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CHAPTER 3

ANALYSIS OF EXISTING SYSTEM

3.1 Company History

RS pondok Indah was open for public in 1st December 1986 to fulfill the needs of

the society for a professional private hospital in Indonesia that has the same level with

modern hospitals abroad. RS Pondok Indah is one of the hospitals in Indonesia that

implements modern facilities and also offers a service and comfort like a hotel.

The hospital received a positive feedback from the peoples that causes an

increase of demand for better and more complete medical services. To answer this

demand, RS Pondok Indah built their 2nd building in 1996.

The rapid development of medical technology and Information System also

influence the people for better medical services. By knowing this fact RS Pondok Indah

realizes that they must add their modern medical facilities. In 2006 the hospital replaced

their old facilities with the new one, the renovations includes:

• UGD (Emergency Unit)

• Automatic Laboratories System

• Modernization in radiology, using MSCT Scan 64 Slices, High Definition MRI

1.5T and also PACS Server

In 2005 RS Pondok Indah received two achievements: the 1st one is “Sertifikat

Akreditasi Rumah Sakit 16 Bidang Pelayanan” and the 2nd one is ISO 9001:2000. RSPI

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also implement Balance Score Card (BSC) for their management strategy and

implementations system that consist of a complete strategic map. RSPI is the 1st hospital

in Indonesia that Implement BSC.

To show the competency of their vision and missions, the head of RSPI implements

some policies that have a connection with managing environment. Their “Management

Environment” received an award from the Governor of DKI Jakarta in 2004.

3.2 Social Works and Puspita Foundation

RSPI shows its concern not only to their patients but also to their employees and

their families. In the process RSPI received many helps and active participation from the

women shareholders

Thanks to Puspita Foundation, more than 850 children received a “sunatan

masal”, 300 people adult/ children received a “program Pemeriksaan Umum” and about

100 children receive a “bibir sumbing” operation and cataract since the first time RSPI

were built. Puspita Foundation often initiated a social works with other institution like

helping the government program in handling bad nutrition and PIN (National

Immunization Program) polio.

With the help of Prof. Dharmawan and his team, in the year 2006 Puspita

Foundation and RSPI were able to made a surgery for separating siam twin named

Maisha and Muthi successfully

Besides their social works, RSPI were actively participated to support

government project in the form of free seminar and also spreading health information

through electronic and printed media freely.

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They show their concern to their employees by giving a free health seminar to

employees and also a scholar ship for their employee’s children who scores well in

school.

Puspita Foundation Organizational Structure

Founder

Head:

Members:

Hj. Sulastri Sudwikatmono

Mr. H Sudwikatmono

Mr. Subagdja Prawata

Trusteeship

General chief

Chief

Secretary

Drg. Aida Hermansyur

Liza Dekon Budiman

Nina Chandra Kirana K.H.H

Ir Anna Rosita Subadgja

Supervisor

Chief

Member

Dr Hermansyur

Noor L.S, Liliani S.S, Christine Arifin,

Dian S.C, Nunung S.B, Amelia

Soekrisman, Medya L.S, Emmy D.P, Sally

T.D, Margareth A.S, Drg. Ratna W.S,

Jeane Kusuma, Sri Suryanti W, Denti Eka

Y.D, Liliana A.S, Zakiah Risjad, Marlena

D.B

Table 3.1 Puspita Foundation Organizational Structure

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3.3 Workers Union

Since the Workers Union ( Ikatan Kekeluargaan Karyawan RSPI/ SP. IKK RSPI)

was declared in November 1st 2000 they have 737 members from 866 total employees

numbers in RSPI. The purpose of this organization is to gather and channel employees

aspirations so it can be deliver to RSPI management in a good and appropriate way.

As the organization grows, they expand their units to:

§ To gives loan to their members with a low interest

§ Sell “sembako”

§ Motorcycle ownership financing

SP.IKK RSPI has an expectation to leverage their employee’s wealth with the help from

the owner and also the management of RSPI.

