Community Health Center Information System in Cimahi City

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Cimahi City as Autonomous City was founded in October 2001 and consists of 3 districts, 15 municipals and 312 residential groups (rukun warga). Its population is 558.178 individuals and with an area of 4.035,75 ha, its population density is 152/ha. Its 2012 HDI is 76.12 with 69.25 Life Expectancy Index, 89.68 Education Index and 63.46 Purchasing Power Parity. Its PPP is lower than that of West Java while the others are higher. The percentage of poor family in Cimahi City is 21.9%. In achieving UN’s Millennium Development Goals, three of the eight target indicators are concerning health service; Reduce Child Mortality, Improve Maternal Health, and Combat HIV/AIDS, Malaria and Other Diseases and the community health centers are in the frontline of the efforts. Improving health service is part of Cimahi City’s Vision and Mission. Community Health Centers are service units of a regency/city’s Health Affairs Office whose responsibility is to run health care services in its region thus becoming Indonesia’s front liner in this matter. Patient’s visits to Community Health Centers, at 100-400 per day, are increasing each year along the 2.4% increase in population. With that number, patient registration and queuing is a compelling matter. Staffs in a Center must register each patient and locate his/her medical record, which can take up to 10 minutes. The fact interferes with the quality of services we provide due to the length of time that the patients must spend waiting before receiving the health care they need. The critical part of a service in a community health center is thus the registration process. One factor that contributes to the length of time for patient’s registration is the habit of some people that register their nicknames or non-formal names. In some instances, multiple names are assigned to one same patient. Poor registration causes problem ranging from misdiagnosis and improper prescription of medicine due to incomplete or duplicated medical records all the way to the strategic mistakes in planning and decision-making. A proper solution for those problems is conducting an extensive improvement of Community Health Center’s registration methods. Cimahi City’s Health Affairs Office developed Community Health Center Information System to respond to such challenge by providing a desktop-based registration for patients in it community health centers.

B. Strategic Approach

 2. What was the solution?
Cimahi City Health Affairs Office initiated Community Health Center Information System (CHCIS) to provide solution for patient’s registration. Its inception involved City Government; Regional Planning and Development Agency; Archiving, Library and Electronic Data Processing Office; Civil Registration Office; all Community Health Centers in Cimahi; and service users. Regional Planning and Development Agency contributed by supporting the budget allocation for system development; Civil Registration Office provides civil statistics used in measuring the need of the public; Community Health Centers plays the important role of implementing the initiative; and the society themself as the recipients of the improved services as well as the source of critiques, inputs and reports in evaluating the initiative.

