A dentist wants to open a clinic (klinik pratama) that provides individual health services, namely

promotive, preventive, curative and rehabilitative. These dentists work together with doctor, and
open job vacancies for needed health workers. The clinic (klinik pratama) also prepares
electronic medical records and various requirements for accreditation of the clinic (klinik
pratama) which must be carried out a maximum of 2 years after the permit is issued. To
optimized referral flow, the private clinic must also established cooperation with near by hospital
network.

Formulation of the Problem

1. What is the function of clinic?

2. What is various kinds of clinics?
3. What is the difference between main clinic and clinic Pratama?
4. What are the human resource for clinic Pratama?
5. What are the requirements for clinic accreditation?
6. What are requirements for the clinic establishment?
7. What is the difference of electronic MR from conventional MR?
8. What are the advantage and disadvantages of both electronic and conventional
MR?
9. How are hospital network selected and referral flow established?

Problem Analysis

1. What is the function of clinic?

(Salsa)

The Role and Function of the Primary Clinic

- Preventive Services.
One of the main roles of Pratama clinics is to provide disease prevention services.
This includes immunizations, nutritional counseling, and education about healthy
lifestyles. Prevention is key to reducing the burden of disease in society.
- Early Detection and Diagnosis.
 Pratama clinics also play a role in early detection of disease. Through regular
check-ups and medical consultations, health conditions can be identified early,
allowing for more effective treatment.
- Treatment of Minor Illnesses.
Treatment services at the Pratama clinic include treating minor illnesses such as
flu, fever, respiratory infections and other illnesses that do not require intensive
care in hospital.
- Referral and Coordination.
If conditions are found that require further attention, the Pratama clinic will refer
the patient to an advanced health facility. Coordination with hospitals and
specialists is an integral part of the clinic's role.
- Reproduction health.
Many pratama clinics also provide reproductive health services, such as family
planning consultations, pregnancy checks, and monitoring the health of pregnant
women.

(Yunita)

1. According to the Permenkes RI No. 9 of 2014, clinics have obligations

which cover:

1. Providing safe, quality services, prioritizing patient interests, in accordance with

professional standards, service standards and operational procedure standards;

2. Provide emergency services to patients according to ability without ask for a down
payment first/put the patient's interests first;

3. Implement a referral system.

(John) Promotive health services are an activity and/or a series of health service
activities that prioritize activities that are health promotion in nature.

Preventive health services are preventive activities against a health problem/disease.

Kurative clinics that provide basic medical services. In its implementation, there are
health services such as:
 Rehabilitation

Rehabilitation is a recovery process for patients with narcotics use disorders, both in
the short and long term, which aims to change their behavior so that they are ready to
return to society.

