The Impact of Implementing a Picture
Archiving and Communication System (PACS) on Minimum Service Standards in the
Field of Radiology
Nur Alim1*, Donny Kristanto
Mulyantoro2, Luthfi Rusyadi3
Poltekkes Kemenkes Semarang,
Semarang, Central Java, Indonesia 1,2,3
Email: nur.alim@gmail.com
|
KEYWORDS |
ABSTRACT |
|
Picture Archiving and
Communication System (PACS),
Minimum Service Standards, Radiology. |
The use of Picture Archiving and
Communication System (PACS) has become an important step to increase the
efficiency of radiology services. With PACS, fast access and flexibility in
accessing patient medical images has had a major impact on reducing waiting
times for radiology examination results. The aim of this research is to
determine the waiting time for radiology services at the UPTD Embung Fatimah Regional Hospital, Batam
City after implementing PACS. The research uses a mix-method method, namely
research that combines quantitative and qualitative methods. Quantitative
method by collecting service time data. Qualitative method by conducting
in-depth interviews (in-depth interviews) and focus group discussions (FGD)
to obtain information on perceptions from service implementers and users,
then researchers will assess the impact of PACS on Minimum Service Standards
(SPM) in the field of radiology at UPTD RSUD Embung
Fatimah Batam city.The
results of this research are that the use of PACS has significantly reduced
radiology service time at the UPTD Embung Fatimah
Regional Hospital, Batam City. There was a
significant decrease in service time for outpatient services previously from
101.09 minutes to 62 minutes or 35.3%, for inpatient services from 108.26
minutes to 65.6 minutes or 41.04% and for CITO patients from 104.27 minutes
to 60.5 minutes or 41.06% after application of PACS. The views of
radiologists and radiographers regarding the differences in the quality of
radiology services before and after using the PACS system show that there are
better changes in the efficiency and quality of radiology services in
hospitals. Stakeholder perceptions related to the speed of radiology service
time after using the PACS system through various factors are considered to
have a positive impact. Implementation of PACS clearly shows the potential
for improving the efficiency, speed, and overall quality of radiology
services. There was a significant reduction in waiting time for radiology
examination services at the UPTD Embung Fatimah
Hospital, Batam City after the implementation of
PACS, which can provide an alternative in changing workflow and efficiency of
radiology services. |
|
DOI:
|
|
Corresponding Author: Nur Alim*
Email: nur.alim@gmail.com
INTRODUCTION
Healthcare
services and hospitals are the cornerstone of providing effective medical care,
providing patients with important diagnostic and treatment solutions (AL
GHIFARI, 2019; World Health Organization (WHO), 2022). In the context of health
services, a smooth diagnostic process, well-structured workflow, and consistent
service quality are very important (Indriani, Larasati, & Lestari, 2015). In Indonesia, health
facilities are bound by a strict regulatory framework that outlines operational
standards that must be upheld (Siringoringo, Hendrawati, & Suharto, 2017). These regulations are
designed to ensure patient safety, guarantee the provision of high-quality
care, and comply with internationally recognized standards, thereby fostering
trust in the healthcare system (Hadiyati, Sekarwana, Sunjaya, & Setiawati, 2017; Utami & Alawiya, 2018).
Decree
of the Minister of Health of the Republic of Indonesia Number
129/Menkes/SK/II/2008 which regulates Minimum Service Standards (SPM) for
Hospitals, has an important role in improving health services in hospitals in
Indonesia (Ministry of Health, 2008a). This decision specifically maps out
guidelines and guidelines for hospitals to provide quality and standardized
health services (Sumardjoko & Akhmadi,
2020). By referring to these standards, hospitals are expected to be able to
optimize existing facilities, medical personnel, and infrastructure to provide
the best service to patients (Kuzairi, Yuswadi, Budiharjo, & Patriadi, 2017). The implementation of this standard also
supports efforts to improve health services as a whole,
because it has a clear and measurable framework, one of which is the
waiting time for thorax photo services within the Minimum Service Standards,
namely 3 hours (Astuti, Arso,
& Wigati, 2015).
Through
the Minister of Health's Decree, health services in hospitals have become more
focused and transparent. This standard-setting provides a reference regarding
facilities, human resources, facilities, and infrastructure, as well as other
aspects that must be present in hospital operations. Not only does it provide
certainty for patients regarding the expected quality of service, but it also
encourages hospitals to innovate and continue to strive to improve services so
that they comply with established standards.
One
area that continues to improve patient services is radiology, radiology
services play an important position in a series of patient care, enabling
correct diagnosis and appropriate treatment planning (Aryati,
2020). In a hospital service system, the radiology installation is a supporting
field that facilitates imaging which is important for making medical decisions
(Sayuti, Imbaruddin, & Rusli, 2015). Ensuring the quality and suitability of
radiology services is the basic goal of optimizing patient services and
continuing to strive to simplify workflow while still providing optimal results
(Suharyanta & A'yunin,
1978). One effort to improve radiology services in this digital era is to use Picture
Archiving and Communication System (PACS).
UPTD
RSUD Embung Fatimah in Batam
City has a strong focus on improving the quality of radiology services.
Determination of Minimum Service Standards (SPM) for Radiology at UPTD RSUD
refers to the guidelines set out in the Decree of the Minister of Health of the
Republic of Indonesia Number 129/Menkes/SK/II/2008, namely 3 hours. This
standard has an important role in ensuring the quality of services in
hospitals, including the length of waiting time for radiology services (Rahmaddian, Semiarty, & Lita,
2019). Although the length of waiting time for expertise by radiologists is not
specifically explained in the standards, the waiting time for radiological
examinations, especially chest x-rays, is regulated not to exceed 3 hours by
the Minimum Service Standards (SPM) (Ministry of Health, 2008b).
In the development of medical technology, the use
of Picture Archiving and Communication Systems (PACS) has become an important
step in improving the efficiency of radiology services. Before the
implementation of PACS, important factors in radiology service quality
standards were diagnostic accuracy and efficient communication of findings to
stakeholders who needed them (Setyawan & Supriatna, 2016). With the existence of PACS, fast access
and flexibility in accessing patient medical images has had a major impact on
reducing the waiting time for radiology examination results (Alalawi, Eid, & Albarrak, 2016). PACS allows
radiologists to access medical images remotely and allows timely intervention
and effective actions (Suandari, Juliantara,
& Rusmana, 2020).
