Workload analysis of medical record and health information officers at a hospital

INTRODUCTION

Health is a basic human right guaranteed by the 1945 Constitution of the Republic of Indonesia.¹ Hospitals as a health service facility, play a crucial role in delivering quality health services. In improving the quality of healthcare, hospitals must manage medical records in accordance with regulations.

A hospital is a healthcare institution that provides complete personal health services through promotive, preventive, curative and rehabilitative efforts, including inpatient, outpatient and emergency services.¹ The increasing public awareness of health has become a challenge for healthcare facilities, including hospitals, which must provide the best and high quality services. In enhancing the quality of healthcare services, hospitals are required to manage medical record according to the regulations.

Medical records are documents that provide data on patient identity, examination, treatment and other services provided to patients.² Medical records help maintain orderly patient administration in hospitals. In order to support patient administration and health quality, hospitals require professional and competent health resources.

Medical record and health information officers are classified under medical technical personnel.¹ The need for professional and competent health personnel, including medical record officers can be determined using workload analysis.⁴

Hospital X is a type C general hospital with a bed capacity of 103 and 16 specialist fields. It is management of patient medical records is still hybrid, meaning that some medical records are electronic, while others remain conventional or manual.

At hospital X, there are several issues related to fulfilling the needs of medical record and health information officers. One major issue is the imbalance in task distribution, leading to multitasking and excessive workload, resulting in many tasks not being completed within the stipulated time.

Based on these problems, the authors are interested in conducting a study titled “Workload Analysis of Medical Record and Health Information Officers at Hospital X” to optimize and rationalize staff performance.

The purpose of this study is to determine the appropriate number of medical records and health information staff need based on a health workforce workload analysis. This ensures that staff can work more optimally, as their tasks align with the actual workload requirements.

METHODS

This study was conducted through direct observation from January to September 2024 in the medical records unit of hospital X, a type C general hospital located in Bandung, West Java, Indonesia, with capacity of 103 and 16 specialist fields. The hospital approved the study, with the researcher having obtained permission after completing a research proposal and ethical clearance provided by the hospital.

The study employs a case study design with a qualitative approach, aimed at exploring and gaining an in-depth understanding of conditions at the research site. Data collection techniques include observation and interviews, allowing for an accurate portrayal of the actual conditions with more specific information.

The sample used is a saturated sample, where all medical records staff at hospital X are include to measure the time norms for each task performed.

RESULTS

At hospital X, the medical record and health information unit has 9 main task categories: registration; filing and distribution; emergency department data management; daily inpatient census management; inpatient data management; outpatient case mix; inpatient case mix; case mix reporting; and report processing. All of these are performed by 20 officers.

The calculating of the number of medical record and health information officers needed at hospital X, based on workload analysis, is a follows.

Determine the healthcare facilities and types of health human resources

The healthcare facilities and types of health human resources for which the requirements will be calculated are as follows in Table 1.

Determine the available working time

Available working time is the time used by healthcare human resources to perform their duties and activities within a period of one year. Effective working hours range from 1.192 to 1.237 hours per year, which is rounded to 1.200 hours per year or 72.000 minutes per year. This applies to those working 5 or 6 days a week (Table 2).⁵

Source: Ministry of Health of the Indonesia Republic, 2015

Determine the workload components and time norms

Workload components refer to the types of tasks and detailed descriptions of tasks actually carried out by each healthcare human resource, in accordance with the main duties set by the management.⁵

Time norms refer to the average time required by an educated, skilled, trained and dedicated healthcare human resource to perform tasks according to the standards set by the management.⁵

The following are the results of determining workload components and time norms based on observations and interviews conducted by the researchers in the medical records unit at hospital X (Table 3).

Calculating the workload standard

The workload standard is the volume / quantity of work over the course of 1 (one) year for each type of healthcare human resource. The formula for calculating the workload standard is as follows.⁵

The results of the workload standard calculation for medical record and health information officers at hospital X are as follows given in Table 4.

Calculating the supporting task standard and supporting task factor

Supporting tasks are tasks performed to complete activities that are either directly or indirectly related to the main tasks carried out by each healthcare human resource. The supporting task factor represents the proportion of time used to complete each activity per unit of time (day/week/month/year). Therefore, the supporting task standard can be defined as a multiplier for human resource needs for main tasks.⁵

The steps for calculating it are as follows.

