Definition and Functions of Hospital

Hospital by the WHO (1957) provided a comprehensive limitation of a portion, (Integration) of the organization and the medical, function is to provide comprehensive health services to the community both curative and rehabilitative, where output services reach families and neighborhood services, the hospital is also a training center personnel health as well as for research biososial.


The hospital functions in addition to the above is also a medical referral service centers spsialistik and sub-specialist with the main function of providing and delivering health efforts that are healing (curative) and Recovery (rehabilitatisi patients) (MOH, 1989) So according to its primary function is necessary in such settings way that the house skit able to leverage its resources with efficient and effective manner (Elias: 2001.)According to the decision of the Minister of Health no. 983 / Menkes / 17 / 1992 on guidelines for the organization of public hospitals are hospitals that provide health services that are basic, spsialistik, and sub-specialist, while the classification based on different levels according to the ability of health services that can be provided by the hospitals of class A, Class B, (Education and Non Education) Class C and Class D.
The hospital is an organization that through an organized medical professionals and medical facilities parmanen organizing health care, continuous nursing care, diagnosis and treatment of diseases suffered by patients.
Of advances in technology coupled with the use of new ways in the field of diagnostic and therapeutic requires hospitals to employ a variety of medical professions and other professions so that hospitals be labor-intensive organization specialist and is a place where there is a process of conversion of inputs into outputs. The main input is a doctor, nurse other personnel, infrastructure, facilities equipment and so on are part of the hospital.

The Role of Information and Communication Technology in Education

  Role of Communications and Information Technology in the Implementation of Online Distance Education in Indonesia Preliminary Distance education is a set of methods of teaching where teaching activities carried out separately from the learning activities. Separator both of these activities can be a physical distance, such as teaching participants residing far away from the location of educational institutions. Separator can also be non-physical distance that is a situation that forces a person who lived near the location where educational institutions but can not follow the learning activities at the institution. Uncoupling activity of teaching and learning activities is a typical characteristic of distance education. Distance education system is an alternative to equal opportunities in education. This system can overcome some of the problems caused by the limitations of qualified teachers. In the educational system of this training teachers and learners should not be in the same geographical environment. The purpose of the construction of these systems, among others, to implement the applications of web-based distance education at the sites of distance education in Indonesia was developed in an environment that is working with other partners together. In sederaha understood this system consists of a collection of applications that can be used as a tool in distance education activities until the delivery of distance education materials that can be done well. Supporting facilities of distance education is information technology. The emergence of information and communication technologies in distance education is very helpful at all. As can be seen, with the advent of online education, either formal or non-formal, using the facilities Internet.Pendekatan teaching system that can be done is by teaching directly (real time) or by using the system as a place of concentration of knowledge ( knowledge). . This allows the formation of an opportunity for anyone to participate in various levels of education. A graduate degree can continue to master degree education online to one of the colleges of interest.
Distance Education System Although technology is an integral part of distance education, but education programs should focus on the instructional needs of students, from the technology itself. There also needs to be considered, age, culture, socioeconomic background, interests, experience, education level, and are familiar with distance education methods. Factors critical to the success of distance education system is a concern, confident teachers, experience, easy to use equipment, creative use of tools, and to establish interaction with students. In the construction of the system need to be considered regarding the design and system development, interactivity, active learning, visual imagery, and effective communication. Design and development of the system. process of instructional development for distance education, consisting of stage design, development, evaluation, and revision. In designing distance education instruction effective, must be considered, not just goals, needs, and characteristics of faculty and students, but also the needs of content and technical barriers that may occur. Revisions were made based on feedback from instructors, content specialists, and students during the process of walking. Interactivity. The success of distance education systems, among others, determined by the interaction between faculty and students, between students and the educational environment, and between students. Active learning. The active participation of participants of distance education affects how they relate to the material to be studied. Visual imagery. Learning through television can motivate and stimulate the desire in the learning process. But lest distortion occurs because of the entertainment. There should be penseleksian between information that is not handy with a quality, determine which ones are feasible and do not, identify irregularities, distinguish fact from which not a fact, and understand how technology can provide quality information. Effective communication. Instructional design begins with understanding user expectations, and know them as individuals who have different views of system designers. By understanding the user's desire to build an effective communication.

Audio Conferencing Group Conferencing

Distance Education Online Technological development has always had a very high role and help provide a direction of development of education. In the historical development of education, information technology is part of the medium used to convey the message of science in many people, ranging from printing technology a few centuries ago, such as a printed book, through media such as telecommunications, sound is recorded on cassette, video, television, and CD. Current developments in information technology, Internet, direct the history of educational technology in a new groove. Online services in both degree and non-education degree is basically providing educational services to users (students) using the Internet as a medium. This online service can consist of various stages of the process of educational programs such as: registration, test entry, payment, lectures, case assignments, case discussions, exams, assessments, discussions, announcements, etc.. Distance education can leverage Internet technologies to the maximum, can provide effectiveness in terms of time, place and even improve the quality of education. A major factor in online distance education known as distance learning that had been considered a problem is the lack of interaction between faculty and students. However, with the internet media is very possible to make the interaction between lecturers and students either in real time (real time) or not. In the form of real time can be done for example in a chatroom, a direct interaction with real audio or real video, and online meetings. That is not real time can be done with mailing lists, discussion groups, newsgroups, and bulletin board. In this way the interaction of faculty and students in the class may be replaced even if not 100%. The forms of matter, exams, quizzes and other educational means can also be implemented into the web, such as lecturers material made in the form of presentations on the web and can be downloaded by students. Similarly, with exams and quizzes are created by faculty can also be done in the same way. Administrative settlement can also be solved directly in a single course registration process, especially boosted by the method of online payment. Online distance education to overcome existing limitations on the types of distance education to another (which in fact also been loaded technology), the distance education by satellite and television technology. In both the above technologies, students still have to go to educational facilities; while the equipment is specialized and expensive. Now with online education via the Internet, students can learn on their own from home with your own computer equipment.
Lecturer Perspective From the faculty standpoint, this online educational solutions must meet the following criteria: Easy to use Allows the creation of online courses and classroom materials online quickly and easily Requires only minimal training Allow teaching in their own way Allowing them to control the teaching environment
Student Perspective From the point of students who look for is Flexibility in taking courses Lecture material is richer than that obtained in the classroom Running on a computer that they already possess Antarmahasiswa such collaboration include the traditional way Includes consultation with the lecturer, class discussion, study buddy, and joint projects.