The
implementation of Minimum Service Standards (SPM) for radiology which refers to
the Decree of the Minister of Health which has been used so far is 3 hours,
with the adoption of PACS at UPTD Embung Fatimah
Regional Hospital, Batam City, it has positively
optimized the radiology service process. The waiting time for radiology
services at UPTD Embung Fatimah Regional Hospital, Batam City in practice tends to be below the Minimum
Service Standard (SPM), although sometimes it is several times above the Minimum
Service Standard (SPM), so it is necessary to measure service time and adjust
the Minimum Service Standard (SPM) indicators. )
radiology, especially in terms of waiting time for radiology services. This
adjustment is due to the advantages of PACS and the mission of UPTD Embung Fatimah Hospital, Batam
City, which continues to strive to improve health services in the community,
one of which is through radiology services.
Based
on the background, it is necessary to prepare Minimum Service Standards (SPM)
for radiology services at UPTD Embung Fatimah
Regional Hospital, Batam City based on the speed of
waiting time for radiology services. For this reason, research was conducted
with the title "Analysis of the Impact of Implementing a Picture Archiving
and Communication System on Minimum Service Standards (SPM) in the Field of
Radiology".
METHOD
This
research uses a mixed-method approach, which combines quantitative and
qualitative methods. Quantitative methods were used to collect radiology
service time data before and after the implementation of the Picture Archiving and
Communication System (PACS) at the UPTD Embung
Fatimah Regional Hospital, Batam City. This
quantitative data will help in measuring differences in the efficiency of
radiology services numerically. Meanwhile, qualitative methods were carried out
through in-depth interviews and Focus Group Discussions (FGD) with various
related parties, such as radiologists, radiographers, and other officers, to
explore their perceptions, experiences, and views on the implementation of PACS
and its impact on radiology services.
A
complete description of the research variables includes the variable scale,
method of measurement, type of variable size, variable units, and range of
variable values which are explained in the following table:
The
research subject consists of two parts. Quantitative subjects included all
officers and patients at UPTD Embung Fatimah Regional
Hospital, Batam City, while qualitative subjects were
divided into informants from the service implementing group and informants from
the user group. Quantitative data collection was carried out through medical
records or hospital information systems, while qualitative data was collected
through in-depth interviews and FGDs.
The
research procedure included collecting quantitative and qualitative data
separately. Quantitative data collection was carried out by collecting data on
waiting times for radiology services before and after PACS implementation,
while qualitative data collection was carried out through in-depth interviews
and FGDs. The research tools used included interview sheets, FGD guides, and
data on the duration of radiological examinations.
Data
analysis techniques include statistical analysis for quantitative data using
the SPSS 21.0 for Windows application, with the data testing criteria being
said to be significant if there is a difference between before and after using
PACS. Meanwhile, for qualitative data, descriptive analysis was carried out in
the form of tables and thematic analysis to identify important patterns and
themes that emerged in the views and experiences of stakeholders regarding the
implementation of PACS and its impact on the efficiency of radiology
examination services. The integration of the results from these two analysis
methods was carried out to provide a more complete understanding of the impact
of PACS implementation on radiology services and its implications for service
standards at UPTD Embung Fatimah Regional Hospital, Batam City.
RESULTS AND DISCUSSION
Radiology
Service Time at UPTD Embung Fatimah Regional
Hospital, Batam City After Implementing PACS
Determining the time of radiology
services at the UPTD Embung Fatimah Regional
Hospital, Batam City was carried out through a
comparison of pre and post-implementation of PACS,
collecting data on radiology examination service times one month
pre-implementation of PACS, totaling 633 patients and post-implementation of
PACS, totaling 654 patients. Data on examination times for radiology services
is separated based on examination qualifications, namely outpatients or
polyclinics, inpatients and CITO patients.
Data Normality Test
The normality test is a test carried out with the aim of
determining whether the data collected on each variable is normally distributed
or not. This test uses the methodKolmogorov-Smirnov
because the number of samples in this study was more than 50 samples.
Table 2. Data normality test for outpatients, inpatients and CITO
|
Variable |
*p-value |
|
Pre
outpatient |
0,200 |
|
Post
outpatient |
0,200 |
|
Pre-hospitalization |
0,00 |
|
Post
hospitalization |
0,008 |
|
I
quote |
0,02 |
|
Soon
after |
0,18 |
* Kolmogorov-Smirnov
Table 2 shows the results of the normality test that value p-value
<0.05 so that the data is not normally distributed, the test that will be
carried out is the test non parametric namely by using
a testMan Whitney and if the data is normally
distributed then the test that will be carried out is the test parametric
namely by using a test unpaired t-test.
Radiology Outpatient Data pre and
post-implementation of PACS
Data
on outpatient radiology service time for one month before implementing PACS
totaling 67 patients and after implementing PACS totaling 67 patients were then
analyzed to obtain information that is useful in managing time and resources in
hospitals. This time measurement was carried out with the number of outpatients,
namely one month before and after the implementation of PACS.
Table 3. Outpatient data on PACS
implementation
|
|
Mean |
SD |
*p-value |
|
Pre
PACS Outpatient |
100.97 |
8.098 |
0,000 |
|
Post PACS Outpatient |
65.61 |
15.091 |
* Unpaired t-test
Table
3 shows that there are differences in waiting times for outpatients a month
before and after implementing PACS. The average time before using PACS was
101.09 (minutes) while after implementing PACS there was a decrease of 65.61
(minutes) or a decrease in time of up to 35.3%. Based on test unpaired t-test
shows the value p-value 0.000 is less than 0.005 which can be interpreted as
meaning that there is a difference in the waiting time for outpatient expertise
results after implementing PACS.
Radiology Inpatient Data pre and
post-implementation of PACS
Data
on inpatient radiology service time for one month before implementing PACS
totaling 413 patients and after implementing PACS totaling 439 patients, has
been analyzed to obtain information that is useful in managing time and
resources in hospitals. This time measurement was carried out by the number of
inpatients, namely one month before and after the implementation of PACS.
Table 4. Inpatient data on PACS implementation
|
|
Mean |
SD |
*p-value |
|
Pre
PACS Inpatient |
108.26 |
8.018 |
0,000 |
|
Post PACS Rawat Inap |
61.90 |
13.077 |
*Man whitney
Table
4 shows that there is a difference in the waiting time experienced by
inpatients in the month before and after implementing PACS. The average time
before using PACS was 108.26 (minutes) while after implementing PACS there was
a decrease of 61.90 (minutes) or a decrease in time of up to 41.04%. Based on the
test Man whitney shows that the value 0.000 is less
than 0.005 which can be interpreted as meaning that there is a difference in
the waiting time for expert results for inpatients after implementing PACS.