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Calculating healthcare human resource requirements

The formula for calculating healthcare human resource requirements is as follows.

The annual output refers to the coverage of main tasks and activities of each healthcare facility over a period of one year.⁵

Based on Table 8, the total requirement for medical record and health information personnel at hospital X is 29 officers, while currently only 20 are available, indicating a shortage of 9 officers. The shortage of 9 personnel is specially in the reporting position, whereas the other positions have been filled.

DISCUSSION

The current number of medical record and health information officers at hospital X is still insufficient. An additional 9 personnel are needed to fulfil the primary duties in the medical records unit.

The registration officers at hospital X are currently in line with the needs. This indicates that the workload is being managed effectively by the staff. Considering the importance of the registration department in every hospital to ensure a smoother healthcare service flow, proper workload distribution in the registration section also helps maintain the efficiency of the initial administrative process for patient and creates a positive first impression for those seeking treatment. This is consistent with the research conducted by Cartmill et al.⁶

The filing and distribution officers at hospital X are currently in line with the needs. This department is responsible for ensuring that patient medical records are ready and available when needed and can be distributed to clinics or wards. With the staffing needs in this department met, the distribution of task will be balanced and there will be no delays in patient services caused by waiting for medical records to be a delivered to clinics or wards. This is also discussed in the research by Fishbein et al.⁷

The data management officers in the emergency department at hospital X are currently in line with the needs. This enables swift administrative handling as the officers’ workload is adjusted to the demands of emergency department management, which requires accuracy and speed due to the emergency conditions of some patients. Research conducted by Cartmill et al.⁵ Mentioned that the workload can increase along with the rise in emergency cases, thus periodic evaluations are necessary to ensure the workload remains stable.⁶

The inpatient daily census processing officers at hospital X are already in line with the needs. These officers play an important role in monitoring the daily number of inpatients. This also needs to be periodically evaluated to ensure the number of officers remains optimal as the number of inpatients increases.⁸

The inpatient data processing officers at hospital X are already in line with the needs. Inpatient data processing is crucial for hospital management, such as for decision making and evaluating the healthcare services provided to patients.⁹ When the officers’ workload is appropriate, they can perform their primary tasks more optimally, resulting in high quality reporting.

The outpatient case mix, inpatient case mix and case mix reporting officers at hospital X are already in line with the needs. These officers are responsible for classifying diagnosis and treatment codes, which are then grouped into the system for billing claims. Therefore, accuracy and precision in coding diagnose and treatments are required.¹⁰ With an appropriate workload, the quality and accuracy of the coding will improve, minimizing the chances of claim failures.

Based on the calculation of the reporting officers’ needs at hospital X using the healthcare workload analysis method, there is a shortage of 9 officers. This indicates the potential for a very high workload, which could lead to delays or errors in both internal and external hospital reporting.¹¹ Reporting officers require more staff because the analysis shows that as activities and working hours increase, the workload on the officers becomes heavier, necessitating additional personnel to fulfil their duties. A possible solution is to hire more staff or adopt technology that can automate work processes to ease the officers’ workload.⁶

The overall result of this study indicated that most sections within the medical records unit at hospital X have a sufficient number of medical record and health information officers to meet the needs, allowing for effective workload distribution. However, there is a significant shortage of personnel in the reporting section, whit a deficit of 9 officers, which requires immediate attention from hospital management to avoid a decline in the quality of healthcare services.

Limitations

A limitation of study is that each medical records staff at hospital X has varying time norms for each task, leading the researcher to average the time norms across all staff for each activity.

CONCLUSION

The medical records unit at hospital X generally has a sufficient number of staff to meet operational needs, allowing for well-managed workload distribution and smooth service delivery. However, there is a significant staff shortage in the reporting management section, where an additional 9 employees are needed to optimally support administrative and reporting processes. This shortage has the potential to cause delays or errors in report preparation. Therefore, it is recommended that hospital management consider adding staff or adopting technology to help reduce the workload in this section.

ACKNOWLEDGEMENTS

The authors would like to acknowledge all parties who provide support in completing this research, especially to the management and all staff of hospital X for granting permission and providing the necessary data for smooth execution of this research. They also greatly appreciate the assistance and input from the colleagues who participated in the analysis and discussion process.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

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