Web-Based Distance Education Online When you return to the basic concepts in a traditional educational system which is done today, students and faculty met at a particular place and time. This traditional education system will eventually shift to long-distance education based on that rather difficult to collect the participants of the course, training or education at a particular time and place while the participants are scattered in different areas and basically materials that should be presented in class , can be given without the presence of students and lecturers directly in the classroom.
The development of information technology very fast today, especially the development of internet technology have promoted the development of this concept of distance learning. Characteristics of Internet technology can always be accessed anytime, anywhere, multiuser and offers all conveniences have made the Internet a medium that is appropriate for further development of distance education.
The use of information technology in supporting a distance education system must be considered from the form of education provided. An English course one of them, at the end of the course students are required to have reading and listening skills are good, for that media can be a sound, images and other multimedia forms are being sent over the internet.
When restricted to web-based distance learning then the user, in this case the faculty and students require internet facilities to maintain connectivity with the distance education. Students' ability to maintain connectivity crucial for the sustainability of a system of distance education. If we assume a web-based distance education as a community in which it should facilitate the convergence or interactions of students and lecturers. Kinda hard indeed to move what is usually done by the lecturer in front of the class to a web form that must involve the interaction of various components in it. The existence of this system to make faculty and student mentality must change, differences in the characteristics of faculty in teaching does not appear in this method. Like a college, this method should also be able to provide lectures to students. That information should always be accessible to students and lecturers and is always updated every time. The information is often needed in the form of lectures syllabi, class schedules, announcements, course participants who lectures, course material and assessment of student achievement.
A web-based distance education, among others, should have the following elements: 1. Student activity center; as a web-based distance learning community must be able to make this facility as a place of student activities, where students can add capabilities, read the course material, searching for information and so on. 2. Interaction within the group; The students can interact with each other to discuss the materials provided lecturers. Lecturers may be present in this group to give a little review about the material that it provides. 3. Student administration system; where students can view information about the status of students, student achievement and so on 4. Deepening materials and exams; Usually lecturers often hold short quizzes and assignments aimed at deepening of what has been taught and do a test at the end of the study. It should also be anticipated by the web-based distance learning 5. Digital libraries; In this section, there are a variety of information literature, not limited to books but also on digital libraries such as sound, pictures and so on. This section is shaped as a support and databases. 6. Online materials beyond the course material; To support the lectures, reading materials is also required from other web. Therefore in this section, faculty and students can be directly involved to provide other materials for publicizing to other students via the web.
Embody the ideas and desires above in a form of reality is not an easy task but if we look to another country that has long developed a web-based distance learning, have a lot of institutions that take advantage of this method. Not only the skills possessed by engineers who needed but also a variety of policies in the field of education greatly influence its development. When viewed from the readiness of supporting facilities such as the hardware it seems this is no doubt. Only one who has always been a major concern of Internet users in Indonesia is the bandwidth problem, of course, with limited bandwidth is reduced comfort, especially on non-text based materials.

Online education abroad Abroad, particularly in developed countries, distance education has been an educational alternative that is quite popular. The method of education is followed by students, employees, executives, housewives and even elderly people (pensioners). Several years ago the exchange of material is done by correspondence, or equipped with audio and video material. Currently, almost the entire distance learning program in America, Australia and Europe can also be accessed via the internet. Studies conducted by the U.S., strongly supports the development of e-learning, states that computer-based learning is very effective, allows 30% better education, 40% less time, and 30% lower cost. World Bank (World Bank) in 1997 has announced a program of Global Distance Learning Network (GDLN), which has disebanyak partners in 80 countries around the world (until June 2000, a new operating center 15 countries, and five of them in Asia but not in Indonesia ). Through GDLN is the World Bank can provide e-learning to students five times more (from 30 to 150 students) and costs 31% less
Nearly half of the approximately 3,900 institutions of higher education in the United States held similar jarakjauh education (distance education / distance learning). Distance education is not new. Initially started with a course in writing and in the form of formal higher education shaped the Open University (Open University). At the beginning of the implementation, distance education by people considered as an alternative type of education or second-class education. Lost prestige with the conventional education yangmengharuskan student attendance.
Over the last three years more than 80% of distance education held online via the Internet. The amount of investment and technology expertise in this educational gathering, as well as a high appreciation of the technology community, create an online distance education is no less or even more prestigious than conventional education. Now even for any conventional education universities provide education online.
Online Education Prospects in Indonesia Because of cultural restrictions and regulatory structures that exist in Indonesia, then distance education is still growing rapidly, but not impossible that Indonesia should follow the global trend is occurring. In Indonesia, the prospects for distance education by means of the Internet has also been a concern from some quarters, both from education and the world of information technology. Currently in Indonesia there are about 75 universities and 1200 colleges and private universities in Indonesia, with more or less total could reach 5 million students who are potential Internet users. While at UB own distance learning program has been implemented since March 2002 which is a joint project between UB with SOI - ASIA (School Of Internet) one of the WIDE project work (An International Organization of Distance Learning), Started in 1997 by establishing a campus environment on the Internet infrastructure that allows students to learn without being limited by time and place. Until now, approximately 700 students enrolled at the University WIDE including from UB, in which more than half are adults who are interested in continuing their education through the Internet. In WIDE University, more than 800 hours of lectures available via video archives, which allows students to learn themselves freely. SOI-Asia project aimed to contribute to the development of higher education in Asian countries, supported by the Ministry of Economy, Trade and Industry (METI) and CSL of Ministry of Public Management, Home Affairs, Posts and Telecommunications in Japan and JSAT Corporation, SEED Institute in cooperation with Asia, and the WIDE Project AI3 (Asian Initiatives of Internet Infrastructure) Project. SOI - ASIA followed by some selected Universities in Southeast Asia include: Chulalongkorn University (Thailand), Asian Institute of Technology (Thailand), National University of Laos (Laos), University of Computer Studies (Yangon), Brawijaya University (Indonesia), Sam Ratulangi University (Indonesia), Hasanuddin University (Indonesia), Institut Teknologi Bandung (Indonesia), Asian Youth Fellowship (Malaysia), Institute Of Information Technology (Vietnam)
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The success of distance education supported by the maximum interaction between faculty and students, between students with various educational facilities, among students with other students, the patterns of education active in the interaction. When education bebasis on the web, it is necessary student activity center, the interaction between groups, administrative support systems, deepening of the material, exams, digital library, and online materials. In terms of information technology; world of the Internet enables a complete overhaul of education concepts that had been valid. Information technology & telecommunications with cheaper & easier to remove the constraints of space & time limits for education. Some of the logical consequences that occur include: (1) Students can easily take the course anywhere in the world with no more confined within the boundaries of institutions & state, (2) Students can easily sit under those experts / specialists in the field of interest. Quite a few experts in this world who are happy to answer questions as they come, (3) Lectures and even can be easily taken in various parts of the world without depending on the university where the students learn. That is the concept of open universities will increasingly blend into the traditional university. Only a matter of accreditation of courses taken at universities in foreign countries through the Internet to be recognized as part of the credit to his scholarship at the local university. Consequences that will happen is a shift in the values ​​of college who was very rigid & should be taken at the local university to be open to be taken from other universities in the world.