 3. How did the initiative solve the problem and improve people’s lives?
The first step of forming our own system was a study trip to Sukabumi City’s Health Affairs Office that has computerized their Community Health Centers since 2007. Dr Bahrul as the Head of Cipelang Community Health Center Sukabumi who initiated the computerization of patients registration has a special interest in adopting technological advancements in public service and developed a software to ease the work of registration staffs in Community Health Centers. The result of the trip was an MoU between our office and Sukabumi Health Affairs Office to cooperate in the development of such software for 3 years. In 2006 we were granted 1 server, 10 client computer and free network subscription for SIKNAS Online application from The Ministry of Health Affairs. The network was synergized with Community Health Center Information System that compiled all activities to support SIKNAS Online. Realizing that the software can only be utilized for 3 years, while the technology is developing fast, we developed our own outpatient care information system named SIMPUS; a desktop-based application. Its future development will accommodate inputs from and the needs of various units in the Office and Community Health Centers. In its practice, we have integrated the database of the holders of both Community Health Insurance Card and Cimahi Cyber City Card from Cimahi Civil Registration Information System. The database is stored in the server and can be access during patient’s registration.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
Community Health Center Information System is the answer to the increasing need of accelerating the service and increasing patient’s convenience in health care. It also serves to facilitate the staffs in composing reports for internal and external purposes. The stages of the system’s development were: a. Data Collection: 1) Conducted by constructing and simplifying business process of service delivery 2) Identifying the needs of the Centers, of Health Affairs Office and of other institution in supporting the system b. System Construction: 1) Approaching the related institution to obtain civil registration data. Civil registration data is the main component of the Information System, because the subject of a Community Health Center is the society from which the data is collected. The institutions that we approached were Civil Registration Office; Archiving, Library and Electronic Data Processing Office; and Regional Planning and Development Agency. 2) Constructing a business process: the processes involved in Community Health Center’s service delivery were identified and simplified. 3) Choosing the program that will be used in relation to the ability of programming staffs. 4) Database designing: the database for the system was designed for in-building activities and consisted of civil registration, medical examination, medical action results, laboratory examination and medication prescription data. Apart from that, this stage also included the design of users accounts databse, staffs input, medicine input, action input etc. 5) The construction of the program: the program was built using Visual Basic and SQL Server database. Community Health Center Information System is a desktop program that can run as Client-Server. 6) Training for registration, examination and medicine staffs. 7) Program installation and testing. c. Implementation Process The implementation of the System involved the following steps: 1) System installation and operation and training: the staffs (registration, examination and medicine staffs) in health centers were given training on entering patient’s data using the program. 2) Execution assistance for every health centers: the step is run periodically in which every month an officer from Cimahi Health Affairs Office visit a community health center to assist the operation of the program. 3) Network and system maintainence: this is also done through routine visits to Community Health Centers. 4) System development and updating according to the latest development in information technology. d. Monitoring and Evaluation This process is aimed at identifying obstacles and the effectiveness of the operation of the program. Our evaluation is not only focused on finding out the faults of the program but also other supporting factors that can potentially be added to the program. This process consists of: 1) Official visits of the system manager in Cimahi Health Affairs Office to all Community Health Centers in Cimahi City each month. 2) Meetings with all operators of the System: this is done every six months and evaluates the operation of the system. 3) Monitoring the submission of monthly reports from each health centers.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
a. Internal parties of Cimahi Health Affairs Office: 1) Community Health Centers data manager: The staffs who manage the data requires its recapitulation to compose weekly, monthly and annual reports. 2) Medic and paramedics who are responsible for entering the data of patient’s medical records. 3) The Division for Service Assurance and Health Information in Cimahi Health Affairs Office who acts as regulator and facilitator in the implementation of the program. b. External parties in Cimahi city that consist of: 1) Civil Registration Office 2) Archiving, Library and Electronic Data Processing Office 3) Regional Planning and Development Agency 4) General members of the public as service users 5) Private institutions who provides suggestions and inputs in the development of the System 6) PT Telkom Indonesia with whom we have cooperation in internet network provision.
 6. How was the strategy implemented and what resources were mobilized?
Human Resources: Human resources who are involved in the operation of the Information System directly or indirectly including system operators, medical and paramedic staffs and Community Health Center’s managements. a. Registration staffs: Any staff with high school qualification can be trained and assigned as registration staff. This job only requires certain level of typing mastery. b. Diagnosis entry: To be assigned to this post, a staff must be qualified to make diagnosis coding and identification according to International Classification of Dieseases. c. Medicine Recapitulation: The staff assigned to this post must record all medicines prescribed to the patient by their physician. Equipment and Infrastructures a. Hardware 1) Data storage 2) Input devices 3) Output devices 4) Data communication devices 5) Modems b. Software c. Procedures Every Health Centers must have a Standard Operating Procedure that contains the manual for operating the software. Funding The development of the program is fully covered by Cimahi City Annual Budget and a portion of the National Budget. In 2009, Cimahi City received IDR600million special appropriation for the development of its healthcare information system. Software development was funded through Cimahi City Annual Budget of the same year. In 2010 and 2011, IDR110.325.000 and IDR115.380.000 respectively were allocated for training, socialization and testing, while in 2012 and 2013, IDR108.425.000 and IDR238.245.000 were allocated for system maintenance and development.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
The implementation of the program since 2011 has resulted in the following conditions: a. The registration time has been reduced to 3-5 minutes. This means the whole process of getting medical attention is getting faster. An additional advantage is that patients from poor family can get medical care without their medical card. b. The program eases the workload of health center’s staffs thanks to flexible and accurate digital data regarding patient’s medical history, thus ensuring more precise treatments. c. Better reporting in term of its timeliness, accuracy and visualization. d. Digital data which is more flexible, accurate and up to date compared to printed and handwritten records can be optimally utilized by the office and Cimahi City Government for analysis and decision making purposes. e. Electronic processing, displaying and storage of patient records eliminate the need for paper consumption.