Cito Radiology Patient Data pre and
post-implementation of PACS
Data
on radiology service time for Cito patients for one month before the
implementation of PACS amounted to 153 people and after implementing PACS there
were 148 people. Research data has been analyzed to obtain information that is
useful in managing time and resources in hospitals. This time measurement was
carried out with the number of CITO patients, namely one month before and after
the implementation of PACS.
Table 5. Cito patient data on PACS
implementation
|
|
Mean |
SD |
*p-value |
|
Pre
PACS Cito
Patients |
104.26 |
7.230 |
0,000 |
|
Post PACS Cito
Patients |
60.52 |
11.919 |
*Man whitney
Table
5 shows that there is a difference in the waiting time received by Cito
patients in the month before and after implementing PACS. The average time
before using PACS was 104.26 (minutes) while after implementing PACS there was
a decrease of 60.52 (minutes) or a decrease in time of up to 41.6%. Based on testMan whitney shows that valuep-value 0.000 is less than 0.005 which can be
interpreted as meaning that there is a difference in the waiting time for CITO
patient expertise results after implementing PACS.
Perceptions of Radiology Specialist Doctors and
Radiographers seen from the Quality of Radiology Examination Services After
Using the PACS System
The
collection of information to determine the perception of radiologists and
radiographers about the quality of radiological examination services after
using the PACS system which was
carried out using in-depth interview methods(indepth interview) to a radiology specialist doctor and
five radiographers, from the interview the following results were obtained:
Table 6. Flow of expertise and
radiology service results after using PACS
|
Source |
Answer |
|
Radiology
Specialist Doctor |
"After
implementing PACS, radiological examinations have become more efficient both
in terms of the overall speed of radiology services because reading time has
been reduced quite significantly." |
|
Radiographer
1 |
"After
implementing PACS, there are several steps that have become more effective,
thereby reducing the overall radiology examination process or time, starting
from the print out process before reading, the
process of sending photos to radiologists, as well as archiving photos, which
has become much more effective." |
|
Radiographers
2 |
“After
implementing PACS, the flow of radiology examination results experienced
significant changes. Radiology images are now available in digital format,
which eliminates the need for printing physical films. This means
radiologists can quickly access patient images and immediately begin
diagnosis without waiting for physical delivery of the film.” |
|
Radiographers
3 |
“The
flow of radiology examination results becomes more efficient after using
PACS. With this system, radiographers upload radiology images to the system,
and radiologists can access them electronically. This saves time previously
spent on physical delivery of images and allows for quicker diagnosis.” |
|
Radiographers
4 |
“In
the context of PACS, the flow of radiology examination results has changed to
become more computerized. Radiology images are available in seconds via the
software, which makes the diagnosis process more efficient. Radiographers no
longer have to physically print films or deliver
photos to radiologists.” |
|
Radiographers
5 |
“After
implementing PACS, the flow of radiology examination results experienced
positive changes. The process of printing and physically delivering radiology
images has been replaced by digital systems. Radiographers can upload images
directly, ensuring radiologists can see them quickly, resulting in faster and
more efficient diagnoses.” |
Based
on the results of the perceptions of the six respondents, through in-depth
interview methods it can be concluded that the use of PACS (Picture Archiving
and Communication System) in radiology services in hospitals has resulted in a
significant increase in time. In terms of overall speed of radiology services,
there have been improvements which include reducing reading time by specialist
radiologists and increasing effectiveness in various steps such as the photo
printing process, sending photos to radiologists, and archiving photos. The
overall use of PACS has brought great benefits in optimizing radiology
examination times and processes, ultimately contributing to more efficient and
quality patient care. Through the first question, it can be
seen that the implementation of PACS makes a positive contribution to
improving quality.
Table 7. Ease of carrying out
expertise and inspections after using PACS
|
Source |
Answer |
|
Radiology
Specialist Doctor |
"Overall,
it makes the series of inspections very easy, especially in terms of
accessibility when reading because the workstation monitor
and reading monitor are separate but the image quality remains the
same." |
|
Radiographer
1 |
“Overall,
PACS significantly simplifies radiology examinations by providing fast
access, sharing capabilities, and software that supports better patient
diagnosis and care processes.” |
|
Radiographer
2 |
“Yes,
the use of PACS makes it significantly easier to carry out radiological
examinations. With instant access to radiology images and a wide range of
software features, radiographers can easily analyze images, make more
accurate assessments and support patient care more effectively.” |
|
Radiographer
3 |
“PACS
really makes radiological examinations easier. With the ability to quickly
access patient images and share data with the rest of the medical team, the
examination process becomes more collaborative and efficient, ultimately
benefiting the patient.” |
|
Radiographer
4 |
“With
PACS, carrying out radiological examinations becomes much more comfortable.
Radiographers no longer have to print physical films
or face delays in image delivery. All images are available in digital format,
which makes diagnosis faster and more accurate.” |
|
Radiographer
5 |
“Yes,
PACS really makes radiological examinations easier. Radiographers can access
patient images instantly, and integrated software allows them to perform more
in-depth analysis. In addition, collaboration with radiologists and other
specialists becomes easier by sharing digital data.” |
Based
on the results of in-depth interviews with the six respondents, it can be
concluded that the use of PACS (Picture Archiving and Communication System) in
radiology services in hospitals as a whole greatly
facilitates and increases the effectiveness of radiological examinations. This
includes increasing accessibility when reading by radiologists, with separate
workstation monitors and reading monitors but with the same image quality. In
addition, PACS provides benefits in the form of fast access, sharing
capabilities, and software that supports better diagnosis and patient care
processes for radiographers. Thus, the implementation of PACS increases the
overall efficiency and quality of radiology services in hospitals.
Table 8. Data accessibility after
using PACS
|
Source |
Answer |
|
Radiology
Specialist Doctor |
"Accessing
data is becoming easier and better. Previously, with the manual photo
archiving storage system, we sometimes had difficulty finding old photos for
comparison. With the PACS system, many things have become easier and more
helpful." |
|
Radiographer
1 |
“With
PACS, radiology images are stored in digital format that can be accessed
quickly via a computer or other device. This eliminates the delays associated
with looking for physical films and allows radiographers to immediately view
patient images.” |
|
Radiographer
2 |
“After
using PACS, the data access process becomes more efficient. Radiology images
are stored in digital format that can be accessed quickly via a computer or
other device. This eliminates the delays associated with searching for
physical films and allows radiographers to immediately view patient images.” |
|
Radiographer
3 |
“With
PACS, data access becomes faster and more practical. All radiology images are
available in a centralized digital system. Radiographers and radiologists can
easily access patient images through an easy-to-use interface, saving time
previously spent searching for physical films.” |
|
Radiographer
4 |
“The
process of accessing data after using PACS becomes more modern and efficient.