The Role of Information Technology to Support Health Information Management in the Hospital

The development of information technology has penetrated so rapidly into a variety of sectors including health. Although the world of health (and medical) is a field that is information-intensive, but the adoption of information technology is relatively lagged. For example, when financial transactions electronically has become one of the standard procedures in the banking world, the majority of hospitals in Indonesia in the planning stage development of new billing system. Although the hospital is known as an organization-intensive, capital-intensive, but the investment in information technology is still a small part. In the U.S., both countries are relatively advanced in terms of health budget as well as information technology, hospital menginvestasinya average only 2% for information technology. On the other hand, people realize that information technology is one important tool in human civilization to overcome (in part) the problem of rapid flow of information. Information technology (and communication) is currently an important part in information management. In the medical world, with the development of knowledge that is so fast (less than 750,000 the latest articles published in medical journals every year), the doctor will quickly left behind if it does not make use of various tools for mengudapte latest developments. Besides having the potential of the filter and process data into information, IT can save it with a number of far more capacity than manual methods. Convergence in communications technology also allows health data to be shared easily and quickly. In addition, the technology has the characteristics of very rapid development. Every two years, will emerge a new product with a processing capability that is twice as fast and twice the storage capacity greater as well as various new innovative applications. With all its potential, it is naive if the health information management in hospitals do not provide special attention. This article will specifically address the development of information technology to support the management of medical records more effectively and efficiently. This paper will begin with various examples of applications of information technology, factors that influence success and reflection for the community medical record.
B. Application of information technology to support health information managementIn general, people familiar with information technology products in the form of hardware, software and infrastructure. The hardware includes an input device (keyboard, monitor, touch screen, scanner, microphone, digital camera, video recorder, barcode reader, or other means of digitization of analog to digital form). The hardware is intended to receive input data / information into digital form to be processed through a computer device. Furthermore, there are more processors the hardware known as a CPU (central procesing unit) and computer memory. This hardware serves to cultivate and manage computer systems controlled by a computer operating system. In addition, there is also a data storage hardware both fixed (hard disk) or portable (removable disk). The next hardware is a device that displays the processed outuput computer to the user via the monitor, printer, speakers, LCD or any other form of response.Furthermore, in differentiated software operating system (eg Windows, Linux or Mac) is tasked to manage the living death of the computer, connecting the input and output media and controlling the various software applications and utilities on the computer. While the application is a practical program that is used to assist the implementation of specific tasks such as writing, creating spreadsheets, create presentations, manage databases and so forth. In addition there is also utility programs that help the operating system in the management of certain functions such as memory management, computer security and others.In the aspect of infrastructure, we know there are good computer networking term which is limited and in certain areas (eg a building) is known as the Local Area Network and the wider network, it can even include a single county or a state or what is known as the Wide Area Network (WAN). Currently, the infrastructure in information technology are often lumped together with the development of communication technology. Thus the term convergence of information and communication technologies. PDAs (personal digital assistant) that acts as a handheld computer, but loaded with communication functions (both Wi-Fi, Bluetooth and GSM) is one such example.Hardware (either the input, processing, storage, and output), software and infrastructure, all three have great potential to improve the effectiveness and efficiency of health information management. Some important examples to be examined are (1) computer-based medical records, (2) portable storage technologies such as smart cards, (3) wireless technology, and (4) handheld computer.B.1. Computer-based medical records (Computer-based patient record)One of the major challenges in the application of information and communication technology in hospitals is the application of computer-based medical records. In his official report, Intitute of Medicine noted that it is still little evidence to demonstrate the successful application of computer-based medical records intact, comprehensive data and can serve as a model for other hospitals.Understanding of computer-based medical records vary, but, in principle, is the use of a database to record all medical data, demographic and every event in the management of patients in the hospital. Computer-based medical record will collect a variety of clinical patient data both derived from the results of the examination the doctor, digitization of diagnosisi tools (ECG, radiology, etc.), conversion of laboratory results and clinical interpretation. Medical records are a complete computer-based facilities are usually accompanied with decision support systems (DSS) which allows the provision of alerts, reminders, diagnosis and therapy in order to help physicians and clinicians can adhere to clinical protocols.Figure 1. Alert lab of excessive demand in one model of computer-based medical record applicationB.2. Portable data storage technologyOne important aspect of health care that uses the approach of reference (referral system) is the continuity of care. In this concept, health services at primary level have a high level of connectivity with the referral on it. One prerequisite is the existence of medical data communications easily and effectively. Some approaches made use of information technology is the use of smart cards (smart card that allows storage of temporary data). Smart cards are already used in several European countries and the U.S. making it easier for patients, physicians and health insurers. In smart cards, in addition to demographic data, some data will also be recorded last diagnosisi. Other portable storage technology is web-based model of electronic health records allow patients to store their health data while on the Internet. The data can then be accessed by doctors or hospitals after authorized by the patient. This technology is one model of telemedicine applications that do not run in real time.Simple portable data storage applications is a bar code (or bar code). Bar code is already available in the industry as a marker of a particular brand's unique coming. It is obviously easier for supermarkets and warehouses in retail and inventory management. Food and Drug Administration (FDA) in the U.S. has required all manufacturers of drugs in the U.S. to use the barcode as a marker drug. The use of bar code will also be beneficial to the pharmacy and pharmaceutical installations in hospitals in accelerating the process of inventory. In addition, the use of barcodes can