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CHAPTER 3

ANALYSIS ON THE EXISTING SYSTEM

3.1Company HistoryKencana Loka clinic is a new clinic that is located in Bumi Serpong Damai, Tangerang.

It was opened in January 1, 2007 and the pharmacy was opened at January 26, 2007.

Even though currently the clinic has not officially opened to the public, it has

successfully reached a large number of patients since their first unofficial opening.

Unlike the other existing clinic, Kencana Loka is really focusing on customer service in

order to obtain patient satisfaction.

The clinic has two main divisions to perform its daily performance, which are

administration and pharmacy division. The administration division is responsible for

handling all the administration processes in the clinic, including patients registration,

appointment, as well as medical billing and payment. The second division, which is

pharmacy division, is in charge to manage the medicines sales transactions within the

pharmacy as well as control the inventory management and distribution, which includes

stock availability assurance, stock distribution, and providing reports for decision-

making.

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3.2Company Organizational Structure

Figure 3.1 Kencana Lokas organizational structure

3.3Policy and Procedure3.3.1 Policy3.3.1.1 PatientThe policies that are applied to the patient are:

Unregistered patient are not allowed to receive any medical treatment, includingprohibition in making any appointment with the doctor.

All patients should get a quality care without any discrimination.

Personal privacy and confidentiality of information are maintained.

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The patient also has right to be given current information concerning thediagnosis, treatment options, or possible outcome of each treatment.

The patient has a freedom to refuse any given or proposed treatment.3.3.1.2 ReceptionistThe policies that are applied to the receptionist are:

Incoming phone calls should be handled in the correct and proper manner by therecepsionist.

The receptionist is responsible for managing the appointment between patientsand doctors, including assigning the exact date and time for each apoointment.

Allocating more than one treatment sessions to a doctor in the same time isprohibited. Each doctor can only handle one patient in a given time.

Upon entering the clinic for appointments, every client must sign in by checkingin with the waiting room attendant. Clinicians are responsible for verifying that

each of his/her clients consistently follows this procedure.

The waiting queue is arranged prior to the appointment schedule and firstattendance of the patients. For instance, if a walk-in patient come to register

himself to doctor A at 10.00, the receptionist has a responsibilty to check whether

at a given time there has already an appoinment made to Doctor A. If yes, then

the patient will be registered immediately to the first empty slot (available time)

after the appointment.

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If the patient late, then the direct subsequent appointment could be moveforwards or else the time slot could be allocated to the walk-in patients.

Whenever, that particular patient comes, he/she will be given the immediate time

slot after the treatment session on progress.

Any appointment made by the doctor should be informed to the receptionist assoon as possible and vice versa.

Any alteration on appointment should be informed to the doctors and receptionistas soon as possible.

The registration for the new member should be handled perfectly.

The receptionist is also responsible for keeping the patients record and data.

Clinicians must be available during scheduled times.3.3.1.3 DoctorThe policies intended for the doctor are:

The doctor has a responsibilty to provide the best care available as well as giveall the treatment alternatives for your care.

The patient will be provided with a secure environments. The doctor has to treat the patients with respect.

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The patient will be provided the services necessary to be treated properly withinthe scope of practice. Any reasonable request for available services will be

satisfied. If necessary, the patient will be transferred to another accepting facility,

after receiving an explanation of the need to transfer and the alternatives

available.

Issuing check-up category fee.

Any schedule including day off and schedule alterations should be reported to thereceptionist as soon as possible.

The patients diagnoses, tests, and treatments should be discussed with patient ina nontechnical way.

The doctor should recommend a reasonable alternative treatments ormedications.

3.3.2 Procedure3.3.2.1 New Patient Registration

Patient attends the clinic and registers him/her self at the receptionist.

The receptionist fills out some patients data and information in the DataPribadi Pasien form.

The head of family will be given an MR card as an identification.

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The patient will be allocated to a particular time slot to meet the appointeddoctor.

The patients data and information will be forwarded to the doctors room.3.3.2.2 Walk-In Registration

Patient attends the clinic and registers him/her self at the receptionist.

The receptionist searchs for patients data and medical records based on the MRshown by the patient.

The patient will be allocated to a particular time slot to meet the appointeddoctor.

The patients data and information will be forwarded to the doctors room.