Radiology images can be retrieved quickly via PACS software, without the need
to search for physical films in various storage locations. This allows
medical teams to respond more quickly to patient needs.” |
|
Radiographer
5 |
“With
PACS, data access becomes more structured and efficient. All radiology images
are stored in a system that can be easily accessed by authorized members of
the medical team. This reduces the risk of loss or error in image capture and
ensures that patient data is available quickly when needed.” |
Based
on the perceptions of the six respondents, through in-depth interview methods
it can be concluded that the implementation of PACS(Picture
Archiving and Communication System) has resulted in positive improvements in
accessing and storing radiology data in hospitals. Previously, manual storage
and archiving systems often resulted in difficulties in finding old photos for
comparison, whereas with PACS, radiology images are stored in a digital format
that can be quickly accessed via a computer or other device. This eliminates
the delays associated with searching for physical films and allows radiologists
and radiographers to easily access and view patient images, thereby improving
the overall efficiency and quality of radiology services, not only for radiologists
and radiographers but also for other parties involved. interested parties, such
as doctors sending polyclinics, or doctors on duty in the ER who generally need
fast access to images.
Table 9. Ease of data access after
using PACS
|
Source |
Answer |
|
Radiology
Specialist Doctor |
"Data
access after using PACS is very easy considering that now I can carry out
interpretation from almost any location as long as the device and network
support it." |
|
Radiographer
1 |
"By
using PACS, the data access process becomes faster, more efficient and
structured, which ultimately increases the efficiency of treatment and
diagnostic capabilities by medical personnel." |
|
Radiographer
2 |
“Yes,
the use of PACS makes it significantly easier to access data. All radiology
images are available in digital format that can be accessed quickly via
computer devices. This eliminates the delays associated with searching for
physical films and ensures that patient data is always easily available.” |
|
Radiographer
3 |
“With
PACS, accessing data becomes much easier. Radiographers and radiology
physicians can quickly search and view patient images through the digital
system, saving time previously spent searching the archives for physical
radiology films.” |
|
Radiographer
4 |
“Yes,
PACS makes it easier to access radiology data. The images are stored in a
structured digital database, allowing radiographers and radiologists to
access them quickly without having to search for films manually. This
increases efficiency in patient management.” |
|
Radiographer
5 |
“PACS
effectively increases the ease of accessing data. By using PACS software,
medical team members can easily search and view patient radiology images from
a computer or other device. This ensures that data is always available when
needed, supporting faster diagnosis and more efficient treatment.” |
Based
on the results of in-depth interviews with the six respondents, through the
in-depth interview method it can be concluded that the use of PACS (Picture
Archiving and Communication System) has resulted in positive improvements in
radiology medical data access in hospitals. Radiology specialists revealed that
after using PACS, data access became very easy, allowing them to carry out
interpretations from almost any location as long as
the device and network supported it. Meanwhile, radiographers highlighted that
PACS increases the efficiency of data access, making the process faster, more efficient and structured. This ultimately increases the
efficiency of patient treatment and diagnostic capabilities by medical
personnel. Thus, PACS has brought great benefits in terms of radiology data
access and improving the quality of service in hospitals.
Table
10. Timeliness of examination and reading of PACS radiology results
|
Source |
Answer |
|
Radiology
Specialist Doctor |
"After
implementing PACS, reading photos is faster than before using PACS, the
inspection results are also more precise and accurate because reading can use
DICOM files more accurately than print outs." |
|
Radiographer
1 |
"PACS
has helped improve timeliness, speed, accuracy and accuracy in radiological
examinations in hospitals, because the system is digital, no longer searches
are carried out manually, the patient registration system has also been
integrated so that in its application, from patient examination to image
reading to results the readings are handed over to the patient, the whole
process becomes more effective and faster.” |
|
Radiographer
2 |
"PACS
has helped improve timeliness, speed, accuracy and accuracy in radiological
examinations in hospitals, because the system is digital, no longer searches
are carried out manually, the patient registration system has also been
integrated so that in its application, from patient examination to image
reading to results the readings are handed over to the patient, the whole
process becomes more effective and faster.” |
|
Radiographer
3 |
"PACS
has helped improve timeliness, speed, accuracy and accuracy in radiological
examinations in hospitals, because the system is digital, no longer searches
are carried out manually, the patient registration system has also been
integrated so that in its application, from patient examination to image
reading to results the readings are handed over to the patient, the whole
process becomes more effective and faster.” |
|
Radiographer
4 |
"PACS
has helped improve timeliness, speed, accuracy and accuracy in radiological
examinations in hospitals, because the system is digital, no longer searches
are carried out manually, the patient registration system has also been
integrated so that in its application, from patient examination to image
reading to results the readings are handed over to the patient, the whole
process becomes more effective and faster.” |
|
Radiographer
5 |
"PACS
has helped improve timeliness, speed, accuracy and accuracy in radiological
examinations in hospitals, because the system is digital, no longer searches
are carried out manually, the patient registration system has also been
integrated so that in its application, from patient examination to image
reading to results the readings are handed over to the patient, the whole
process becomes more effective and faster.” |
The
conclusion from these two answers is that the use of PACS (Picture Archiving
and Communication System) has resulted in significant improvements in radiology
services in hospitals. The radiology specialist emphasized that after using
PACS, reading photos became faster, examination results were more precise and
accurate because this system allows reading using DICOM files which are more
accurate than print outs. Meanwhile, radiographers highlighted that PACS has
helped improve timeliness, speed, accuracy and
accuracy in radiology examinations in hospitals. The process of examining
patients from reading images to sending results to patients has become more
effective and faster because this system has become digital, eliminating manual
searches and integrating the patient registration
system. Thus, PACS has brought great benefits in terms of efficiency and
accuracy in radiology services in hospitals.
Stakeholder Perceptions Regarding Analysis of the Speed of
Radiology Service Time in Determining Minimum Service Standards (SPM) for
Radiology After Using the PACS System
Perceptionstakeholder (director, deputy director, medical support management, JKN
unit head, radiology specialist, and emergency room doctor/sender) related to
the speed of radiology service time in determining minimum service standards
(SPM) for radiology at UPTD Embung Fatimah Regional
Hospital, Batam City, explored through a processFocus Group Discussion (FGD), this is a data
collection process by gathering the Director, Deputy Director of the Support
Section, Head of the Medical Support Section, Head of the JKN Section, two
specialist doctors, and two doctors on duty at the ER, in a meeting room and
then asked questions for discussion. using the FGD guide. Of the eight
questions for each question, all participants were invited to answer, then a
discussion was held together to reach a conclusion on one answer for each
question.