also be used as a unique marker on the card and the patient's medical record.Unique marker technologies are now increasingly popular is RFID (radio frequency identifier) ​​that allows pengidentifikasikan identity via radio frequency. If using a barcode, the hospital still requires a barcode reader, the use of RFID will eliminate the use of these tools. Each item (eg drugs or medical record file) with RFID will transmit a continuous signal into a computer database. So that identification will run automatically.B. 3. Wireless TechnologyUtilization of computer networks in the medical world has actually been initiated since almost 40 years ago. In 1976/1977, the University of Vermon Hospital and Walter Reed Army Hospital to develop local area network (LAN) that allows users to log on to multiple computers from a single terminal in the nursing station. At that time, the medium used was either wired koaxial. Currently, wireless network cables to be excellent because the user remains connected to the network without mobility hampered by wires. Through a wireless network cables, the doctor can always connect to the database without having to terganggun patient mobility.B. 4. Handheld computers (Personal Digital Assistant)Currently, the use of handheld computers (PDAs) become an increasingly commonplace in the medical community. In Canada, fifty percent of physicians under the age of 35 years using a PDA. PDAs can be used to store a variety of clinical data of patients, drug information, and guide therapy / treatment of certain clinical. Some sites on the Internet provides an example of clinical application of dapta used in PDAs such as Epocrates. Utilization of PDAs that have been accompanied by a fixed telephone network enabling physicians can have access to a database of patients in rumahs akit through the Internet network. One example of the application of telemedicine technology is the delivery of patient radiological data that can be passed directly through the GSM network. Furthermore, physicians can provide direct interpretation PDAs and feed it back to the hospital.C. What is the factor of the successful application of computer-based medical records? Indeed, to date no one facility in the world who can apply the concept of an ideal electronic medical records. Nevertheless, several studies have reported the characteristics and hospital experience in implementing an electronic medical record. Doolan, Bates and James published a study of successful implementation of the five major hospitals in the U.S. who apply computer-based medical records and was awarded the Computer-Based Patient Record Institute Davies' Award. The five are:1. LDS Hospital, Salt Lake City (LDSH) in 19952. Wishard Memorial Hospital, Indianapolis (WMH) in 19973. Brigham and Women's Hospital, Boston (BWH) in 19964. Queen's Medical Center, Honolulu (QMC) in19995. Veteran's Affairs Puget Sound Healthcare System, Seattle and Tacoma (VAPS) of 2000The fifth hospital was a teaching hospital with a varied number of beds (from TT 246-712). Based on ownership, three of whom are non-profit private hospitals (no 1, 3 and 4), 1 is a regional hospital (number 2) and a military hospital (number 5).Electronic medical records has been applied to support inpatient services, outpatient and emergency care. Various results of laboratory examination either in the form of text, numbers or images (such as pathology, radiology, nuclear medicine, cardiology to neurology is already available in electronic format. In addition, clinical records of patients identified by doctors and nurses have also been incorporated into the computer either natural directly (in the form of free text or coded) using a dictation system as well. While in the intensive care unit, the computer will capture data directly from various monitors and electronic equipment. Decision support system (DSS) has also been applied to assist doctors and nurses in determining the diagnosis , notice of a history of allergy, drug selection as well as comply with clinic protocols. With the completeness of electronic facilities, doctors routinely use computers to find patients, look for clinical data and provide clinical instruction. However, it does not mean the paper is not used. Doctors still use it to print a summary of the data clinical inpatients when do visit. In an outpatient, clinical summaries were printed by the administrative staff in advance.Although using the approach, type of application and experience vary, but generally there is a common factor that factors that determine their success in implementing computer-based medical records, namely:Leadership, commitment and vision of the organizationLeadership from the head of the hospital is an important factor. It is characterized by long-term commitment and vision is very clear. Often a senior clinician who became leader in computerized and establish cooperation with informatics experts. Further commitment is realized in financial and human resources.Aiming to improve clinical processes and patient care.The key to the success of both systems development is an investment to improve and enhance clinical processes and patient care. Today, along with medical issues and patient safety errors, IT development needs are becoming increasingly dominant.Involving clinicians in the design and modification system.On the fifth hospital, efforts were made, both formal and non formal to involve physicians and in the design and modification of the system. Doctors, nurses and other health professionals who have experience Informatik involved as a liaison between clinicians and information systems. This is particularly important in clinical decision support systems merancangn. One IT manager said that "We had over 530 people INVOLVED, and doctors hired to help us design screens and everything. The doctors were the resource persons very much part of the effort. "Maintain and improve clinical productivityAlthough it is recognized that the use of computers increase the burden on doctors, but hospital facilities are very supportive. Wireless network cables are provided so that clinicians can access mobile data. Likewise, Internet facilities enabling them to monitor the patient's progress from home. Computers are also available equitably, for outpatient care beds with a computer comparison between 1:3-5, 1:1 even in the LDS. While in an outpatient unit of a computer room.Maintain momentum and support for clinicians.One doctor said that ".. We demonstrated and talked about it and evangelized the clinical staff That this was something good, something sexy, high tech and innovative and it was going to be expected to be utilized." Because all of which is a teaching hospital , each resident is required to use computers to record patient progress. However, maintaining the momentum so the doctor can use the computer directly varies, from 3 years up to a decade.Experience in the above reveals that the application of IT to medical records is an incredible effort from the leadership that reflected the leadership, financial and human resource commitments, organizational goals, the grueling process of designing, networking among medical workers, non-medical and Informatik to maintain the momentum.D. Barriers and constraintsHowever, it is undeniable that there are still many obstacles in the application of information technology for health management in hospitals. If still in early stages of the transaction information system development (eg administrative data, financial and demographic) sosiokltural problem is not too obvious. However, if it is up to the clinical aspects, the challenge will be even greater. On the other hand, the readiness of human resources issues often become a booster. Understanding of health personnel in hospitals of the potential of IT sometimes becomes weak because of a mistaken understanding. Therefore, strengthening the aspects of knowledge and skills is