3.3.2.3

On-schedule Appointment

After conduct medical check-up with the patient, the doctor could initiate anothercheck-up schedule.

Doctor reports the day and time to the receptionist regarding the on-scheduleappointment.

Patient attends the clinic and register him/her self at appointed time.3.3.2.4 By phone Appointment

Patients make an appointment via phone call with the receptionist.

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Patients choose the desired doctor and schedule.

The receptionist check the schedules availability of the doctor. If the desired time slot is still available, that slot is immediately allocated to that

particular patient.

If the time slot is already occupied, the receptionist offers another available timeslot to the patients.

3.3.2.5 Payment After finish examining the patient, doctor fills out the patients medical record as

well as treatments category and fees, and required prescription.

Patient brings those information to the receptionist, whom charges the patientsbased on the the treatments category and fees written by the doctor.

Patient pays for the fees. If the prescription is going to be purchased, the patientcould go to pharmacy to conduct the transaction.

The patients medical record file is kept by the receptionist.

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3.4Data Flow Diagram3.4.1 Context Diagram

Figure 3.2 Manual Clinic System Context Diagram

The current clinic systems context diagram is shown in the Figure 3.2. Since the system

is a manual system, the receptionist is considered as the system itself. Currently,

receptionist performs almost all of the processes and has the privileges to gain access to

most of the processes inside the existing system.

As shown above, there are four actors, which directly connected with the system. Those

are doctor, management, member patient, and non-member patient. The patient is divided

into member and non-member patient, since the non-member patient does not have any

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privileges to the system while the member patient could have benefit from any services

offered by the clinic. Thus, in order to get those benefits, the non-member patient must

firstly register to be the clinics member. For the registration purpose, he /she must give

their personal data and payment details to the receptionist. Whenever the registration is

succeed, receptionist informs the member confirmation status and gives identification

members card (MR card) to the patient.

Every patient that has been registered is considered as member patient. They can ask for

visit appointment or make appointment request via phone or scheduled-appointment.

Visit appointment is appointment that is made exactly while the patient attends the clinic.

As the response, receptionist gives the approved date and time confirmation to the

customer. Besides having a privilege to make an appointment, member patient has a duty

to make payment every time they finished their examination-check. The receptionist then

generates receipt to the member as the payment confirmation.

The receptionist would provide various types of reports and statistics as requested by the

management. These reports are used as the tools to analyze and evaluate the current

progresses that occur in the clinic.

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3.4.2 Level 1 Data Flow Diagram

Figure 3.3 Level 1 Data Flow Diagram

For the Level 1 DFD of the current system, the system is divided into two main

processes, which are Register Patient and Schedule Appointment. Similar with the

context diagram, for the level 1 DFD receptionist is considered as the system. Hence, for

the rest of this chapter, our thesis team would use the word receptionist as the

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replacement for the current manual system. Both of the processes are explained in the

following paragraphs.

For the Register Patient, the input comes from non-member patient and patient store file.

Currently for storing customer file, the clinic uses Microsoft Excel as the data store. As

described in the context diagram at section 3.4.1, the non-member patient, in order to

perform medical check-up must previously register himself or herself as the member.

Non-member patient makes a request to be a member, and then submit his/her personal

data and payment details. Afterward, he/she will get the member confirmation status and

MR card as the return from the Register Patient process. The new members data is

stored in the excel file named patient.

The Scheduled Appointment system takes the eligible patie nt list from the patient data

store. The eligible patient list is the patient that has already be a member in the clinic.

Those verified patient is able to request for appointment, and ask for the desired date and

time. The receptionist checks the doctors schedule from the schedule data store. The

doctor submits and updates their schedule to the receptionist, who will update that

particular doctors schedule in the schedule data store. Whenever the date and time has

already been confirmed, the appointment list detail would be informed to the intended

doctor. Finally, the doctor will update his/her appointment list. After examining the

patient, the doctor updates the patient historical record, which will be used as the input

for the receptionist to keep the patient medical record up to date. Together with the

medical record, the doctor also lists the medical fee details and the needs for performing

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scheduled-appointment to the patient. At the end, all those information is submitted to the

receptionist to calculate total payment and update the appointment list.