Table
11. Flow of radiology services after using PACS
|
Source |
Answer |
|
FGD
Team (8 People) |
a. Sending
Doctor: The sending doctor prescribes radiology examinations based on the
patient's needs. These requests can be entered into the PACS system as
specific radiology examination requests. b. Carrying
out the Examination: The radiographer carries out a radiological examination
according to the request of the sending doctor. The resulting radiological
images are stored in PACS. c. Radiology
Expertise: A radiology specialist examines radiology images via PACS. They
provide a diagnosis and specialist review of the results. d. Return
to the sending doctor: The results of the radiology expertise can then be
shared via the PACS system with the sending doctor. The sending doctor can
access the results to determine further treatment or communicate with the
patient. |
Based
on the discussion of the FGD team above, the flow of radiology services using
PACS begins with the sending doctor who prescribes a radiology examination,
then continues with the radiographer then carries out the examination and saves
the results in PACS, followed by a specialist radiology doctor carrying out
expertise on radiological images via PACS, then the results This expertise can
be shared back with the sending doctor via the PACS system, enabling better
collaboration and communication in determining patient care. Thus, PACS facilitates
an efficient and integrative workflow in radiology services in hospitals.
Table 12. Ease of flow of radiology
services
|
Source |
Answer |
|
FGD
Team (8
People) |
"Yes, using PACS makes it very easy to request
photos, radiological examinations, and get expert results. Inspection
requests and results can be logged, accessed and
shared digitally via PACS, saving the time and effort previously required to
print and mail physical results.” |
Based
on the results of the FGD on the questions above, information was obtained that
the use of PACS (Picture Archiving and Communication System) has facilitated
the process of requesting photos, radiological examinations, and obtaining
expert results. This system enables digital recording, access, and sharing of
data, reducing the need to print and send physical results, which in turn saves
time and effort in improving radiology services. This information shows that
PACS provides great efficiency to work flow and
radiology services in hospitals.
Table 13. Data access process after
using PACS
|
Source |
Answer |
|
FGD
Team (8
People) |
"The process of accessing data via PACS involves
searching patient data, accessing radiology images, then reviewing by
radiologists, accessing expertise results and viewing images for relevant
stakeholders becomes easier, this can be done quickly through the integrated
PACS system." |
Based
on the results of the discussion from the FGD Team, it can be concluded that
the answer to the third question is, the use of PACS (Picture Archiving and
Communication System) has simplified and accelerated the process of accessing
radiology data. This process involves searching patient data, access to
radiology images, review by a radiology doctor, access to expertise results,
and the ability to view radiology images for relevant stakeholders. All of these steps can be done quickly and efficiently through
an integrated PACS system. Thus, PACS allows easier and faster data access for
various parties involved in radiology services in hospitals.
Table 14. Ease of data access after
using PACS
|
Source |
Answer |
|
FGD
Team (8
People) |
“Yes, PACS increases the ease of accessing patient data
and radiology images. "Data can be accessed from various locations in
the hospital with an internet connection, enabling faster and more efficient
access, both for the sending doctor, reviewing and searching for data again
by the radiographer, as well as reviewing and reading images by the
radiologist to become more efficient and faster." |
The
results of the discussion from the FGD Team for the fourth question, namely,
the use of PACS (Picture Archiving and Communication System) has significantly
improved the ease of accessing patient data and radiology images in hospitals.
Data can be accessed from various locations in the hospital with an internet
connection, allowing faster and more efficient access. This applies to both the
sending doctor who makes the request, the radiographer who reviews and
re-searches the data, and the radiologist who reviews and reads the images.
Overall, PACS has increased efficiency in radiology services in hospitals.
Table 15. Timeliness of radiology
services with PACS
|
Source |
Answer |
|
FGD
Team |
“With PACS, radiology services become faster, more precise and accurate. Quick access to radiology images,
reduced risk of errors, and better coordination of the medical team
contribute to increased timeliness and accuracy in patient diagnosis and
treatment.” |
Based
on the results of the discussion from the FGD Team, it can be concluded that
the answer to the fifth question is, the use of PACS (Picture Archiving and
Communication System) has significantly improved radiology services in
hospitals. With PACS, radiology services become faster, more precise
and accurate. Quick access to radiology images, reduced risk of errors, and
better coordination between medical teams contribute to increased timeliness
and accuracy in patient diagnosis and treatment. This shows that PACS brings
great benefits in improving the quality of medical services through more
efficient and accurate radiology processes.
Table 16. Data access after using PACS
|
Source |
Answer |
|
FGD
Team |
“Yes, data stored in PACS can be accessed from various
locations with a secure internet connection and according to permission. This
allows wider access by medical teams who need this information,
and allows radiologists to interpret images without being in a
hospital environment or in a radiology room." |
The
conclusion of the discussion on the sixth question by the FGD Team was that the
use of PACS (Picture Archiving and Communication System) has resulted in
significant improvements in the accessibility of radiology data. Data stored in
PACS can be accessed from various locations with a secure and
permission-compliant internet connection. This not only facilitates wider
access for medical teams who need this information, but also allows radiologists
to interpret radiological images without having to be in the hospital
environment or in the radiology room. Thus, PACS provides flexibility in terms
of radiology data access, which contributes to improving the quality of medical
services and the mobility of medical personnel.
Table 17. Length of time for the
radiology service process from start to finish after using PACS
|
Source |
Answer |
|
FGD
Team |
"After using PACS for radiology expertise, the time
required can be shorter. For example, for Thorax Photos, expert results can
be available within a few hours or even faster, depending on the priority of
the case and the availability of a specialist radiologist." |
Based
on the results of the FGD Team's discussion in answering the seventh question,
the following answer was obtained, the use of PACS (Picture Archiving and
Communication System), the time required for radiology services can vary and
tends to be slower. For example, in the case of a Thorax X-ray, the time
required may be several hours to a day, depending on various factors such as
the volume of work and manual processes applied. However, with the
implementation of PACS, the overall radiology service process becomes faster
and more efficient, reducing the time needed to access, evaluate, and convey
results to patients. Thus, PACS contributes to increasing efficiency in
radiology services in hospitals.