3.4 Facilities and Health Services

Surgery Rooms

They have 5 operation rooms that equip with the moderns medical equipments, a high

standard before-after surgery procedures. They also have a high sterilize standard that

are continuously watch by “Panitia Infeksi Nosokomial”. We can say that their level of

Nosokomial Infection is 0%

Policlinic

§ Surgery

§ Alergic Imunologi

§ Dentistry

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§ Nutrition

§ Heart and catheter

§ OBGYN

§ Children health

§ Skin

§ Eyes

§ Internist

§ Psychiatry

§ Neurology

§ Respiratory decease

§ Acupuncture

Rooms

§ Suite room

§ VVIP

§ VIP

§ Class I, II, III

§ ICCU/ ICU/ NICU/ PICU

§ Nursery room

Special services

§ Heart and heart catheter

§ Neurology center (NNC)

§ OBGYN

§ Jakarta Spine & Orthopedic

§ Lasik center and orthopedic

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§ Aesthetic breast clinic

§ Japanese clinic

§ Advance education clinic

§ Diabetes

§ Check-up

Medical Support

§ Laboratory

§ Radiology

§ Pharmacy

§ Physiotherapy

§ Hermodialisa

Other facilities

§ Flowers & fruits shop

§ Coffee shop & cafeteria

§ Salon

Health club

§ Yoga class

§ Exercise for diabetes mellitus

§ “PKO” aerobic club

§ Dr. Sadoso, etc

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3.5 Company Organizational Structures

Figure 3.1 RSPI organizational structure

48

Current organizational structure explanations

Position Names

President Director H. Sudwikatmono

Steering Committee Dr. Hermansyur

Drs. Budiman Kusika

Ir. Dedy Kusuma

Ir. Budi Brasali

Ir. Anna Subagdja

Board of Management Ir. Anna Subagdja

Dr. Hermansyur

Luci E.B.Soh

Solution Design Dr. Taufik S.

Elizabeth Indah

Pambudi R

Table 3.2 Current organizational structure explanation

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Position Names

Chief of Marketing, Business &

Customer Management

Ir. Bambang N.I.

Operational dir. Nursing Service Hilda da Cunha

Clinical dir. Medical Service Dr. M sulaeman

Operational dir. Finance, Acc &

purchasing

Drs. Benny Murjianto

Operational dir. Clinical support

service

Dr. Agus Wahjudi

CIO Tavri Deviyan

Manager HRD Dharmawan P.H

Divisional Head

Patient Advocate Dr. Mus Aida

Responsible to

Antonius Trisno

Kamala dewi

Chief of Marketing, Business &

Customer Management

V.S Budijati

Sr. Yuliana S.S

Operational dir. Nursing Service

Ir. Deddy K

Operational dir. Finance, Acc &

purchasing

Departmental Heads

Budi Ramli Operational dir. Clinical support

service

Table 3.3 Current organizational structure explanation (continue)

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3.6 Vision, Mission and Motto

Vision

Making RS Pondok Indah the best medical service in Indonesia

Missions:

To help the government achieving their medical program “Towards Healthy Indonesia

2010” and also to compete in the globalization era with steps like:

• Increasing the customers satisfaction

• Efficiency in all field

• Increasing the quality continuously

• Education and training

• Implement safety management system and healthy works

• Implement a competent management

Motto:

Their motto is “F.A.C.E with a smile” which has the meaning:

• F: Face

• A: Accurate

• C: Caring

• E: Efficient

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3.7 Data Flow Diagram

3.7.1 Context Diagram

This is the general picture of the existing system in RSPI that are related with the

thesis scope

Figure 3.3 Context diagram RSPI current system

These current systems further are divided into three processes:

§ The booking handler system: this system handle the booking procedure if

there is a request from a patient

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§ The prescription handler system : this system handles the prescription

process, starting from a doctor that gives the prescription to a patient until the

cashier generates the invoice for them.