2. What is various kinds of clinics?

(Ikhlas) Based on the type of service, the clinic is divided into:
a. Pratama Clinic; And
b. Main clinic.
(2) Pratama clinic as intended in paragraph (1) letter a is a clinic that provides basic
medical services both general and specific.
(3) The main clinic as intended in paragraph (1) letter b is Clinics that provide
specialist medical services or basic and specialist medical services.
(4) Clinics as intended in paragraph (1) can specialize services in a particular field
based on branch/discipline science or organ system.
(5) Further provisions regarding clinics with specific services as intended in
paragraph (4) is regulated by the Minister.
3. What is the difference between main clinic and clinic Pratama?
(Juhdan) Pratama Clinic is the first level clinic of the health service network system
which is intended to provide basic or primary medical services. Pratama Clinic
consists of small clinics spread across various regions in Indonesia. The main task of
the Pratama Clinic is to handle less serious health problems by providing
examinations, treatment and other health services, as well as providing preventive and
promotive services for the community in the surrounding area. Apart from that, the
Pratama Clinic plays a role in identifying more serious health problems and providing
first aid to patients before being referred to advanced health service facilities such as
the Main Clinic or Hospital.
The Main Clinic is an advanced level clinic (second level below the hospital) of the
health service network with more specific health services and focuses on more serious
medical treatment and more complicated medical procedures with the help of more
sophisticated medical equipment. The Main Clinic consists of clinics that are larger
than the Pratama Clinic, tasked with providing examinations, treatment and other
health services for the surrounding community as well as accepting referral patients
from the Pratama Clinic who require further action or treatment.
(Dito) Pros of hospitals. Medical professionals at hospitals give you complete
attention from start to finish. They assess you based on your concerns and offer short-
term care for immediate needs. Doctors can then make referrals to specialists. then
the pros of clinics is a clinic offers care that falls between that of your doctor’s office
and a hospital. It may have extended hours and be open during evenings, weekends,
and holidays. Then the cons of hospitals. When you visit a doctor’s office or clinic,
you often pay a copay based on your insurance plan. At a hospital, you may pay for
the time you stay in a room in addition to your care. Hospitals often have a higher
price tag than other options.
(Laura) Pratama Clinic gives basic general medical healthcare service. Utama Clinic
provides special healthcare service and/without general healthcare service. The clinic
provides healthcare service mainly for outpatient, but certain clinic can serve a
limited number or limited case of inpatient. A clinic may be equipped with 5-10
inpatient beds. A clinic can do homecare. A clinic can be developed by the
government, by local government, by private (PMK 9/14).
(Yunita)
Klinik Pratama
Pratama Clinic is a clinic that provides basic medical services. In its implementation,
there are health services as follows:
- General practitioner services
- General dentist services
- Simple action service
- Simple midwifery services
- Medical record administration services

