patients and new patients so it is very helpful if in this case there is a
special information system to handle the medical record system at the Puskesmas in Makassar City .
The benefits expected in this study are:

1. For the research team, this research is expected to be able to increase empirical research finding
in healthcare domain based IT.

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2. For university stakeholders, this research is expected to be able to add references for relevant
further research.
3. For the target Puskesmas, this research can provide facilities for the development of an
information system for the regestration of patient visits and to facilitate online reporting.

Theoretical Foundation

Basic Concepts of Information Systems

According to Jensen (2016), Information systems are a combination of four main parts. The four
main areas include software (software), hardware (hardware), infrastructure, supported Human
Resources (HR). Meanwhile, according to Bang et al. (2005) that the information system is a system
within an organization that meets the needs of daily transaction processing that supports
organizational operations that support managerial with the strategic activities of an organization to be
able to provide reports needed by certain outsiders. From these two theories it can be concluded that
the resolution of information systems is a relationship of various interrelated information and one
linkage to another for specific purposes and objectives.

Benefits of Healthcare Information System

Users of information systems in this era are increasing along with the rapid development of computer
technology (software, hardware), the internet and the awareness and interest of the public to use
computers to facilitate their work. An information system provides many benefits including the
following: (Jensen, 2016; Su and Shih, 2003):

1) Data centered.
2) Ease of Accessing Information.
3) Time efficiency.
4) The scope and dissemination of information becomes wider and faster.
5) Facilitating business and work processes.
6) Low cost for access and provision of information.
7) Cheap, economical and reliable communication solutions.
8) Data storage can be developed as needed.

Electronic Medical Records

Electronic medical records are files containing records and documents about patient identity,
examinations, treatment, actions, and other services that have been provided by doctors to patients,
both inpatients and outpatients (Ladden et al., 2013; Patwardhan, 2012; Jansen, 2016). These records
and documents are very important for patient care, because they can provide information in making
decisions, both for treatment, treatment and other medical measures. Patient medical record
information must be kept confidential by doctors, leaders of health service providers, certain health
workers, and management officers, but can be disclosed in certain cases. As regulated in the Minister
of Health Regulation No. 269 of 2008 concerning Medical Records Chapter IV article 10,
information on identity, diagnosis, disease history, examination history and treatment history can be
disclosed in terms of:

1. For the benefit of the patient's health,

2. Fulfill the request of law enforcement officials in the context of law enforcement according to a
court order,
3. Request and / or the patient's own consent,
4. Request for institutions / institutions based on statutory provisions, and
5. For the purposes of research, education and medical audits, as long as they do not mention the
patient's identity.

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Education Excellence and Innovation Management: A 2025 Vision to Sustain Economic Development during Global Challenges

Benefits of Electronic Medical Record Information Systems

The benefits of the EMR information system according to Joynt et al., (2011); Winpenny et al.,
(2016), can be mentioned, among others as follows:

1. Management can see reports issued by hospitals (Puskesmas), such as drug data reports,
employee data reports, visit history reports, and medical record reports.
2. Administrative staff can manage patient data, manage head of household data, add visits, print
queuing numbers, print medical treatment cards, and make reports.
3. Poly officers / nurses can manage the results of physical examinations.
4. Doctors can manage data from disease examination results (diagnoses and medical actions),
manage prescription drugs and make referral letters.
5. Pharmacists can manage drug data, view prescription drugs, and ACC prescription drugs.
6. Patients can see the visit history and medical record of the patient himself.
7. Admin manages poly data, employee data, user access data, and view Hospital reports.

Research Methods

Framework

To assist in the preparation of this study, it is necessary to have a clear framework for the stages. This
framework is the steps that will be taken in solving the problem to be discussed or a series of ideas
arranged systematically, logically, clearly, structurally and regularly.

Plan for System Design Recommendations

In analyzing the needs of this outpatient service information system, researchers will use the basic
method of developing the System Development Life Cycle (SDLC) system with the waterfall model
reference for the benefit of recommendations.

This reference model can be explained in 4 (four) stages, namely:

First, the analysis phase. This stage is the process of identifying and evaluating the problems that
occur, and the expected needs of the Type C Hospital in Makassar City. The ongoing system analysis
process is described using:

1 Literature Study
At this stage a search for theoretical foundations is obtained from various books and journals to
complement the vocabulary of concepts and theories, so that they have good and appropriate
foundation and knowledge.
2 Data Collection
At this stage the data collection process is carried out by interview and observation methods to
make observations and analysis of the actual state of management of outpatient information data
in Makassar Type C Hospital so that data and information are needed by researchers for
information system development needs.
3 Old System Analysis
At this stage identification of problems in the current system (manual or computerized) is carried
out. Thus, researchers are expected to find solutions to problems and needs.

Second, the design stage. This stage determines the overall system architecture, design of making
software programs, and coding procedures. At this stage system design is carried out which consists
of designing ERD (Entity Relational Diagram), software architecture, interface design using UML

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Education Excellence and Innovation Management: A 2025 Vision to Sustain Economic Development during Global Challenges

tools. After that the interface design for web-based information systems was carried out until the Beta
version.