 8. What were the most successful outputs and why was the initiative effective?
The utilization of Community Health Center Information System is not a simple transfer from paper-based data administration to digital administration and makes its storage, processing, communicating and retrieving more flexible; it allows various other advantages that are related to monitoring and evaluation to take place: a. Identifying each patients information stored by every centers b. The ability to prepare patients records before being used in delivering service c. Data availability for all staffs in any health care facility The following steps can be taken to maximize the function of the System a. Standardizing the elements of the data collected by service giver. b. Connecting all in-building activity systems. c. Standardizing the way in with which all medical information are defined and coded. d. Filtering and monitoring all regular records. e. Creating a protocol to ensure the security and secrecy of patient’s records. f. Storing medical records in post automation.

 9. What were the main obstacles encountered and how were they overcome?
The implementation of Community Health Center Information System faces various challenges that include: a. The formats of the data entered in each center are sometimes incompatible with the data from provincial level. b. The volume of monthly reports is overwhelming especially for newly assigned staffs. c. Staffs are often transferred between posts thus need time to adapt to the procedure for data entry. d. Staffs in Community Health Centers in Cimahi City who are assigned to operate the system are also assigned to various other jobs thus creating problems when no one is available in registration counter due to abundant workload. Recruitments are being done to solve this problem. e. Almost every staff has access to the system thus could possibly modified the data. Creating different usernames and passwords for different staffs was considered an unnecessary complication to the system. Now that the staffs are familiar with system, username and password are necessary and will be included in the next upgrading of the program.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
a. The time spent by a patient in registration process is cut to half: it is now 3-5 minutes for each patient. New and recurring patients are only required to state their names and the staffs can access their medical records through the program. b. Improving health care for the poor: Cimahi Cyber Card database has been integrated to Community Health Center Information System thus allowing its holder to obtain free medical care in the centers. c. Easy, fast and accurate reporting system.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
The next version of Community Health Center Information System is currently being developed to become a web-based software using PHP and My-SQL. The two programming languages are used to conform to government recommendation to use open source materials thus reducing costs. The new version will also be equipped with Executive Dashboard to allow easier analysis and planning. The City’s annual budget will take into account the need improve the hardware and its network; and in the same time prepare the system for the implementation of National Health Insurance. There is an apparent need to improve coordination with other institutions in respond to new regulations; the system must be prepared for and be able to accommodate such need. Cimahi City Government is committed to allowing possible replication by other regions. University students, a total of 8 since 2010, have conducted and published their degree researches in various Community Health Centers in Cimahi. Legally, Civil Registration Records are to be used solely for public interests. Its inclusion in the System must consequently aim at increasing the quality of public services.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
Through the implementation of Community Health Center Information System we learned the various differences between manual and computerized data management: a. Computerized data processing can reduce time consumption by half b. Digital data is more accurate for its ability to easily detect or even completely eliminate chances for data multiplication. c. Computerized data processing opens the possibility for the integration of health care records and civil registration data. d. Computerized data processing can produce various reports in much less time with more flexibility in its attribution.

Contact Information

Institution Type:   Government Agency  
Contact Person:   pratiwi pratiwi
Title:   Head of community Health cimahi  
Telephone/ Fax:   +6222-6632197
Institution's / Project's Website:  
Address:   Komplek Perkantoran Pemkot Cimahi Jl. Rd. Demang Hardjakusumah Gd. C lt. 3, Cihanjuang Cimahi
Postal Code:   40513
City:   cimahi
State/Province:   West Java

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