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All Journal Kesmas Indonesia: Jurnal Ilmiah Kesehatan Masyarakat Jurnal Manajemen Informasi Kesehatan Indonesia (JMIKI) Journal of Public Health Research and Community Health Development (JPH RECODE) Jurnal Aisyah : Jurnal Ilmu Kesehatan International Journal of Health and Information System (IJHIS) International Journal of Healthcare and Information Technology SEJAGAT : Jurnal Pengabdian Masyarakat
Wijayanti, Rossalina Adi
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Optimalisasi Manajemen Penanganan Klaim Pending Pasien Bpjs Rawat Inap di Rumah Sakit Citra Husada Jember Tahun 2018 Alfiansyah, Gamasiano; Nuraini, Novita; Wijayanti, Rossalina Adi; Putri, Fitriana; Deharja, Atma; Santi, Maya Weka
Kesmas Indonesia: Jurnal Ilmiah Kesehatan Masyarakat Vol 11 No 1 (2019): Jurnal Kesmas Indonesia
Publisher : Jurusan Kesehatan Masyarakat dan Fakultas Ilmu-Ilmu Kesehatan Universitas Jenderal Soedirman

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (87.268 KB) | DOI: 10.20884/1.ki.2019.11.1.1314

Abstract

Latar belakang: Perubahan paradigma pelayanan kesehatan harus disikapi oleh para pengelola rumah sakit. Peningkatan mutu dan patient safety menjadi faktor utama yang akan mempengaruhi peningkatan kinerja rumah sakit dalam era BPJS. Berdasarkan studi pendahuluan, ditemukan banyak formulir persyaratan klaim BPJS yang tidak lengkap dalam pengisiannya. Data menunjukkan masih ditemukan beberapa berkas klaim yang dikembalikan. Tujuan: melakukan optimalisasi manajemen dalam penanganan klaim pending melalui POAC. Metode: Penelitian ini merupakan penelitian kualitatif, dengan maksud menggali lebih dalam fungsi manajemen yang telah dilakukan. Penelitian dilakukan di Rumah Sakit Citra Husada Jember pada bulan Mei ? September 2018 dengan unit analisis adalah unit rekam medis di rumah sakit tersebut. Hasil: Proses penanganan claim pending berdasarkan aspek planning, organizing, actuating, dan controlling masih belum berjalan dengan baik. Hal tersebut diantaranya dikarenakan tidak adanya rincian pekerjaan dan job description, kurangnya motivasi dari pimpinan, dan tidak ada jadwal supervisi pimpinan yang jelas. Saran: Menyusun rencana kerja operasional dalam proses pengisian berkas persyaratan klaim BPJS, membuat susunan rincian pekerjaan dan job description dalam pengelolaan pengisian berkas persyaratan klaim BPJS rawat inap, menyusun SOP untuk memudahkan komunikasi antar petugas, dan menyusun jadwal supervisi pimpinan untuk mempermudah staf dalam melaporkan informasi yang harus dilaporkan. Kata kunci: Klaim Pending, BPJS, Manajemen
Factors Causing Delays in Submitting Inpatient BPJS Claims at RSU dr. H. Koesnadi Bondowoso Nuraini, Novita; Damayani, Desnia Sindi; Wijayanti, Rossalina Adi
Jurnal Aisyah : Jurnal Ilmu Kesehatan Vol 6, No 2: June 2021
Publisher : Universitas Aisyah Pringsewu

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1996.252 KB) | DOI: 10.30604/jika.v6i2.481