one of the key. In addition, of course, is financial problems. Without the help of experts accompanied by a good, sometimes just the IT investment will provide more shall waste no value. The latter is a suspicion of the weak aspects of security, confidentiality and privacy of medical data.E. Applying aplikasiBagaimana select and implement information technology applications for health management in the hospital?This is a crucial question to be answered. Looking at the experience of the above, we must return to the commitment, vision and leadership of the organization. Is this just because of me-too or already contained in the strategic plan of the hospital? In addition, how the cost implications and human resources? How to establish cooperation between the various components in the hospital, both medical and non medical?If this question has been answered, we can choose the appropriate application with the ability of the organization. The most important step is the development of transactional information systems (administrative and clinical data is simple). Furthermore, the development of the second level, the system of management information systems and executive information systems (decision support systems) can be done later. Applications SMS as a reminder for pregnant women to check in a timely manner meruapakan also one of the SPK model for the patient. Likewise, a similar model to the immunization schedule for infants is not too late. The investment required is quite a computer that has been filled with a clinical database of patients, as well as rules regarding the number HP immunization scheduling. Application of the current wireless network is also not an expensive investment. And still seabreg other innovations that can be developed.From the context of information and communication technology, it can be said that various potential applications in the medical world once applied. But we should note that until recently culturally, the medical world, including those that already apply sophisticated electronic infrastructure in most of the clinical information transactions still running face to face. So it is not wrong if someone says that the success of information systems in hospitals 90% is a cultural social issues and only 10% that is the problem of informatics.F. Afterword: reflections for the community medical record Given the rapid development of information and communication technology is quite rapid, community medical records need to understand the various concepts and application of medical informatics (medical informatics). Medical informatics (sometimes also called health informatics) is a discipline which is closely involved with computers and communications as well as their utilization in environmental medicine known as medical informatics (medical informatics). In a more detailed, Shortliffe defines medical informatics as follows: "Discipline is rapidly expanding science that deals with the storage, withdrawal and use of data, information, and knowledge (knowledge) is optimal for the purposes of biomedical problem solving and decision making. Therefore, medical informatics in contact with all the basic science and applied research in medicine and related very closely to modern information technology, namely computers and communications. The presence of medical informatics as a new discipline which is mainly caused by the rapid advances in communications technology and computers, raises awareness that medical knowledge is essentially not be able to managed (unmanageable) by paper-based methods (paper-based methods). ". The scope of medical informatics studies include theoretical and applied. Thus, it can be said that medical informatics is a discipline in itself.In applied research, medical informatics applications include electronic medical records, medical decision support systems, medical information withdrawal systems, to the use of internet and intranet for the health sector, including the couple the clinical information systems with Internet-based bibliographic search. Thus, community medical records will have extensive knowledge about the prospects for bridging the information technology as well as clinicians (users and a major provider of health information) with computer experts (informatics) that aims to design applications and system design in order to produce products in the health information management application hospitals are more effective and efficient.

Peran Teknologi Informasi untuk Mendukung Manajemen Informasi Kesehatan di Rumah Sakit

Perkembangan teknologi informasi yang begitu pesat telah merambah ke berbagai sektor termasuk kesehatan. Meskipun dunia kesehatan (dan medis) merupakan bidang yang bersifat information-intensive, akan tetapi adopsi teknologi informasi relatif tertinggal. Sebagai contoh, ketika transaksi finansial secara elektronik sudah menjadi salah satu prosedur standar dalam dunia perbankan, sebagian besar rumah sakit di Indonesia baru dalam tahap perencanaan pengembangan billing system. Meskipun rumah sakit dikenal sebagai organisasi yang padat modal-padat karya, tetapi investasi teknologi informasi masih merupakan bagian kecil. Di AS, negara yang relatif maju baik dari sisi anggaran kesehatan maupun teknologi informasinya, rumah sakit rerata hanya menginvestasinya 2% untuk teknologi informasi. Di sisi yang lain, masyarakat menyadari bahwa teknologi informasi merupakan salah satu tool penting dalam peradaban manusia untuk mengatasi (sebagian) masalah derasnya arus informasi. Teknologi informasi (dan komunikasi) saat ini adalah bagian penting dalam manajemen informasi. Di dunia medis, dengan perkembangan pengetahuan yang begitu cepat (kurang lebih 750.000 artikel terbaru di jurnal kedokteran dipublikasikan tiap tahun), dokter akan cepat tertinggal jika tidak memanfaatkan berbagai tool untuk mengudapte perkembangan terbaru. Selain memiliki potensi dalam memfilter data dan mengolah menjadi informasi, TI mampu menyimpannya dengan jumlah kapasitas jauh lebih banyak dari cara-cara manual. Konvergensi dengan teknologi komunikasi juga memungkinkan data kesehatan di-share secara mudah dan cepat. Disamping itu, teknologi memiliki karakteristik perkembangan yang sangat cepat. Setiap dua tahun, akan muncul produk baru dengan kemampuan pengolahan yang dua kali lebih cepat dan kapasitas penyimpanan dua kali lebih besar serta berbagai aplikasi inovatif terbaru. Dengan berbagai potensinya ini, adalah naif apabila manajemen informasi kesehatan di rumah sakit tidak memberikan perhatian istimewa. Artikel ini secara khusus akan membahas perkembangan teknologi informasi untuk mendukung manajemen rekam medis secara lebih efektif dan efisien. Tulisan ini akan dimulai dengan berbagai contoh aplikasi teknologi informasi, faktor yang mempengaruhi keberhasilan serta refleksi bagi komunitas rekam medis.

B. Aplikasi teknologi informasi untuk mendukung manajemen informasi kesehatan
Secara umum masyarakat mengenal produk teknologi informasi dalam bentuk perangkat keras, perangkat lunak dan infrastruktur. Perangkat keras meliputi perangkat input (keyboard, monitor, touch screen, scanner, mike, camera digital, perekam video, barcode reader, maupun alat digitasi lain dari bentuk analog ke digital). Perangkat keras ini bertujuan untuk menerima masukan data/informasi ke dalam bentuk digital agar dapat diolah melalui perangkat komputer. Selanjutnya, terdapat perangkat keras pemroses lebih dikenal sebagai CPU (central procesing unit) dan memori komputer. Perangkat keras ini berfungsi untuk mengolah serta mengelola sistem komputer dengan dikendalikan oleh sistem operasi komputer. Selain itu, terdapat juga perangkat keras penyimpan data baik yang bersifat tetap (hard disk) maupun portabel (removable disk). Perangkat keras berikutnya adalah perangkat outuput yang menampilkan hasil olahan komputer kepada pengguna melalui monitor, printer, speaker, LCD maupun bentuk respon lainnya.