§ The system for selected doctor payment : this system show how different

doctor name can charge the service price differently

3.7.2 Level 0 contexts Diagram

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Figure 3.4 DFD booking level 0 Data flows Patient Data Used Description

Booking request (none) The patient call the hospital to ask for booking

Booking

confirmation

(none) The patient receive a confirmation from the

nurse telling that his/her name is recorded

Table 3.4 Booking level 0 - Data Flow Patient

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Data flows Nurse Data Used Description

check request Doctor list Nurse use this to see which doctor is

available, doctor working time, the

specialization

Patient Nurse use this to record patient booking

details, so they can get the right patient file in

the warehouse

Department Nurse use this to see which department is

available and also to see the number of patient

that already booked earlier (can tell whether

it is full or not)

Add booking

details

Booking book This is the book where the nurse put the

patient booking name.

Table 3.5 Booking level 0 - Data flows Nurse

First a patient call the hospital ask for booking, then a nurse checks the

patient request (is the doctor or department available or not) using the doctor list to

see the doctor’s schedule. If the request matches, then the nurse adds the booking

details, they record the details in a manual book.

54

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Figure 3.5 DFD prescription level 0 Data flows Doctor Data Used Description

Create prescription Prescription The doctor creates a prescription that contains

of some medicine names for that the patient

need to consume. (this prescription is still

written in a manual book not in a computer)

Table 3.6 prescription level 0 - data flow Doctor Data flows Patient Data Used Description

Prescription details Prescription The patient received the prescription that

came from the doctor and then s/he has to

bring that prescription to the pharmacy

manually.

Table 3.7 Prescription level 0 - data flow patient

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Data flows Pharmacy Data Used Description

Patient’s prescription prescription The pharmacy department receives the

prescription from the patient

Medicine list To make the medicines, the pharmacist has to

search for the ingredient that are listed in the

medicine database

Update inventory Medicine list If the pharmacist create a generic medicine or

took a non-generic medicine the system will

automatically reduce the quantity of the

medicines in the database (for the complete

system works the hospital don’t want to share

it)

Purchase

request

If the amount of medicines is not enough, the

system will generate a purchase request for

the management automatically

Table 8 3.8 prescription level 0 - Data flow pharmacy Data flows from

management

Data Used Description

Purchase request Purchase request The management receive the purchase request

that are generated automatically by the system

Purchase

confirmation

Purchase request The management gives a confirmation to buy

the medicines.

Table 3.9 prescription level 0 - Data flow management

56

Data flows cashier Data Used Description

Create invoice Prescription The cashie r generates an invoice for the

patient. The invoice can be used to pick up

our requested medicines in the pharmacy

Table 3.10 prescription level 0 - Data flow cashier

The doctor creates prescription for the patient (s/he will write it on a

prescription paper), then the patient will receive the prescription detail. The

pharmacy department will receive the prescription from the patient and start to

process it. The pharmacy will update their inventory that will be decrease due the

prescription process (it will update the medicine list database). If the medicine

amount is less then the amount that they standardized, the system will

automatically create a purchase request to the management, and then they will give

the purchase confirmation feedback. At the other process, the billing system will

receive a prescription information (it listed the price of every medicine that the

patient took), based on that the cashier will create an invoice.

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Figure 3.6 DFD Selected doctor payment level 0 Data flows Nurse Data Used Description

Create doctor

payment

Doctor list The nurse uses this to see the price for the

doctor service (every doctor has a different

price tag for their services)

Doctor payment

struck

For every selected doctor the nurse creates a

stuck that consists of doctor name and their

service price tag (this process is still in paper

based).

Table 3.11 selected doctor payment level 0 - Data flow nurse Data flows patient Data Used Description

Doctor payment

details

Doctor payment

struck

Patient receives the stuck from the nurse, and

then s/he has to bring it to the cashier.

Table 3.12 selected doctor payment level 0 - Data flow Patient

58

Data flows Cashier Data Used Description

Create invoice Doctor payment

struck

The cashier uses the doctor payment struck

that was given by the patient to create the

invoice.

Table 3.13 selected doctor payment level 0 - Data flow Cashier

The nurse creating doctor payment struck (using the doctor list to see the

doctor service price), the patient will receive the doctor payment stuck and give it

to the cashier. Then the cashier will create the invoice

3.7.3 Level 1 Context Diagram

Figure 3.7 DFD booking level 1

59

In this diagram, the patient booking request enters the Service Availability

System. Using department and doctor list the nurse will see if the request is

available or not. If the requests match with the availability the nurse will add the

booking details (Booking Recorder System). The booking recorder will use the

patient list to see if the customer that ask for booking is already became their

member or not. At the end, it will update the booking book. All the processes are

done manually.