Klinik utama

Klinik utama is a clinic that provides specialist medical services or basic and
specialist medical services. The health services provided are as follows:
 - Medical services which include:
- General practitioner examination services.
- General dentist examination services.
- Specialist medical examination services consisting of Heart and Blood Vessel
specialist doctors, Lung specialist doctors, Occupational specialist doctors and
Medical Rehabilitation specialist doctors.
- Emergency Services
- Laboratory services which include examinations include:
- Clinical Chemistry, such as checking cholesterol, blood sugar, SGOT, SGPT, uric
acid, etc.
- Serology, such as widal examination, HbSAg, NS1, etc.
- Hematology, such as examination of platelets, Hb, leukocytes, etc.
- Radiology services that provide general non-contrast conventional examinations
and panoramic dental examinations.
- Physiotherapy services which include simple, moderate and skilled physiotherapy
procedures
- Pharmacy Services
4. What are the human resource for clinic Pratama?
(Soti) In carrying out medical services therein, the Pratama Clinic must be equipped
with medical personnel consisting of at least 2 (two) doctors and/or dentists as
providers of medical services.
The health service efforts at Pratama Clinic include aspects of basic outpatient and
inpatient medical services. Pratama Clinics that provide inpatient care must have staff
consisting of at least:
doctors, dentists, and/or specialists in the field of primary care;
pharmacists and pharmaceutical technical personnel;
medical personnel;
nutritional staff;
medical laboratory technology experts; And non-health workers
(Juhdan)
Regulation of the minister of health of the republic of indonesia number 14 of 2021
 Pratama Clinic human resources consist of at least:
1. 2 (two) doctors;
2. 2 (two) specialist doctors in the field of primary care;
3. 1 (one) doctor and 1 (one) specialist doctor in the field of primary care; or
4. 2 (two) dentists.
Pratama Clinic human resources that provide basic medical services and dental and
oral health services consist of at least
1. 2 (two) doctors or specialists in the field of primary care, and 1 (one) dentist;
2. 1 (one) doctor, 1 (one) specialist doctor in the field of primary care, and 1 (one)
dentist; or
3. 2 (two) dentists, and 1 (one) doctor or specialist in the field of primary care.
(John) The staff at the Pratama Clinic which provides inpatient care consists of at
least:
- doctors, dentists, and/or specialist doctors in the field of primary care;
- pharmacists and pharmaceutical technical personnel;
- nursing staff;
- nutritional staff;
- medical laboratory technology experts; And non-health workers.
5. What are the requirements for clinic accreditation?
(Yunita) Clinical accreditation requirements:
1. The clinic is registered with the Ministry of Health and has a business license
2. The person in charge, medical personnel and health workers in the clinic must have
an active Practice License and Registration Certificate
3. There is proof of filling out the Medical Equipment Infrastructure Application
(ASPAK) which has been 100% updated and 100% validated by the District/City
Health Service
4. Those applying for initial accreditation must have reported the National Quality
Indicators in the Health Service Facility Quality application at least 3 months before
registering, while for re-accreditation at least 12 months
 5. There is evidence of reporting Patient Safety Incidents (IKP) through the Health
Service Facility Quality application for the last 3 (three) months for the initial survey
and the last 12 (twelve) months for the re-accreditation survey.
(Ikhlas) Regulation of the minister of health of the republic of indonesia number 34 of
2022 about accreditation of community health centers, clinics, laboratories health,
blood transfusion unit, doctor's independent practice place, and a dentist's
independent practice place
6. What are requirements for the clinic establishment?
(Salsa) Requirements for establishing a clinic from the health department
1. Application Letter
2. Photo of NPWP, BPJS, KTP of Facility Owner
3. Copy/photocopy of the establishment of a legal entity or business entity except for
individual ownership
4. Copy/photocopy of land certificate, other proof of ownership legalized by a notary
or proof of Contract Letter for a minimum period of 5 (five) years
5. SPPL documents for Outpatient Clinics or UKL-UPL documents for Inpatient
Clinics in accordance with the provisions of laws and regulations and
6. Clinic Profile
7. Letter of responsibility from the Doctor in Charge
8. Room Plan and Location Plan
9. List of equipment at the clinic
10. List of Personnel at the Clinic
7. What is the difference of electronic MR from conventional MR?
(Tineu) The difference between conventional medical records and electronic medical
records is that electronic medical records can create an integrated hospital
information system (SIMRS) and can be accessed online, whereas conventional
medical records cannot be integrated.
(Ikhlas)
- Storage Method
Manual medical records use written notes and physical documents as the primary
storage method. This means information must be physically moved and archived
 by medical personnel. On the other hand, electronic medical records use a digital
format, allowing for faster data processing and more efficient storage.
- Accessibility and Ease of Use
Manual medical records may be difficult to access because they have to be
searched manually and can be complicated if there is a lot of data that needs to be
found. In this regard, electronic medical records have clear advantages.
Information can be searched quickly through the search system, and doctors can
easily view patient medical records with just a few clicks.
- Security and Privacy
Security and privacy issues are important concerns in medical records. Manual
medical records are vulnerable to physical damage, theft, or unauthorized access.
However, electronic medical records have better access controls and additional
security protections, such as data encryption and user authentication, that help
maintain patient privacy.
- Efficiency and Cost Savings
Manual medical records often take a lot of time and resources to manage and store
data. Physical documents should be printed, filed, and neatly organized.
Electronic medical records can increase efficiency because the process is more
automated. In addition, with the use of digital technology, physical printing and
storage costs can be reduced.
(Laura) Conventional records often rely on handwritten notes and various paper-
based forms, which can lead to challenges in data organization and retrieval. EMRs,
on the other hand, offer structured and standardized formats for data entry, making it
easier to organize, search, and retrieve information. This can improve efficiency and
accuracy in healthcare settings.
8. What are the advantage and disadvantages of both electronic and conventional
MR?
(Dito)
advantage :
- By creating a more risk-focused culture, integrating risk evaluation into business
and IT practices is a good way to improve overall risk management.
- Companies can implement more standardized risk reporting that helps with long-
term metrics and measurements.
- Organizations can increase focus and improve their perspective on risks in various
categories.
- A greater focus on risks related to business objectives can lead to more efficient
use of resources — for example, implementing limited endpoint security licensing
on the most open and critical systems.
Disadvantage :
- Capital and operational expenses often increase initially because ERM programs
can require specialized and expensive software and services.
- ERM initiatives increase the emphasis on governance, which requires business
units to invest a lot of time and money.
(Yunita)
Advantage :
- more cheaper than ERM
Disadvantage of conventional medical records
1. Conventional RM requires a lot of paper to record each patient's condition and
complaints during visits.
2. the possibility of the writing being illegible
3. It takes time to search
(John)
EMR advantages:
1. There is data that can be backed up in the cloud
2. Faster data search access
3. RM access is easy to access and can be accessed from other hospital lines
EMR loss:
1. Requires analyst data
2. need electricity if isolated areas will be
Disadvantaged RM's profit
1. Does not require analyst data
2. does not require electricity
 Lack of RM
1. There is no data backup if a disaster occurs, data is lost
2. requires a lot of file locations
3. Long search time
(Dito) https://youtu.be/_j0qfzf7mas?si=soIQ0AgHyazSlHBU
9. How are hospital network selected and referral flow established?
(Juhdan)
1. Officers ensure that the referred patient meets the patient criteria
referred to.
2. The officer provides an explanation to the patient and the patient's family regarding
the reason the patient was referred.
3. The officer prepares a referral letter, according to the referral SOP.
4. The officer writes the patient's complete biodata.
5. The officer calls an ambulance to refer the patient to hospital.
6. The patient is accompanied by officers, then the patient is immediately taken to
hospital.
(Laura) The referral system originated at the FKTP. Health referrals are organized
according to a patient's medical needs, and they can deliver patients to second- or
third-level health facilities. Service at second- and third-level facilities can only be
performed if there exists a referral from the previous-level health facility. Other
referral cases, such as referrals from midwives or health nurses, can only be
administered by a doctor or dentist at an FKTP. illustrates the health referral process