Selanjutnya dalam perangkat lunak dibedakan sistem operasi (misalnya Windows, Linux atau Mac) yang bertugas untuk mengelola hidup matinya komputer, menhubungkan media input dan output serta mengendalikan berbagai perangkat lunak aplikasi maupun utiliti di komputer. Sedangkan perangkat aplikasi adalah program praktis yang digunakan untuk membantu pelaksanaan tugas yang spesifik seperti menulis, membuat lembar kerja, membuat presentasi, mengelola database dan lain sebagainya. Selain itu terdapat juga program utility yang membantu sistem operasi dalam pengelolaan fungsi tertentu seperti manajemen memori, keamanan komputer dan lain-lain.
Pada aspek infrastruktur, kita mengenal ada istilah jaringan komputer baik yang bersifat terbatas dan dalam kawasan tertentu (misalnya satu gedung) yang dikenal dengan nama Local Area Network maupun jaringan yang lebih luas, bahkan bisa meliputi satu kabupaten atau negara atau yang dikenal sebagai Wide Area Network (WAN). Saat ini, aspek infrastruktur dalam teknologi informasi seringkali disatukan dengan perkembangan teknologi komunikasi. Sehingga muncul istilah konvergensi teknologi informasi dan komunikasi. Perangkat PDA (personal digital assistant) yang berperan sebagai komputer genggam tetapi sarat dengan fungsi komunikasi (baik Wi-Fi, bluetooth maupun GSM) merupakan salah satu contoh diantaranya.
Perangkat keras (baik input, pemroses, penyimpan, maupun output), perangkat lunak serta infrastruktur, ketiga-tiganya memiliki potensi besar untuk meningkatkan efektivitas maupun efisiensi manajemen informasi kesehatan. Beberapa contoh penting yang akan diulas adalah (1)rekam medis berbasis komputer, (2) teknologi penyimpan portabel seperti smart card,(3) teknologi nirkabel dan (4) komputer genggam.
B.1. Rekam medis berbasis komputer (Computer based patient record)
Salah satu tantangan besar dalam penerapan teknologi informasi dan komunikasi di rumah sakit adalah penerapan rekam medis medis berbasis komputer. Dalam laporan resminya, Intitute of Medicine mencatat bahwa hingga saat ini masih sedikit bukti yang menunjukkan keberhasilan penerapan rekam medis berbasis komputer secara utuh, komprehensif dan dapat dijadikan data model bagi rumah sakit lainnya.
Pengertian rekam medis berbasis komputer bervariasi, akan tetapi, secara prinsip adalah penggunaan database untuk mencatat semua data medis, demografis serta setiap event dalam manajemen pasien di rumah sakit. Rekam medis berbasis komputer akan menghimpun berbagai data klinis pasien baik yang berasal dari hasil pemeriksaan dokter, digitasi dari alat diagnosisi (EKG, radiologi, dll), konversi hasil pemeriksaan laboratorium maupun interpretasi klinis. Rekam medis berbasis komputer yang lengkap biasanya disertai dengan fasilitas sistem pendukung keputusan (SPK) yang memungkinkan pemberian alert, reminder, bantuan diagnosis maupun terapi agar dokter maupun klinisi dapat mematuhi protokol klinik.
Gambar 1. Alert tentang permintaan lab yang berlebihan dalam salah satu model aplikasi rekam medis berbasis komputer
B.2. Teknologi penyimpan data portable
Salah satu aspek penting dalam pelayanan kesehatan yang menggunakan pendekatan rujukan (referral system) adalah continuity of care. Dalam konsep ini, pelayanan kesehatan di tingkat primer memiliki tingkat konektivitas yang tinggi dengan tingkat rujukan di atasnya. Salah satu syaratnya adalah adanya komunikasi data medis secara mudah dan efektif. Beberapa pendekatan yang dilakukan menggunakan teknologi informasi adalah penggunaan smart card (kartu cerdas yang memungkinkan penyimpanan data sementara). Smart card sudah digunakan di beberapa negara Eropa maupun AS sehingga memudahkan pasien, dokter maupun pihak asuransi kesehatan. Dalam smart card tersebut, selain data demografis, beberapa data diagnosisi terakhir juga akan tercatat. Teknologi penyimpan portabel lainnya adalah model web based electronic health record yang memungkinkan pasien menyimpan data sementara kesehatan mereka di Internet. Data tersebut kemudian dapat diakses oleh dokter atau rumah sakit setelah diotorisasi oleh pasien. Teknologi ini merupakan salah satu model aplikasi telemedicine yang tidak berjalan secara real time.
Aplikasi penyimpan data portabel sederhana adalah bar code (atau kode batang). Kode batang ini sudah jamak digunakan di kalangan industri sebagai penanda unik merek datang tertentu. Hal ini jelas sekali mempermudah supermarket dan gudang dalam manajemen retail dan inventori. Food and Drug Administration (FDA) di AS telah mewajibkan seluruh pabrik obat di AS untuk menggunakan barcode sebagai penanda obat. Penggunaan bar code juga akan bermanfaat bagi apotik dan instalasi farmasi di rumah sakit dalam mempercepat proses inventori. Selain itu, penggunaan barcode juga dapat digunakan sebagai penanda unik pada kartu dan rekam medis pasien.
Teknologi penanda unik yang sekarang semakin populer adalah RFID (radio frequency identifier) yang memungkinkan pengidentifikasikan identitas melalui radio frekuensi. Jika menggunakan barcode, rumah sakit masih memerlukan barcode reader, maka penggunaan RFID akan mengeliminasi penggunaan alat tersebut. Setiap barang (misalnya obat ataupun berkas rekam medis) yang disertai dengan RFID akan mengirimkan sinyal terus menerus ke dalam database komputer. Sehingga pengidentifikasian akan berjalan secara otomatis.
B. 3. Teknologi nirkabel
Pemanfaatan jaringan computer dalam dunia medis sebenarnya sudah dirintis sejak hampir 40 tahun yang lalu. Pada tahun 1976/1977, University of Vermon Hospital dan Walter Reed Army Hospital mengembangkan local area network (LAN) yang memungkinkan pengguna dapat log on ke berbagai komputer dari satu terminal di nursing station. Saat itu, media yang digunakan masih berupa kabel koaxial. Saat ini, jaringan nir kabel menjadi primadona karena pengguna tetap tersambung ke dalam jaringan tanpa terhambat mobilitasnya oleh kabel. Melalui jaringan nir kabel, dokter dapat selalu terkoneksi ke dalam database pasien tanpa harus terganggun mobilitasnya.