In the system design recommendation stage, follow these steps:

1 Process Modelling. Modelling information systems outpatient services using system use case and
activity diagrams. system use case which is a more detailed description of what the actor does in
the outpatient service information system. While the activity diagram is a detailed description of
the procedures perfoEMRd in the outpatient service process.
2 Data Modelling. Data modelling in the outpatient service information system includes the
description of entity relationship diagrams, designing the tables needed in the database, and
making relations between tables. Entity Relationship that is made has a relationship between data
one with the other data. The tables that have been designed are then realized between tables with
one another to support the smooth processing of data.
3 The interface design, the application interface design is used to provide an overview of the
outpatient service information system designed. Interface design Check function to enter patient
check data. In the patient interface design check, the user can search data, add data, save data,
edit data and delete data.
4 Implementation of the system, the hardware needed to develop an Outpatient Patient Information
System is a desktop computer. The testing method used is black box testing, which is by giving
input from the user to the system that is already running and observing the output of the system.

Third stage of coding. At this stage, software design is realized as a set of programs or program units.
System implementation is done using the PHP, HTML, java script, and PostgreSQL database
languages.

The fourth stage of testing. At this stage, software testing is carried out to ensure that all system
requirements are met and ensure that the output gives results that match the needs. In this study
system testing was carried out using black-box testing. To compare the test results according to the
functional that has been determined.
The system development method that will be used on the recommendations of the analysis of
information system development needs is the System Development Life Cycle (SDLC).

Conclusion

It is expected that the research finding will build a unique framework addressing the following issues
(1) the existing conditions of patient data management, and (2) current manual registration system.
By analysing the need assessment, EMR information system that beneficial for accessing information
regarding to patients, doctors and pharmacies, will be more easy to be implemented. This conceptual
assessment will guide the planning for identifying system development life cycle in the perspectives
of modern outpatient information system.

References

• Bang, M, A. Larsson, E. Berglund, H. Eriksson. (2005), ‘Distributed user interfaces for clinical
ubiquitous computing applications’, International Journal Medical Information, 74 (7–8), 545–
551.
• Baskaran V, Bali R, Arochena H, Naguib R, Ghani M, Shah B. (2008), ‘Health informatics: a
UK and Canadian perspective on current and future challenges. In: Benbasat Izak, Montazemi
Ali R, editors. Am. Conf. Inf. Syst. Toronto, ON, Canada: AIS, 1—6.
• Crossing the Quality Chasm. (2001), ‘A New Health System for the 21st Century. Washington,
DC: The National Academies Press.

13976
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• Fletcher, G. F., Berra, K., Fletcher, B. J., Gilstrap, L., & Wood, M. J. (2012), ‘The integrated
team approach to the care of the patient with cardiovascular disease.’,Current Problems in
Cardiology, 37 (9), 369-397.
• Ofcom (2009), ‘The consumer experience: telecoms, internet and digital broadcasting 2009,
Evaluation report.
• International Telecommunications Union (2010), ‘The world in 2010: ICT facts and figures.
International Telecommunication Union.
• Jensen LG, Bossen C. (2016), ‘Factors affecting physicians’ use of a dedicated overview
interface in an electronic health record: the importance of standard information and standard
documentation’, International Journal of Medical Information, 87, 44—53.
• Joynt KE, Orav EJ, Jha AK. (2011), ‘Thirty-day readmission rates for Medicare beneficiaries by
race and site of care. JAMA, 305 (7), 675–681.
• Ladden, M., Bodenheimer, T., Fishman, N, Flinter, M., Hsu, C., Parchman, M., & Wagner, E.
(2013), ‘The emerging primary care workforce: Preliminary observations from the primary care
team: Learning from effective ambulatory practices project’, Academic Medicine, 88(12), 1830-
1834.
• Patwardhan (2012), ‘After-hours access of convenient care clinics and cost savings associated
with avoidance of higher-cost sites of care’, Journal of Primary Care Community Health, 3 (4),
243–245.
th
• Syafar, F., Gao, J., & Du, T. (2014), ‘Refereed proceedings of the 18 Pacific Asia Conference
on Information Systems (PACIS): Mobile-Enabled Collaborative Maintenance. Chengdu, China.
• Syafar, F. and Husain, H. (2017), ‘Development of an Integrated Framework for Successful
Adoption and Implementation of Mobile Collaboration Technology in Indonesian Healthcare’
,Proceedings of the 30th International Business Information Management Association
Conference - Crafting Global Competitive Economies: 2020 Vision Strategic Planning and
Smart Implementation.
• Syafar, F., Husain, H., Harun, S., Ridwansyah & Sokku, S. (2017), ‘Key Data and Information
Quality Requirements for Asset Management in Higher Education: A case Study’,Proceedings of
the 30th International Business Information Management Association Conference - Crafting
Global Competitive Economies: 2020 Vision Strategic Planning and Smart Implementation.
• Syafar, F., and Gao, J. (2013), ‘Mobile Collaboration Technology In Engineering Asset
th
Maintenance: A Delphy Study. Paper presented at the 2013 IEEE 17 International Conference
on CSCWD, Whistler, BC, Canada, 27-29 June.
th
• Syafar, F., Gao, J., & Du, T. (2013), ‘Refereed proceedings of the 17 Pacific Asia Conference
on Information Systems (PACIS): Applying The International Delphi Technique In A Study Of
Mobile Collaborative Maintenance Requirements. Jeju Island, Korea.
• Su, S and C.L. Shih. (2003), ‘Managing a mixed-registration-type appointment system in
outpatient clinics, International Journal of Medical Information, 70 (1), 31–40.
• Winpenny E, Miani C, Pitchforth E. (2016), ‘Outpatient services and primary care: scoping
review, substudies and international comparisons’,Health Service Delivery Res, 4.

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