Table 18. Adjustments for Radiology SPM after PACS use
|
Source |
Answer |
|
FGD Team |
“By
considering factors such as changes in service processes, increased
efficiency, integration with other systems, data security, increased quality
of service, staff training needs, adjustments to the Radiology SPM after
using PACS can be an important step to ensure that radiology services remain
in accordance with standards highest, efficient and
safe for patients. This adjustment process usually involves collaboration
between the radiology team, hospital management, and other related parties to
ensure that the new SPM reflects the current conditions post PACS
implementation." |
After
conducting discussions by the FGD Team, the answer to the last question was
obtained, namely, adjusting the Radiology SPM after using PACS is a very
important step to ensure that radiology services remain in accordance with the
highest standards, are efficient and safe for patients. This adjustment process
includes changes in service processes, increased efficiency, integration with
other systems, increased data security, and increased service quality. In
addition, this adjustment also takes into account the
training needs of radiology staff so that they can operate the PACS properly.
Collaboration
between the radiology team, hospital management, and other related parties is
key in ensuring that the new SPM reflects the current conditions post PACS
implementation. Thus, hospitals can maximize the benefits of using PACS in
increasing the efficiency of radiology services, improving the quality of
patient care, and ensuring the security of patient data in this process.
Discussion
Radiology
Service Time at UPTD Embung Fatimah Regional
Hospital, Batam City After Implementing PACS
There
are good changes after implementing PACS (Picture Archiving and Communication
System) data on radiology services for outpatients for one month before
implementing PACS, namely 67 patients, after implementing PACS, namely in
August 2023 with a total of 67 patients. The average time before using PACS was
101.09 (minutes) while after implementing PACS there was a decrease of 65.61
(minutes) or a decrease in time of up to 35.3%. Based on testunpaired
t-test shows that valuep-value 0.000 is less than
0.005, which means that the waiting time for outpatient expertise results is
faster after implementing PACS.
There
was a decrease in waiting time for expertise results in outpatients by 35.48
after implementing PACS. By reducing specialist waiting times for outpatients,
the radiology unit can serve more patients in the same time
period, thereby increasing the overall productivity and output of the
radiology unit. This increased efficiency also extends to the diagnosis and
reporting process, as radiology physicians can access and review images quickly
and easily through the PACS system, thereby enabling timely and accurate
reporting to referring physicians (Gottumukkala, Le, Duszak Jr, & Prabhakar, 2018). By simplifying workflows
and reducing wait times, PACS improves the overall efficiency of radiology
services, enabling better resource utilization and the provision of more
effective patient care.
With
shorter waiting times, patients can receive the reading results they need more
quickly, resulting in better diagnosis and treatment planning (Alrasheedi, Al-Mohaithef, Edrees, & Chandramohan,
2019). So, when compared with the radiology service time currently adopted by
UPTD Embung Fatimah Regional Hospital, Batam City, there is a fairly good
reduction in service time for outpatients after implementing PACS.
Based
on data on service time for inpatient radiology patients during the month
before the implementation of PACS, there were 413 patients, while in August
2023, after the implementation of PACS, there were 439 patients who had
statistical tests carried out using theMan whitney which shows that valuep-value
0.000 is less than 0.005 which can be interpreted as meaning that there is a
difference in the waiting time for expert results for inpatients after
implementing PACS. The average time before using PACS was 108.26 (minutes)
while after implementing PACS there was a decrease of 61.90 (minutes) or a
decrease in time of up to 41.04%. The mean result before implementing PACS was
101.09 (minutes) which shows the length of waiting time for expertise compared
to the result after implementing PACS, namely 65.61 (minutes). So from here we get quite good differences in the
application of PACS. If we compare radiology service times at UPTD Embung Fatimah Regional Hospital, Batam
City with those before the implementation of PACS, there is a significant
reduction in service time for inpatients after using PACS.
Data
on radiology service times for Cito patients for one month before implementing
PACS showed 153 patients, while in August 2023 after implementing PACS it
showed there were 148 patients. The average time before using PACS was 104.26
(minutes) while after implementing PACS there was a decrease of 60.52 (minutes)
or a decrease in time of up to 41.6%. Based on testMan
whitney shows that valuep-value
0.000 is less than 0.005 which can be interpreted as meaning that there is a
difference in the waiting time for CITO patient expertise results after
implementing PACS. In this case, it is clear that there
is a difference in radiology service time for Cito patients, which shows that
the waiting time for expert results is faster. So in
other words, implementing PACS can improve the waiting time for Cito patients.
This
reduction in service time is a noteworthy development in the context of health
services. This drastic reduction in service time can be explained by a number of key factors introduced by PACS. First, PACS
allows storing and managing medical data, including radiology images and
patient medical records, digitally and centrally. This eliminates the need for
manual searches or physical transfer of data, which previously took quite a
long time. With quick and easy access to this information, medical teams can
make decisions more quickly, speed up the diagnosis process, and plan treatment
more efficiently.
The
implementation of PACS has a positive effect on radiology service time at the
UPTD Embung Fatimah Regional Hospital, Batam City, both for outpatients, inpatients
and CITO patients. Data shows that radiology service time was reduced
drastically, with an average time of 65.61 minutes for outpatient services,
61.90 minutes for inpatient radiology services, and 60.52 minutes for CITO
radiology services after implementing PACS. This reflects significant
efficiency in managing radiology data and patient medical records. With quick
and easy access to information, medical teams can make decisions more quickly,
speed up the diagnosis process, and plan treatment more efficiently.
The
positive impact of reducing service time also has an internal impact on Embung Fatimah Regional Hospital. Medical staff have more
time to provide care to other patients or to perform other medical tasks,
reducing fatigue and increasing productivity. In addition, resource management
becomes more efficient, optimizing the use of radiology equipment and personnel
and reducing operational costs related to long service times. Therefore, the
implementation of PACS impacts the efficiency and long-term sustainability of
healthcare institutions.
Although
reducing service time has many benefits, it is necessary to monitor overall
service quality. PACS must support high medical standards and patient safety.
Continuous evaluation of PACS use and monitoring of time-to-service data are
important steps to ensure that this positive impact is sustainable and can be
improved over time.
Overall,
the implementation of PACS has had a significant positive impact on the
development of services at UPTD Embung Fatimah
Regional Hospital, Batam City. This increases patient
satisfaction, medical staff productivity, and resource management efficiency.
However, ongoing attention to quality of care and careful monitoring is needed
to ensure the benefits of PACS continue and improve the quality of health care
in these institutions.
Perceptions of Radiologists and Radiographers Seen From the Quality of Radiology Services After Using the PACS
System
Views
of radiologists and radiographers regarding differences in the quality of
radiology services before and after using the PACS system(Picture
Archiving and Communication System) shows a change for the better in the
efficiency and quality of radiology services in hospitals. First
of all, in terms of speed of radiology services, both radiologists and
radiographers agree that the use of PACS has resulted in real improvements.
Previously, the radiology reading process took a long time, but with the
adoption of PACS, the reading time has become shorter. This provides immediate
benefits to patients with quicker diagnosis, which in turn can increase the
chances of earlier cure or treatment.