B. 4. Komputer genggam (Personal Digital Assistant)
Saat ini, penggunaan komputer genggam (PDA) menjadi hal yang semakin lumrah di kalangan medis. Di Kanada, limapuluh persen dokter yang berusia di bawah 35 tahun menggunakan PDA. PDA dapat digunakan untuk menyimpan berbagai data klinis pasien, informasi obat, maupun panduan terapi/penanganan klinis tertentu. Beberapa situs di Internet memberikan contoh aplikasi klinis yang dapta digunakan di PDA seperti epocrates. Pemanfaatan PDA yang sudah disertai dengan jaringan telepon memungkinkan dokter tetap dapat memiliki akses terhadap database pasien di rumahs akit melalui jaringan Internet. Salah satu contoh penerapan teknologi telemedicine adalah pengiriman data radiologis pasien yang dapat dikirimkan secara langsung melalui jaringan GSM. Selanjutnya dokter dapat memberikan interpretasinya secara langsung PDA dan memberikan feedback kepada rumah sakit.
C. Apa faktor keberhasilan penerapan rekam medis berbasis komputer?Memang, hingga saat ini tidak ada satu rumah sakit di dunia yang dapat menerapkan konsep rekam medis elektronik yang ideal. Namun demikian, beberapa penelitian melaporkan karakteristik dan pengalaman rumah sakit dalam menerapkan rekam medis elektronik. Doolan, Bates dan James mempublikasikan suatu studi tentang keberhasilan penerapan 5 rumah sakit utama di AS yang menerapkan rekam medis berbasis komputer dan mendapatkan penghargaan Computer-Based Patient Record Institute Davies’ Award. Kelimanya adalah :
1. LDS Hospital, Salt Lake City (LDSH) pada 1995
2. Wishard Memorial Hospital, Indianapolis (WMH) tahun 1997
3. Brigham and Women’s Hospital, Boston (BWH) tahun 1996
4. Queen’s Medical Center, Honolulu (QMC) in1999
5. Veteran’s Affairs Puget Sound Healthcare System, Seattle and Tacoma (VAPS) tahun 2000
Kelima rumah sakit tersebut merupakan rumah sakit pendidikan dengan jumlah tempat tidur bervariasi (dari 246-712 TT). Berdasarkan kepemilikan, 3 diantaranya merupakan rumah sakit swasta non profit (no 1, 3 dan 4), 1 merupakan rumah sakit daerah (nomer 2) dan 1 rumah sakit tentara (nomer 5).
Rekam medis elektronis telah diterapkan untuk mendukung pelayanan rawat inap, rawat jalan maupun rawat darurat. Berbagai hasil pemeriksaan laboratoris baik berupa teks, angka maupun gambar (seperti patologi, radiologi, kedokteran nuklir, kardiologi sampai ke neurologi sudah tersedia dalam format elektronik. Disamping itu, catatan klinis pasien yang ditemukan oleh dokter maupun perawat juga telah dimasukkan ke alam komputer baik secara langsung (dalam bentuk teks bebas atau terkode) maupun menggunakan dictation system. Sedangkan pada bagian rawat intensif, komputer akan mengcapture data secara langsung dari berbagai monitor dan peralatan elektronik. Sistem pendukung keputusan (SPK) juga sudah diterapkan untuk membantu dokter dan perawat dalam menentukan diagnosis, pemberitahuan riwayat alergi, pemilihan obat serta mematuhi protokol klinik. Dengan kelengkapan fasilitas elektronik, dokter secara rutin menggunakan komputer untuk menemukan pasien, mencari data klinis serta memberikan instruksi klinis. Namun demikian, bukan berarti kertas tidak digunakan. Dokter masih menggunakannya untuk mencetak ringkasan data klinis pasien rawat inap sewaktu melakukan visit. Di bagian rawat jalan, ringkasan klinis tersebut dicetak oleh staf administratif terlebih dahulu.
Meskipun menggunakan pendekatan, jenis aplikasi serta pengalaman yang berbeda-beda, namun secara umum ada kesamaan faktor yang faktor yang menentukan keberhasilan mereka dalam menerapkan rekam medis berbasis komputer, yaitu:
Leadership, komitmen dan visi organisasi
Leadership dari pimpinan rumah sakit merupakan faktor terpenting. Hal ini ditandai dengan komitmen jangka panjang serta visi sangat jelas. Seringkali klinisi senior yang menjadi leader dalam komputerisasi dan menjalin kerjasama dengan ahli informatika. Selanjutnya komitmen tersebut direalisasikan secara finansial maupun sumber daya manusia.
Bertujuan untuk meningkatkan proses klinis dan pelayanan pasien.
Kunci keberhasilan kedua pengembangan sistem merupakan investasi untuk memperbaiki dan meningkatkan proses klinis dan pelayanan pasien. Saat ini, seiring dengan isyu medical error dan patient safety, kebutuhan pengembangan IT menjadi semakin dominan.
Melibatkan klinisi dalam perancangan dan modifikasi sistem.
Di kelima rumah sakit tersebut, berbagai upaya dilakukan, baik formal maupun non formal untuk melibatkan dokter dan dalam perancangan dan modifikasi sistem. Dokter, perawat maupun tenaga kesehatan lain yang memiliki pengalaman informatik dilibatkan sebagai penghubung antara klinisi dan sistem informasi. Hal ini terutama sangat penting dalam merancangn sistem pendukung keputusan klinis. Salah satu manajer IT mengatakan bahwa “We had over 530 people involved, and doctors hired to help us design screens and everything. The doctors were very much part of the effort.”
Menjaga dan meningkatkan produktivitas klinis
Meskipun diakui bahwa penggunaan komputer menambah beban bagi dokter, tetapi rumah sakit menyediakan fasilitas yang sangat mendukung. Jaringan nir kabel disediakan agar dokter tetap dapat mengakses data secara mobile. Demikian juga, fasilitas Internet memungkinkan mereka memantau perkembangan pasien dari rumah. Komputer juga tersedia secara merata, untuk rawat jalan perbandingan tempat tidur dengan komputer antara 1:3-5, bahkan di LDS 1:1. Sedangkan di unit rawat jalan 1 ruang 1 komputer.
Menjaga momentum dan dukungan terhadap klinisi.
