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INDONESIA
Indonesian of Health Information Management Journal (INOHIM)
Published by Universitas Esa Unggul
ISSN : 23548932     EISSN : 26559129     DOI : -
Core Subject : Health,
Health Professions
Indonesian of Health Information Management Journal (INOHIM) is a scientific publication devoted to disseminate all information contributing to the understanding and development of Health Information management, Health Informatics and Health Information Management System.
Arjuna Subject : -
Articles 182 Documents
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Perancangan Standar Prosedur Operasional Pelepasan Informasi Rekam Medis di RSU Gotong Royong Surabaya Masyfufah, Lilis; Pangestu, Raden Bagus Mochammad Tahta; Saadah, Alfina Aisatus; Erica, Resty Nadia Bella
Indonesian of Health Information Management Journal (INOHIM) Vol 13, No 1 (2025): INOHIM
Publisher : Lembaga Penerbitan Universitas Esa Unggul

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47007/inohim.v13i1.581

Abstract

AbstractThe development of Standard Operating Procedures (SOP) for each staff activity is essential to ensure patient safety, improve service quality, and prevent malpractice claims. SOPs serve as control tools for both clinical and administrative services provided to patients. Gotong Royong General Hospital has not yet established an SOP for the release of medical information, resulting in unstandardized procedures, particularly regarding processing time and fees charged to patients. This study aimed to design an SOP for the release of medical information at the hospital. A descriptive qualitative approach was applied, using questionnaires for data collection, followed by confirmation with the respondents. The study was conducted in the Medical Records Unit of Gotong Royong General Hospital during April–May 2024. The object of this study was the SOP draft, while the subjects were medical records staff involved in releasing patient information. Data obtained from the questionnaires were analyzed and presented narratively. The results showed that the proposed SOP included time limits for processing requests, official payment through receipts recorded in the hospital information system, the use of a stamped authorization letter, and a clear flow of information release for patients. The hospital is advised to consider implementing the SOP, as it has been adjusted to suit the operational context. Socialization efforts are also needed to inform patients through official media such as banners.Keywords: SOP, medical information, medical records, service quality, socialization AbstrakPenyusunan Standar Prosedur Operasional (SPO) bagi setiap tindakan petugas merupakan langkah penting dalam menjaga keselamatan pasien, meningkatkan mutu pelayanan, serta menghindari risiko malpraktik. SPO berfungsi sebagai alat kendali terhadap layanan yang diberikan, baik layanan kesehatan maupun administrasi. Rumah Sakit Umum Gotong Royong belum memiliki SPO pelepasan informasi medis, sehingga pelaksanaannya belum terstandar, khususnya terkait waktu penyelesaian dan biaya yang dibebankan kepada pasien. Penelitian ini bertujuan untuk merancang SPO pelepasan informasi medis di rumah sakit tersebut. Penelitian menggunakan pendekatan deskriptif kualitatif, dengan pengumpulan data melalui penyebaran kuesioner dan proses konfirmasi hasil kepada responden. Penelitian dilakukan di Unit Rekam Medis Rumah Sakit Umum Gotong Royong pada April–Mei 2024. Objek penelitian adalah rancangan SPO, sedangkan subjeknya adalah petugas rekam medis yang terlibat dalam pelepasan informasi medis pasien. Data hasil kuesioner dikaji dan disajikan dalam bentuk narasi. Hasil penelitian menunjukkan bahwa rancangan SPO yang disusun telah mencakup batasan waktu proses pelepasan informasi, sistem pembayaran resmi melalui nota tercatat di SIMRS, penggunaan surat kuasa bermaterai, serta alur pelepasan informasi yang jelas bagi pasien. Rumah Sakit Umum Gotong Royong disarankan untuk mempertimbangkan implementasi SPO tersebut, karena telah disesuaikan dengan kondisi di lapangan. SPO ini juga perlu disosialisasikan kepada pasien melalui media resmi seperti banner.Kata kunci: SPO, informasi medis, rekam medis, pelayanan, sosialisasi 
Korelasi Kompetensi dan Kinerja Perekam Medis dan Informasi Kesehatan di Puskesmas Kabupaten Cirebon Indriartanti, Dian Rizki; Subianto, Totok; Suhartini, Suhartini; Elfi, Elfi
Indonesian of Health Information Management Journal (INOHIM) Vol 13, No 1 (2025): INOHIM
Publisher : Lembaga Penerbitan Universitas Esa Unggul

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47007/inohim.v13i1.571

Abstract

AbstractCompetence is a person's ability to carry out tasks and responsibilities in a work environment that includes knowledge and skills in improving professional performance standards. The performance of employees is determined by their level of motivation and competence to achieve good work results. The study aims to determine the relationship between competence and performance of medical records and health information officers in Cirebon district. The population in this study were 60 medical record officers in Cirebon district. The sample taken was 44 PMIK officers with a medical record and health information education background who worked at the health center. This research uses a type of observational quantitative method and research design using a cross-sectional approach. The results of the univariate analysis showed that the characteristics of the dominant age respondents were ≤ 25 years by 65.9%, the most tenure was < 2 years by 56.8%. Then, the competence of medical record officers in the competent category was 50% of respondents and the performance of medical record officers in the good category was 54.5% of respondents. Analysis bivariate using the chi-square test which obtained a P-value of 0.762> 0.05, meaning that there is no correlation between the competence and performance of medical recorders and health information at the Cirebon district health center.Keyword: Competency, Performance, Medical Records, Health Center. AbstrakKompetensi merupakan kemampuan seseorang untuk melaksanakan tugas dan tanggung jawab di lingkungan kerja yang mencakup pengetahuan dan keterampilan dalam meningkatkan standar kinerja professional. Kinerja karyawan ditentukan oleh tingkat motivasi dan kompetensi mereka untuk mencapai hasil kerja yang baik. Penelitian ini bertujuan mengetahui hubungan antara kompetensi dengan kinerja petugas rekam medis dan informasi kesehatan di kabupaten Cirebon. Populasi dalam penelitian ini sebanyak 60 orang petugas rekam medis di kabupaten Cirebon. Sampel yang diambil yaitu 44 orang petugas PMIK berlatar pendidikan rekam medis dan informasi kesehatan yang bekerja di puskesmas. Penelitian ini mempergunakan jenis metode kuantitatif observasional dan desain penelitian menggunakan pendekatan cross sectional. Hasil penelitian Analisis univariat menunjukkan karakteristik responden umur dominan adalah ≤ 25 tahun sebesar 65.9%, masa kerja paling banyak adalah < 2 tahun sebanyak 56.8%. Kemudian, kompetensi petugas rekam medis dengan kategori kompeten sebesar 50% responden dan kinerja petugas rekam medis dengan kategori baik sebesar 54.5% responden. Analisis bivariat menggunakan uji chi-square yang memperoleh hasil P-value 0.762 > 0,05 artinya tidak ada korelasi antara kompetensi dan kinerja perekam medis dan informasi kesehatan di puskesmas kabupaten Cirebon.Kata Kunci: kompetensi, kinerja, rekam medis, puskesmas

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