The
use of PACS also results in improvements in the accessibility of radiology
data. Radiologist specialists reveal that they can now access radiology data
from almost any location as long as it is connected to
a network, which eliminates limitations in physical access to radiology films.
This means doctors can quickly respond to emergency cases or consult with
fellow doctors from various locations. In other words, PACS increases the
mobility of radiology professionals and enables faster and more responsive
service to patients.
Differences
in service quality are also reflected in radiology data storage capabilities.
Before PACS, manual storage and archiving of radiology data often made it
difficult to find old photos for comparison. With the adoption of PACS,
radiology images are stored in a digital format that can be quickly accessed
via a computer or other device. This eliminates delays associated with
searching for physical films and ensures that patient data is always available
when needed. In other words, PACS allows radiology professionals to quickly
access a patient's examination history, which facilitates more accurate
diagnosis and better treatment.
Efficiency
in radiology services is also reflected in the patient registration process.
PACS integrates well with patient registration systems, enabling more
structured and effective management. This not only speeds up the patient
registration process, but also allows better use of data in tracking patient
medical records. With this capability, hospitals can monitor patient progress
over time and identify patterns that may be relevant for diagnosis and
treatment.
Overall,
the use of PACS not only brings increased efficiency in radiology services, but
also produces direct benefits for patients in the form of faster and more
accurate diagnoses. Moreover, better data access capabilities and structured
storage improve the quality of radiology services and enable radiology
professionals to provide better care. All of this contributes to improving the
overall quality of radiology services in hospitals, having a significant
positive impact on patients, medical staff and healthcare
management.
Stakeholder Perceptions Regarding Analysis of the Speed of
Radiology Service Time in Determining Minimum Service Standards (SPM) for
Radiology After Using the PACS System
Perceptions
of stakeholders (director, deputy director, medical support management, JKN
unit head, radiology specialist doctor, and emergency room doctor/sender)
regarding the analysis of the speed of radiology service time after using the
PACS (Picture Archiving and Communication System) system at the Embung Fatimah Regional Hospital UPTD Batam
City reveals a number of important aspects. First, the
results of discussions from the FGD Team show that PACS has brought significant
changes to the radiology service workflow. One of them includes increasing
efficiency in the process of requesting photos, radiology examinations, and
obtaining expert results. This process is now more efficient and better
integrated, enabling better collaboration and communication between medical
teams. In other words, PACS has optimized the workflow in radiology services in
hospitals.
The
positive impact of this change is very important in improving service quality.
With a more efficient workflow, patients will get radiology examination results
more quickly. The direct impact of these changes on the diagnosis and treatment
process can be started earlier, which in turn can increase the patient's
chances of recovery. In the case of patients requiring immediate treatment
(Cito), reducing service time is key in saving lives or reducing the risk of
complications. By adjusting the Radiology Minimum Service Standards (SPM) to
reflect these changes, hospitals will effectively improve the quality of
radiology services, providing direct benefits to patients.
Increased
efficiency in radiology services is reflected in the accessibility of radiology
data. With the adoption of PACS, patient data and radiology images can be
accessed from any location with a secure and permission-compliant internet
connection. This allows radiology professionals to quickly respond to requests,
view and evaluate radiology images, and share expertise results. This speed in
accessing radiology data is an important factor in ensuring rapid diagnosis and
better care for patients.
The
significant reduction in time in radiology services also has a positive impact
on the overall quality of service. Patients will experience less waiting, discomfort and anxiety because radiology results can be
provided more quickly. This contributes to increasing patient satisfaction,
which is an important aspect in assessing the quality of health services.
Patients who are satisfied with the service will tend to be more trusting and
loyal to the hospital, which can support the positive reputation of RSUD Embung Fatimah.
Adjusting
SPM to suit current conditions after PACS implementation, hospitals will be
able to measure and monitor service quality better. The updated standards will
reflect changes in service efficiency and ensure that hospitals remain
committed to quality improvement. This could encourage continued efforts to
improve radiology services in the future, including training radiology staff in
optimal use of PACS, which in turn could improve service quality.
SPM
adjustments also reflect the hospital's commitment to maintaining the security
of patient data. With PACS, radiology data becomes more easily accessible
digitally. Therefore, careful data protection and management is very important.
SPM adjustments can include provisions governing the secure use of PACS,
ensuring that patient data remains properly protected. This is a critical step
in maintaining patient trust and carrying out ethical medical practices.
Overall,
views and analysis from stakeholders show that the use of PACS has brought
significant positive changes in radiology services at UPTD Embung
Fatimah Regional Hospital, Batam City. This positive
impact includes increased efficiency, data accessibility, service quality and
patient satisfaction. By adjusting the SPM accordingly, hospitals will be able
to ensure that service standards reflect these changes, resulting in radiology
services that are more efficient, responsive, quality
and safe for patients.
Research Limitations
One
of the limitations of this research is that although qualitative data was
obtained through interviews with stakeholders, and also
interviews with radiographers and radiologists, the interpretation of the
results is still limited to the perspective presented by the resource person or
informant. Additionally, qualitative data is subjective and can be influenced
by individual opinions.
Another
limitation if viewed from a contextual perspective, is that the results of this
research will depend greatly on the context and special characteristics of the Embung Fatimah Regional Hospital UPTD, Batam
City. The results may not be directly applicable to hospitals or other health
facilities that have different characteristics, but the results of this
research will be a positive contribution in the learning and application of
PACS as well as in relation to the adjustment of radiology SPM.
CONCLUSION
Based
on research on the impact analysis of the implementation of the Picture
Archiving and Communication System on minimum service standards in the field of
radiology, conclusions can be drawn, namely:
1.
The use of PACS significantly
reduces radiology service time at the UPTD Embung
Fatimah Regional Hospital, Batam City. There is a
significant decrease in service time when compared to radiology SPM, namely 3
hours, in the previous outpatient service it was 101.09 minutes to 62 minutes
or 35.3%, in the previous inpatient service it was 108.26 minutes to 65.6
minutes or 41.04% and in Cito patient service 104.27 minutes to 60.5 minutes or
41.06% after implementing PACS.
2.
The use of PACS has increased the
efficiency, speed and accessibility of radiology
services. These changes have had a positive impact on the quality of radiology
services, with faster and more accurate diagnoses and the ability to respond
more quickly to patient requests.
3.
Stakeholders realize that
significant changes in the speed of radiology service times require adjustments
to the Radiology Minimum Service Standards (SPM). These adjustments include
accommodating changes in workflow and efficiency of radiology services. By
adjusting the SPM accordingly, hospitals will be able to ensure that service
standards reflect these changes, resulting in radiology services that are more
efficient, responsive, quality and safe for patients.