Abstract

The submission of BPJS claims by health care facilities according to the technical verification manual is at least on the 10th of the following month. Meanwhile, in October 2019, the process of submitting inpatient BPJS claims at RSU dr. H. Koesnadi Bondowoso exceeded the 10th of the next month which was 130 days delayed. The purpose of this study analyzes the factors that cause the delays in submitting inpatient BPJS claims. The Type of qualitative research by finding out causal factors based on personal factors, leadership factors, team factors, system factors and contextual/situational factors using Problem Tree Analysis. Data collection techniques are in-depth interviews, observation, documentation and brainstorming. The results showed a lack of knowledge related to the deadline for submitting a BPJS claim and a delay in file submission from inpatient rooms. Incomplete files for inpatient BPJS, internal verifier have multiple jobs and lack of guidance from chief nurse also causes of delay in submitting claims. There are no standard operating procedures, hospital information management system and scanner error, an increase of workload, and less supportive of work environment due to the Covid-19 pandemic. It is recommended to make standard operating procedures for submitting inpatient BPJS claims, discipline the employees, give rewards and add more employees for the Controller Installation.Abstrak: Pengajuan klaim BPJS oleh fasilitas pelayanan kesehatan berdasarkan buku petunjuk teknis verifikasi maksimal tanggal 10 bulan berikutnya. Proses pengajuan klaim BPJS rawat inap di RSU dr. H. Koesnadi mengalami keterlambatan dimana pengajuan bulan Oktober 2019 melebihi tanggal 10 bulan berikutnya yaitu terlambat 130 hari. Tujuan penelitian ini menganalisis faktor yang menyebabkan keterlambatan pengajuan klaim BPJS rawat inap. Jenis Penelitian kualitatif dengan mencari faktor penyebab berdasarkan personal factors, leadership factors, team factors, system factors dan contextual/situational factors menggunakan Problem Tree Analysis. Teknik pengumpulan data dengan wawancara mendalam, observasi, dokumentasi dan brainstorming. Hasil penelitian menunjukkan penyebab keterlambatan pengajuan klaim BPJS rawat inap yaitu kurangnya pengetahuan batas tanggal pengajuan klaim BPJS rawat inap, keterlambatan setor berkas klaim BPJS rawat inap dari ruangan, ketidaklengkapan berkas klaim BPJS rawat inap, verifikator internal double job, kurangnya bimbingan Kepala Ruangan, kerja sama belum maksimal, belum adanya SOP, SIMRS dan scanner eror dan beban kerja bertambah serta lingkungan kerja kurang mendukung karena pandemic Covid-19. Solusi yang dapat dilakukan yaitu membuat SOP pengajuan klaim BPJS rawat inap, pendisiplinan petugas, pemberian reward dan menambah petugas di Instalasi Pengendali.
LITERATURE REVIEW: STAFF PERFORMANCE FACTORS RELATED TO INCOMPLETE MEDICAL RECORD DOCUMENTS IN PUBLIC HEALTH CENTER Wijayanti, Rossalina Adi; Lestari, Melia Sinta; Deharja, Atma; Santi, Maya Weka
Journal of Public Health Research and Community Health Development Vol. 7 No. 2 (2024): March
Publisher : Fakultas Ilmu Kesehatan, Kedokteran dan Ilmu Alam (FIKKIA), Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jphrecode.v7i2.30241

Abstract

Background: Patient medical records are records relating to the patient's identity, diagnosis, action, and to the treatment that has been given to the patient. Thus, medical records must be protected from damage, but damage to medical records is still found in every hospital. Purpose: This study attempts to investigate the causes of damage to hospital medical record materials. Methods: this is literature review, and the research was obtained from google scholar and the portal garuda, using full text articles. The measured results were factors that cause damage to medical record documents. Results: The main factor were still officers with a low level of education, namely high school graduates. This has an impact on filing officers to be not disciplined in maintaining medical record documents, and the absence of implementation of training related to management and storage management in the filing section. The machine factor was that there was no medical record rack available in accordance with the number of medical record documents. The method factor was that there was no SOP for maintaining medical records. The material factor was the raw material for the map using thin paper. The media factor, namely the storage space, has not been avoided from the dangers of water, fire, and biological damage. Conclusion: Based on 5M factors, the factors that have the highest influence on damage to medical record documents are the elements of people, machine, and material. While the factor that causes the least damage to medical record documents is the method.
STUDY OF LITERATURE RELATED TO STAFF PERFORMANCE FACTORS' LINKAGES TO INCOMPLETE MEDICAL RECORD DOCUMENTS IN PUBLIC HEALTH CENTER Wijayanti, Rossalina Adi; Zatin, Widian Almas; Nuraini, Novita
Journal of Public Health Research and Community Health Development Vol. 6 No. 2 (2023): March
Publisher : Fakultas Ilmu Kesehatan, Kedokteran dan Ilmu Alam (FIKKIA), Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jphrecode.v6i2.31050