Salah satu dokter mengatakan bahwa “..We demonstrated and talked about it and evangelized the clinical staff that this was something good, something sexy, high tech and innovative and it was going to be expected to be utilized.” Karena kesemuanya adalah rumah sakit pendidikan, setiap residen diharuskan menggunakan komputer untuk mencatat perkembangan pasien. Akan tetapi, memelihara momentum agar dokter dapat menggunakan komputer secara langsung bervariasi, dari 3 tahunan hingga satu dekade.
Pengalaman di atas mengungkapkan bahwa penerapan IT untuk rekam medis merupakan effort yang luar biasa yang tercermin mulai dari leadership pimpinan, komitmen finansial dan SDM, tujuan organisasi, proses perancangan yang melelahkan, networking antara tenaga medis, non medis dan informatik hingga menjaga momentum.
D. Hambatan dan kendala
Namun demikian, tidak dipungkiri bahwa masih banyak kendala dalam penerapan teknologi informasi untuk manajemen kesehatan di rumah sakit. Jika masih dalam taraf pengembangan sistem informasi transaksi (misalnya data administratif, keuangan dan demografis) problem sosiokltural tidak terlalu kentara. Namun demikian, jika sudah sampai aspek klinis, tantangan akan semakin besar. Di sisi lain, persoalan kesiapan SDM seringkali menjadi pengganjal. Pemahaman tenaga kesehatan di rumah sakit terhadap potensi TI kadang menjadi lemah karena pemahaman yang keliru. Oleh karena itu penguatan pada aspek pengetahuan dan ketrampilan merupakan salah satu kuncinya. Disamping itu, tentu saja adalah masalah finansial. Tanpa disertai dengan bantuan tenaga ahli yang baik, terkadang investasi TI hanya akan memberikan pemborosan tanpa ada nilai lebihnya. Yang terakhir adalah kecurigaan terhadap lemahnya aspek security, konfidensialitas dan privacy data medis.
E. Menerapkan aplikasiBagaimana memilih dan menerapkan aplikasi teknologi informasi untuk manajemen kesehatan di rumah sakit?
Ini merupakan pertanyaan krusial yang harus dijawab. Melihat pada pengalaman di atas, kita harus mengembalikan kepada komitmen, visi dan leadership dari organisasi. Apakah ini hanya karena ikut-ikutan atau memang sudah tertuang dalam rencana stratejik rumah sakit? Selain itu, bagaimana implikasi biaya dan sumber daya manusia? Bagaimana menjalin kerjasama antar berbagai komponen di rumah sakit, baik tenaga medis maupun non medis?
Jika pertanyaan tersebut sudah dijawab, kita dapat memilih aplikasi yang sesuai dengan kemampuan organisasi. Langkah yang paling penting adalah pengembangan sistem informasi transaksional (data administratif dan klinis sederhana). Selanjutnya, pengembangan level kedua, yaitu sistem informasi manajemen dan sistem sistem informasi eksekutif(sistem pendukung keputusan) dapat dilakukan kemudian. Aplikasi SMS sebagai reminder bagi ibu hamil untuk memeriksakan secara tepat waktu juga meruapakan salah satu model SPK bagi pasien. Demikian juga model serupa agar jadwal imunisasi bagi balita tidak terlambat. Investasi yang diperlukan cukup dengan komputer yang telah diisi dengan database klinik pasien, nomer HP serta rule mengenai penjadwalan imunisasi. Penerapan jaringan wireless saat ini juga bukan investasi yang mahal. Dan masih seabreg inovasi lain yang dapat dikembangkan.
Dari konteks teknologi informasi dan komunikasi, dapat dikatakan bahwa pelbagai aplikasi sangat potensial sekali diterapkan di dunia medis. Akan tetapi kita harus memperhatikan bahwa hingga saat ini secara kultural, dunia medis, termasuk yang sudah menerapkan infrastruktur elektronik secara canggih sebagian besar transaksi informasi klinis masih berjalan secara face to face. Sehingga tidak salah bila ada yang mengatakan bahwa keberhasilan sistem informasi di rumah sakit 90% merupakan masalah sosial kultural dan hanya 10% saja yang merupakan masalah informatika.
F. Penutup: refleksi bagi komunitas rekam medis Mengingat pesatnya perkembangan teknologi informasi dan komunikasi yang cukup pesat, komunitas rekam medis perlu memahami berbagai konsep serta aplikasi medical informatics (informatika kedokteran). Informatika kedokteran (kadang disebut juga informatika kesehatan) adalah disiplin yang terlibat erat dengan komputer dan komunikasi serta pemanfaatannya di lingkungan kedokteran dikenal sebagai informatika kedokteran (medical informatics). Dalam pengertian yang lebih rinci, Shortliffe mendefinisikan informatika kedokteran sebagai berikut: “Disiplin ilmu yang berkembang dengan cepat yang berurusan dengan penyimpanan, penarikan dan penggunaan data, informasi, serta pengetahuan (knowledge) biomedik secara optimal untuk tujuan problem solving dan pengambilan keputusan. Oleh karena itu, informatika kedokteran bersentuhan dengan semua ilmu dasar dan terapan dalam kedokteran dan terkait sangat erat dengan teknologi informasi modern, yaitu komputer dan komunikasi. Kehadiran informatika kedokteran sebagai disiplin baru yang terutama disebabkan oleh pesatnya kemajuan teknologi komunikasi dan komputer, menimbulkan kesadaran bahwa pengetahuan kedokteran secara esensial tidak akan mampu terkelola (unmanageable) oleh metode berbasis kertas (paper-based methods).”. Lingkup kajian informatika kedokteran meliputi teori dan terapan. Dengan demikian, dapat dikatakan bahwa informatika kedokteran merupakan disiplin ilmu tersendiri.
Secara terapan, aplikasi informatika kedokteran meliputi rekam medik elektronik, sistem pendukung keputusan medik, sistem penarikan informasi kedokteran, hingga pemanfaatan internet dan intranet untuk sektor kesehatan, termasuk merangkaikan sistem informasi klinik dengan penelusuran bibliografi berbasis internet. Dengan demikian, komunitas rekam medis akan memiliki wawasan yang luas mengenai prospek teknologi informasi serta mampu menjembatani klinisi (pengguna dan penyedia utama informasi kesehatan) dengan para ahli komputer (informatika) yang bertujuan merancang desain aplikasi dan sistem agar dapat menghasilkan produk aplikasi manajemen informasi kesehatan di rumah sakit yang lebih efektif dan efisien.