REFERENCES
Al Ghifari,
Satria. (2019). Hubungan Persepsi
Pasien Tentang Fasilitas Dan Pelayanan Rumah Sakit Terhadap
Kepuasan Pasien Di RSU
Muhammadiyah Siti Aminah Bumiayu. Universitas
Muhammadiyah Purwokerto.
Alalawi, Zainab M., Eid, Monief M.,
& Albarrak, Ahmed I. (2016). Assessment of picture archiving and
communication system (PACS) at three of ministry of health hospitals in Riyadh
region–content analysis. Journal of Infection and Public Health, 9(6),
713–724.
Alrasheedi, Khaled Falah, Al-Mohaithef,
Mohammed, Edrees, Hanan H., & Chandramohan, Sriram. (2019). The Association Between Wait
Times and Patient Satisfaction: Findings From Primary
Health Centers in the Kingdom of Saudi Arabia. Health Services Research and
Managerial Epidemiology, 6, 2333392819861246.
https://doi.org/10.1177/2333392819861246
Aryati, Kus Endah.
(2020). Analisis Mutu Pelayanan Radiologi Terhadap Kepuasan Pasien Rawat Jalan Di Instalasi Radiologi Rumah Sakit Umum Aminah Blitar. Health Care Media, 4(2), 55–58.
Astuti, Sinta Indi, Arso, Septo Pawelas, & Wigati, Putri Asmita. (2015). Analisis standar pelayanan minimal pada instalasi
rawat jalan di RSUD Kota
Semarang. Jurnal Kesehatan Masyarakat, 3(1),
103–111.
Gottumukkala, Ravi V, Le, Thang Q., Duszak
Jr, Richard, & Prabhakar, Anand M. (2018). Radiologists are actually well positioned to innovate in patient experience.
Current Problems in Diagnostic Radiology, 47(4), 206–208.
Hadiyati, Ida, Sekarwana, Nanan, Sunjaya, Deni Kurniadi, & Setiawati, Elsa Pudji. (2017). Konsep kualitas pelayanan kesehatan berdasar atas ekspektasi peserta jaminan kesehatan nasional. Majalah Kedokteran Bandung,
49(2), 102–109.
Indriani, Ela, Larasati, Endang, & Lestari, Hesti.
(2015). Analisis Kepuasan
Atas Kualitas Pelayanan
Kesehatan Di Rumah Sakit Umum Daerah (RSUD) Kota
Semarang. Journal Of Public Policy And Management
Review, 4(3), 555–568.
Kemenkes. (2008a). Standar Pelayanan Minimal Rumah Sakit Menteri Kesehatan Republik
Indonesia. Retrieved August 20, 2023, from Keputusan Mentri
Kesehatan website: https://bprs.kemkes.go.id/v1/uploads/pdffiles/peraturan/6
KMK No. 129 ttg Standar Pelayanan Minimal RS.pdf
Kemenkes. (2008b). Standar Pelayanan Minimal Rumah Sakit Menteri Kesehatan Republik
Indonesia. Retrieved August 20, 2023, from Keputusan Mentri
Kesehatan website: https://bprs.kemkes.go.id/v1/uploads/pdffiles/peraturan/6
KMK No. 129 ttg Standar Pelayanan Minimal RS.pdf
Kuzairi, Untung, Yuswadi, Hary, Budiharjo, Agus, & Patriadi, Himawan Bayu. (2017). Implementasi Standar Pelayanan Minimal (SPM) pada pelayanan
publik bidang pelayanan kesehatan (studi kasus pada rumah sakit umum
dr. H. Koesnadi Bondowoso).
Politico, 17(2).
Rahmaddian, Tosi, Semiarty, Rima, &
Lita, Ratni Prima. (2019). Evaluasi
Implementasi Kebijakan Standar Pelayanan Minimal Unit Radiologi Rumah Sakit Umum Daerah (RSUD) Dr. Rasidin Padang. Jurnal Kesehatan
Andalas, 8(3), 583–589.
Sayuti, Nuraeni, Imbaruddin,
Amir, & Rusli, Rini Hatma. (2015). Mutu Pelayanan Radiologi Pasien Rawat Jalan Di Rumah Sakit Bhayangkara
Makassar. Jurnal Administrasi
Negara STIA LAN Makassar, 21(2), 42643.
Setyawan, Nurhuda Hendra, & Supriatna, Yana. (2016). Implementasi
Picture Archiving and Communication System (PACS) dan Radiology Information
System (RIS) di RSUP Dr. Sardjito Yogyakarta. Jurnal Radiologi Indonesia,
1(4), 260–274.
Siringoringo, Valeri M. P., Hendrawati, Dewi, & Suharto, R. (2017). Pengaturan
Perlindungan Hukum Hak-Hak
Pasien Dalam Peraturan Perundang-Undangan Tentang Kesehatan Di Indonesia. Diponegoro
Law Journal, 6(2), 1–13.
Suandari, P. V. L., Juliantara, I. Putu
Eka, & Rusmana, Erni
R. (2020). Peran Implementasi Picture Archiving and
Communication System dalam Pelayanan
Radiologi di Rumah Sakit Premier Bintaro. Jurnal Manajemen Kesehatan
Indonesia, 8(3), 161–166.
Suharyanta, Dwi, & A’yunin,
Qurrota. (1978). Analisis tingkat kualitas pelayanan jasa menggunakan metode service
quality (servqual) fuzzy di instalasi
radiologi Rumah Sakit Umum Daerah (RSUD) Panembahan Senopati Bantul. Jurnal KESMAS, 7(1), 27–50.
Sumardjoko, Imam, & Akhmadi, Muhammad Heru. (2020). Pengukuran Utilitas Dana Kapitasi Puskesmas Dengan Capaian Standar Pelayanan Minimal Kesehatan di Indonesia. Gorontalo
Journal of Public Health, 3(2), 80–90.
Utami, Nurani Ajeng Tri, & Alawiya, Nayla. (2018). Perlindungan Hukum Terhadap Pelayanan Kesehatan Tradisional
di Indonesia. Volksgeist: Jurnal
Ilmu Hukum Dan Konstitusi,
11–20.
World Health Organization (WHO).
(2022). No Title. Retrieved November 27, 2022, from https://www.who.int/health-topics/hospitals#tab=tab_1
|
© 2023 by the authors. It was
submitted for possible open-access publication under the terms and conditions
of the Creative Commons Attribution (CC BY SA) license (https://creativecommons.org/licenses/by-sa/4.0/). |