Abstract

ABSTRACT Background:  Excellent and quality medical record services can be seen from the contents of the completeness of the file, timely, accurate and compliance with aspects of legal requirements.  The ideal standard for the completeness of medical record documents is 100%. However, based on a literature review, there are still medical record documents which weren't 100% complete. The incomplete filling of medical record documents is related to many things, including the delay in fulfilling the patient's rights to the contents of the medical record and reduction in the quality of medical record services. Purpose:  The study aims to analyze the factors causing the incomplete filling of medical record documents at the  public health center. Method:  Data collection was conducted by literature search from the Google Scholar database and the Garuda Portal, and 12 articles were reviewed. Result: The biggest factor identified was the individual factors, namely the skills factor (75%), then knowledge factor (50%), and the lowest percentage was the ability factor (16.67%). On the organizational and motivator variables, the identified factors were leadership (50%) and motivator (16.67%). Conclusion: There was a need for documentation procedures in the form of Standard Operating Procedure that were socialized to health workers.  There is also a need for leaders to provide communication forum between health personnels, and a form of evaluation and control in good and correct documentation of medical records combined with rewards and punishment system. It is also necessary to provide seminars and trainings to health workers regarding correct medical record filling. Health workers who have limited time to fill out, can arrange a good work plan.  
The Optimization of Pharmacy Waiting Time Using the Lean Healthcare Method Nuraini, Novita; Wijayanti, Rossalina Adi
International Journal of Healthcare and Information Technology Vol. 1 No. 1 (2023): July
Publisher : P3M Politeknik Negeri Jember

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25047/ijhitech.v1i1.3915

Abstract

The waiting time for prescription services at dr. M. Suherman Clinic, a primary healthcare clinic with pharmacy services, did not meet the standard. It was about 15 minutes for the maximum waiting time for non-concoction prescriptions and 30 minutes for concoction medicines. A pre-liminary study of 100 patient visits in a day revealed that 15 non-concoction prescriptions and 20 concoction prescriptions exceeded the waiting times standard. It explicated the inefficiency in pharmacy services. The purpose of this research was to make the waiting time for pharmacies became more efficient. This research used lean healthcare method by using fishbone and 5M management elements. The data were collected by interviews, observation, and brainstorming. This study found that waiting time for pharmacy services approximately 36 minutes, with the Non-Value-Added ratio 56,7 %. It is concluded that the condition of pharmacy services had been inefficient. The units which contributed most waste were polyclinics and pharmacies. This research will produce a definite solution using the brainstorming method. The clinics need to standardize the deadline for doctors to input prescriptions, update the medical drug formulary, add new computers and drug blenders, add the number of staffs as human resources, and rearrange the clinic rooms.
BPJS Pending Claim Settlement Strategy In Hospital With Management Approach (Planning, Organizing, Actuating, Controlling) Wijayanti, Rossalina Adi; Dewi, Riskha Dora Candra; Farlinda, Sustin; Nuraini, Novita
International Journal of Healthcare and Information Technology Vol. 1 No. 1 (2023): July
Publisher : P3M Politeknik Negeri Jember

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25047/ijhitech.v1i1.3917

Abstract

The pending claim incident at Citra Husada Hospital Jember reached 33 files in December 2021, impacting health services' sustainability. This study aims to formulate a strategic policy review in the settlement of BPJS pending claims in hospitals with the Planning, Organizing, Actuating, and Controlling management approach. This research is qualitative. Data collection techniques using observation, interviews, documentation, and brainstorming. Test the validity of the data using source triangulation and technique triangulation. Based on the study results, the BPJS pending claim settlement strategy at Citra Husada Hospital Jember was implemented with a Planning, Organizing, Actuating, and Controlling management approach. Planning is carried out by preparing the quality of human resources and SOPs. Implementation of Organizing through coordination between officers and between fields, but there are still incomplete files and different interpretations between fields. Actuating is constrained by the system, while controlling is carried out through scheduled supervision.
Improvement Strategy to Reduce Delay in Returning Inpatient Medical Record at Jenggawah Primary Health Center in 2023 Nuraini, Novita; Febriyanti, Bella Amalia; Wijayanti, Rossalina Adi
International Journal of Health and Information System Vol. 2 No. 2 (2024): September
Publisher : Indonesian Journal Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47134/ijhis.v2i2.44