3.4.3 Level 2 Data Flow Diagram

Figure 3.4 Level 2 Data Flow Diagram - Registration

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Figure 3.5 Level 2 data Flow Diagram Appointment

Figure 3.4 and Figure 3.5 show the Level 2 DFD of the current system. Similar with the

previous diagrams, receptionist is considered as the system. Figure 3.4 illustrates the

Data Flow Diagram for Registration subsystem, while Figure 3.5 shows the diagrams for

the appointment subsystem.

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3.4.4 System FlowchartAll of the explanation about the flowchart diagrams are referred to the Procedure

section in Chapter 3.3.2

3.4.4.1 Patient registration

Figure 3.6 Patient Registration Flowchart page 1

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Figure 3.7 Patient Registration Flowchart page 2

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Figure 3.8 Patient Regis tration Flowchart page 3

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3.4.4.2 Appointment process

Figure 3.9 Appointment process Flowchart

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3.5Existing ProblemsSince both departments, mostly works on paper environment, all the registration,

appointment, and inventory requests are done manually by fill out the form by hand.

Even though the clinic is just opened to the public, the downside of the existing system

has caused some problems for the clinic, especially in information searching process.

However, as described above, it is clear enough to figure out some potential problem that

would appear in the future.

3.5.1 Registration Process Storages inefficiencies. There are a lot of inefficiencies in the current system

while most processes are still done manually. For instance, a new patient comes

to the clinic to register for a check-up, his/her personal data is stored in a paper-

based form. Moreover in the next visits, his/her medical history is also updated in

the same file. Since all patients data is kept in the paper-based files, the physical

storage required for storing those files will be enormous. In addition, the need for

paper is compulsory.

Time-consuming on searching progress. The paper-based system makes thesearching information progress become time-consuming. The increase on number

of patient will soon overwork the administration staffs ability on searching

patients data. For instance, in order to get the patientss information in their

visits, the receptionist has to search their ID in the excell (if and only if the

patients do not forget their IDs). It occurs especially because of the storage

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sustains excessive data. Consequently, it would cause degradation on registration

progress.

3.5.2 Appointment Process Without a computerized system, appointment management is problematical. The

administration staff has to manage the doctors appointment agenda including

appointment by attendance (walk-in patient), by phone, or scheduled

appointment. Consequently, a long queue at the front desk may happen, which is

wasting the patients time. Besides, it will produce overcrowding and noisiness

as well in the waiting room. Another outcome is appointment overlapping. The

doctor to the front office with the purpose of preventing this issue must inform

every scheduled appointment manually, and vice versa.

Inefficiencies and difficulties in manually managing, recording, and controllingpatients payment inefficient. The doctor writes down the type of consultation

performed in a paper-form given and hand those information to the patient.

Afterward, the consultation and check-up lists must be carefully examined by the

front desk to determine the total payment. Finally, the receptionist receives

payment and records the transaction details in excell file. Consequently, it

becomes time consuming and at the end depreciates the customers response

time.

Information flow between rooms within the clinic is not perfectly organized. Themanual system and the lack of computer in each room make the data flow among

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doctors rooms, front desk, and pharmacy become inefficient. As a result,

duplicate efforts may happen for entering or inputting some data.

From the patients side, coming to the clinic physically for obtaining waitingnumber is tiresome. Afterward, they still have to wait to be called. This

procedure is very time-consuming and inefficient since some of them are busy.

At the end, it would contradict to the clinics principle to be customer oriented.

3.6Alternative Solutions for the ProblemsAfter identifying existing problems and examining the current business process, our

thesis team figures out some possible approaches as the appropriate solutions. Each

approach has different advantages and disadvantages, and knowing what they are will

give us a better image to decide the best choice.

3.6.1 Web Based ApplicationNowadays, web applications are getting popular due to the flexibility of the browser as a

client, sometimes called a thin client. The web-based application can be applied to

enhance existing system since it is changed the existing manual system into computerized

system. By applying web-based application, the programs installation in each computer

is not required. Thus, there will only one computer that has the systems installation

while the rest will only access the system through main computer.

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3.6.2 Windows Based ApplicationThe windows-based application can also be used to improve existing system from

manual-based into computer-based system. It sometimes could be useful for a high

complexity system. In windows-based, each program has to be installed in every clients

computer. Hence, it rises the system response time.

3.6.3 Purchase commercial software

The commercial software to manage the clinics process is available widely in the

internet. They provide various features varying from the basic features to complex and

advanced features. However, generally they offer general clinical functions that is

bundled into one software.