Figure 3.8 DFD prescription level 1

The pharmacy will receive the patient prescription and process it to become

patient medicine. Then they must update their medicine inventory (this will update

the medicine database). If the automatic request system read a shortage in the

medicine inventory, it will automatically generate purchase request to the

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management. Then the management will give the purchase confirmation a

feedback.

3.7.4 Level 2 Context Diagrams

Figure 3.9 DFD Booking level 2

The patient ask for department that they want, the department availability

will use the department list, this process is done manually by the nurse, or the

patient can ask for doctor information then nurse will answer the patient by using

the doctor list.

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3.7.5 System flowchart

Figure 3.10 Workflow for current booking process

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The patient makes a call to the hospital, the phone will directly answered by an

automatic phone operator. If it is a business call the non-medic human operator will

answer the phone after that the process finish. If it is a medic cal,l the patient has to

choose which department that they want to get by pressing the department code. After

patient dial the department code, nurse will start to ask the patient about the booking

details (they ask for your name, patient ID, preferred booking time). When the booking

date arrived the courier, will retrieve the patient’s file from the files cabinet and put the

file in the right department so when the patient arrived they don’t have to wait for the

file to be retrieved (every day they look at the booking book manually and prepare the

file at the morning).

63

Figure 3.11 Workflow for patient check without booking

64

The patient goes to the preferred department, and then a staff there will ask for

your ID card. After that you will receive your queuing number. The nurse will directly

call the person in the file cabinet (file courier) to deliver the patient file to her

department. While waiting for the queuing and the file to be delivered the nurse create a

doctor struck then she slice the card on a simple machine so the patient name will appear

on the struck (the machine use to emboss on the card).

65

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Figure 3.12 Workflow for creating prescription

66

First the nurse creates the doctor struck payment then she slice the card on a

simple machine so the patient name will appear on the struck (the machine use the

emboss on the card). The doctor will receive the patient’s file that has been prepared by

nurse. Then s/he updates the patient record and makes the prescription. Then the patient

receives the doctor payment stuck and the prescription, the patient has two choices

whether to get the medicines on the hospital pharmacy or on other drugstore. If patient

choose to get the prescription on the hospital, s/he has to put the prescription on the

pharmacy table, the pharmacist will process the prescription and give the total price of

the medicines to the cashier (data transferred using computer), then the cashier will

create an invoice based on the doctor struck that the patient give to them and also from

the information that the pharmacist gave. The invoice then will be used to take our

medicine from the pharmacist hand. If the patient decides to get the medicines, s/he just

has to give the doctor payment struck to the cashier.

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3.8 Entity Relationship Diagram Current System

Figure 3.13 ERD current System

68

3.9 Existing Problems

The problems that RSPI has at the moment are:

§ paper based patient record: this type of system can caused problems, such as the

patients file lost/ miss placed due of the human error and the hospital will not

have the back up for that patients. The docter sometimes find it difficult to read

other docter hand writing, to know the patient history is very important for the

docter to determine the next step.

§ manual prescription order process: this sytem is time consuming for the patients.

They have to deliver the prescription manually to the pharmacy after the docter

give the prescription and wait until the the medicines finished to be made.

§ the telephone oftenly busy, this may be coused by so many people access the

phone in the same time & the hospital only provide 2 phone line for the outsiders

§ limited time for booking (patients only can book in working hours). People

sometimes forgot to call to make a booking because they were so busy at their

work and realized it when they arrived at home, but its alredy to late because the

working hours has passed. In this case that person has to wait for the next day to

make a book (if s/he remember)

§ unefficient queing wating time: in the curent system we cant no how much time

do we need to wait until the docter check us. The patients some times need to

wait for more than an hour. It is mean that the patients have to postponned their

work for a long time which can reduce the productivity of the patients in their

job.