Abstract

Delay return of inpatient medical records still occur at Jenggawah Primary Health Center with an average percentage 52,15%. This situation leads to misfiled records, potentially causing disruptions and errors in patient care. The purpose’s research was to develop a strategy to reduce delay return of inpatient medical records using action research. This research methodology is quasi-semi-experimental methodology, incorporating interviews, observations, documentation, and discussions for data collection. Results in diagnosing action, the delay in returning the medical record of inpatient was caused by the officers' lack of medical record knowledge and their lack of medical record training, the contents of the SOP, which required evaluation, and the tracer's inadequate work. Planning action to plan strategy which are hold medical record training, reviewing returning medical record’s SOP and redesigning tracer. Taking action to implement strategy during 3 month. There is the evaluation action, which includes 4 success parameters. Overall, it is considered successful if the percentage of delays in returning inpatient medical records is dropped to a maximum of 50% per month. Evaluating action to evaluate taking action were carried out properly because the percentage of delays in returning inpatient medical record was reduced below 50%. It’s hoped medical recorder always monev and remind each other regarding the return of inpatient medical records. And it’s hoped Jenggawah Primary Health Center will hold in house training, hold socialization of SOP and budgeting funds for supporting facilities.
Improvement Strategy For Outpatient Medical Record Return Delay At Jambesari Public Health Center Bondowoso Nuraini, Novita; Kiromah, Siska Ainul; Wijayanti, Rossalina Adi
International Journal of Healthcare and Information Technology Vol. 3 No. 1 (2025): July
Publisher : P3M Politeknik Negeri Jember

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25047/ijhitech.v3i1.4951

Abstract

The delay in returning medical records significantly affects the quality of healthcare services. It was found that at Jambesari Health Center, there is a delay in returning outpatient medical records by 80 % due to the absence of Standard Operating Procedures (SOP), lack of tracer usage, and limited information media about service hours. Therefore, the purpose of this study is to develop an improvement strategy for outpatient medical record return delay using the PDCA approach. This type of research uses qualitative. The research informan were 8 informants consisting of 6 main subjects, namely 1 medical records officer, 1 counter clerk, 1 nurse, 1 general practitioner, 1 midwife, 1 dentist and 2 supporting subjects, namely 1 head of community health center and 1 head of administration. Data collection method use interviews, observation, documentation and brainstorming. The planning phase resulted in identifying 3 priority causes from the 7M process elements, namely the absence of specific SOP for returning outpatient medical records, lack of tracer usage and insufficient information for the community regarding operating hours with improvement actions including creating SOPs related to outpatient medical record return, acquiring tracers, and using banners as information media for service hours. The implementation phase lasted for 3 months from March to May 2023, guided by previously established TOR. The checking phase revealed a decrease of record return delay by 17% after improvements, followed by the action phase, which included brainstorming and socializing SOPs every month and optimizing tracer design and medical record training.
Analysis of Factors Causing Noncompliance with Medical Record File Destruction Scheduling at Kalabahi Regional Hospital Olidela, Imanuel Nikson; Wijayanti, Rossalina Adi; Nuraini, Novita; Muflihatin, Indah
International Journal of Healthcare and Information Technology Vol. 2 No. 2 (2025): January
Publisher : P3M Politeknik Negeri Jember