in Indonesia.
 (Yunita) Horizontal referral is a referral made between internal health services one
level if the referrer cannot provide service health according to the patient's needs due
to limitations temporary facilities, equipment and/or personnel or meneta

Vertical referral is a referral made between health services different levels, can be
done from different service levels lower to a higher level of service or on the
contrary. Vertical referrals from lower levels of service to A higher level of service is
provided if:
- the patient requires specialist health services or subspecialty;
- the referrer cannot provide appropriate health services with patient needs due to
limited facilities, equipment and/or manpower. Vertical referral from a higher level of
service to a lower level of service is provided if:
- Patient health problems can be handled by levels lower health services accordingly
competence and authority;
- competence and authority of first level services or secondly better in treating these
patients;
- the patient requires further services that can be handled by lower levels of health
services and for reasons of convenience, efficiency and long service long; and/or
- the referrer cannot provide appropriate health services with patient needs due to
limited facilities, infrastructure, equipment and/or manpower. The health service
referral system is implemented regularly tiered according to medical need, ie Starting
from services at FKTP
- If further service is required by a specialist, then the patient can be referred to
FKRTL - Second level health services in secondary health facilities only can be given
on referral from primary health facilities.
- Third level health services in tertiary health facilities only can be given on referral
from secondary health facilities and health facilities primary
10. What are the promotive, preventive, curative and rehabilitative?
(Ikhlas)
- promotive : to promotive health
- Preventive Services : One of the main roles of Pratama clinics is to provide
disease prevention services. This includes immunizations, nutritional counseling,
and education about healthy lifestyles. Prevention is key to reducing the burden of
disease in society.
- Rehabilitation: a recovery process for patients with narcotics use disorders, both
in the short and long term, which aims to change their behavior so that they are
ready to return to society.

(Yunita)

The referral system “SISRUT”