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25047/ijhitech.v2i2.6163

Abstract

Destruction of medical records has not been carried out at Kalabahi Regional Hospital, resulting in the accumulation of medical record files that are not properly placed on storage shelves. This study aims to analyze the factors contributing to the mismatch in the scheduling of record destruction at Kalabahi Regional Hospital, based on the MOA (Motivation, Opportunity, Ability) performance theory. This research employed a qualitative approach, with problem-solving recommendations developed through brainstorming. The subjects in this study included the Head of the Medical Records Installation, the Head of the Medical Records Committee, and three filing officers. Data were collected through in-depth interviews, observation, documentation, and brainstorming sessions. Data validity was ensured using technique triangulation and source triangulation. The results of the study, based on the MOA performance theory, showed: Motivation factors included the absence of praise or reprimands from the head of the medical records installation to staff related to destruction activities. Opportunity factors included the lack of a designated room for destruction activities, insufficient filing shelves, the absence of an SOP for destruction, the absence of a dedicated destruction team, the lack of job descriptions for the destruction team, no budget planning for destruction activities, no preservation list, and no destruction tools. Ability factors included the officers' lack of practical skills and knowledge about destruction activities. Based on these findings, it is recommended to plan and implement training programs, provide praise and reprimands to filing staff regarding destruction activities, provide a designated room for destruction, increase the number of filing shelves, develop an SOP for destruction, establish a dedicated destruction team along with clear job descriptions, and allocate a budget for destruction activities.
Pendampingan Optimalisasi Manajemen Asuhan Gizi Pasien melalui Penerapan Electronic Mecial Record (EMR) dengan QR Code dan Whatsapp Bot di NCC Wijayanti, Rossalina Adi; Dewi, Riskha Dora Candra; Nuraini, Novita
SEJAGAT : Jurnal Pengabdian Masyarakat Vol. 2 No. 2 (2025): October
Publisher : P3M Politeknik Negeri Jember

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25047/sejagat.v2i2.6343

Abstract

The Nutrition Care Center (NCC) at Politeknik Negeri Jember (Polije) functions as a Teaching Factory (TEFA), providing comprehensive nutritional assessment, diagnostic services, nutritional counseling, and tailored dietary plans for clients. Health services, including nutrition, necessitate accurate medical records encompassing patient identification, examinations, treatments, interventions, and other pertinent information. However, NCC's manual paper-based medical records system faces challenges. It uses age-based instead of date of birth-based record numbering, lacks standardized nutrition assessment, and lacks disease code classification. This manual system is prone to damage, loss, and demands considerable time and storage space. Since its establishment in November 2021, NCC has seen a steady increase in both internal and external clients. Collaborations with educational institutions, offices, and senior citizen groups have further boosted visits. To enhance efficiency, NCC plans to implement Electronic Medical Records (EMR) with QR Codes and WhatsApp Bots. This approach aims to simplify access to clients' medical histories, allergies, and previous therapies, while also streamlining record retrieval. EMR integration is vital in managing the complexity of nutritional services and supports NCC's mission to provide high-quality care. This initiative aligns with the 2022 Health Department's Research Masterplan and the development of TEFA services. It also reflects the growing trend of using technology, including mobile apps and Artificial Intelligence, in healthcare services. In summary, the increasing number of clients and collaborative screenings with external institutions have led to complex medical records. NCC recognizes the need for a more efficient system and proposes implementation of EMR with QR Codes and WhatsApp Bots to optimize patient care. The project's outcomes will include publications, videos, and improved partner capabilities in EMR usage for patient nutrition care at NCC.
Co-Authors Alfiansyah, Gamasiano Ardianto, Efri Tri Damayani, Desnia Sindi Deharja, Atma Dewi, Riskha Dora Candra Febriyanti, Bella Amalia Irfiah, Irfiah Kiromah, Siska Ainul Lestari, Melia Sinta maya weka santi, maya weka Muflihatin, Indah Nuraini, Novita Olidela, Imanuel Nikson Putri, Fitriana Rachmawati, Ervina Rahagiyanto, Angga Rohman, Nonik Aisyah Rohman, Nur Cholis Abdul Sustin Farlinda, Sustin Wicaksono, Andri Permana Zatin, Widian Almas