Application of Scrum Methodology on Medical Record Development

Tri Ismardiko Widyawan

, Riya Widayanti

, Malabay

and Yulhendri

Faculty of Computer Science, University Esa Unggul, Jakarta

Keywords: Medical Record, SCRUM, Web Application, Agile Methodology, PHP, BPJS,BlackBox.

Abstract: Along with the development of information and communication technology (ICT) has been influential for

change on all fronts, including health sector especially in the process of medical record data storage which

is called with the electronic medical record. Yet most hospitals in Indonesia at the moment still rely on the

medical record using paper files including Siloam Hospitals in Bali and TB Simatupang where this hospital

became the location of the study authors. So it could be said to get to the electronic medical record

implementation is still far away. The existence of information and communication technologies in the

medical record Department currently can be used to its full potential, it can be seen from the way of making

the report, the provision of patient information, data management application which uses diagnosis

worksheet by means of input data that is in the file to an excel document that is already in the prepare in

advance. The impact of this is the duration of the provision of the information having to input and

manipulate data that is already in the input it manually. Based on these problems, the authors tried to make a

prototype module medical records by using a systems development method SCRUM is part of Agile

Development where the focus point to the application's speed and user satisfaction. Scrum has its own

characteristics that are looping at each milestone in its development other than that this methodology can

adapt to any changes that occur. The results want to achieve from this research is the creation of a Prototype

module Medical Record where functionally tested and complies with users needs and can support the

performance of the Department of medical records in the hospital so that more effective in service to

patients and also capable to passing the blackbox test which stressed to the standard dimensions of the

quality of the Content web application, Function, Structure, Usability, Navigability, Performance,

Compatibility, interoperability, and security.

1 INTRODUCTION

In carrying out its role, the medical record

department has several problems in processing data

that will later be made into reports, the first problem

is to make reports they must input all information in

the patient's medical record file into the worksheet

application one by one to be processed into reports

daily, weekly or monthly. This results in the

performance of the medical record department being

inefficient and ineffective. The second problem that

often occurs is the limited information on the last

location of where the patient’s documentswere last

used; this is because medical record documents are

possible to move hands in one episode of patient

service, to resolve this medical record tried to solve

the problem using a log book manual. The third

problem that becomes a new problem in medical

records is that in serving BPJS patients, the medical

record department must use an additional application

namely INACBG and SEP provided by the

Indonesian Ministry of Health. Also, they must

prepare other patient documents that must be

attached to support the BPJS report in order to make

a claim.

Out of the several problems mentioned above, it

is necessary to design an electronic medical record

system that accommodates a patient's medical record

in a centralized database. Centralized storage

referred to here is a condition in which outpatient

medical records, hospitalizations, emergency care,

diagnostic information, actions, drugs consumed and

the results of checking both laboratory and radiology

stored in a storage database. Then the ability to be

integrated with services outside the medical record

itself such as BPJS.

Widyawan, T., Widayanti, R., Malabay, . and Yulhendri, .

Application of Scrum Methodology on Medical Record Development.

DOI: 10.5220/0009950431513158

In Proceedings of the 1st International Conference on Recent Innovations (ICRI 2018), pages 3151-3158

ISBN: 978-989-758-458-9

3151

1.1 Problem Identification

Based on the background in this research, the

following problem identification can be formulated :

1. Application

2. How hospitals can easily obtain medical record

information from patients

1.2 Research Purpose

1. Analyze the need for development

2. Make a prototype of medical record module

1.3 Medical Record

Medical record is: “The collection of information

concerning a patient and his or her health care that

is created and maintained in the regular course of

business in accordance with policies, made by a

person who has knowledge of the acts, events,

opinions or diagnoses relating to the patient, and

made at or around the time indicated in the

documentation”. (IFHRO: International Federation

of Health Records)

1.4 Software Process

The software process is a framework for activities,

actions, and tasks needed when building a software

[PRE, 2014].

The process framework establishes a complete

software engineering process by identifying a small

number of activities that apply to all software

projects, regardless of the size or complexity

(Pressman, 2010).

1.5 Scrum Methodology

Scrum is a framework for developing and managing

complex products. Scrum can be used to solve

complex problems that are constantly changing,

which at the same time produce products of the

highest value possible creatively and productively

(Schwaber and Stuherland. 2014).

Scrum has been used to manage complex product

development since the early 1990s. Scrum is not a

process or technique for developing products; more

than that; it is a framework where various processes

and techniques can be included.

1.6 Software Testing

The software is tested to reveal errors that were

made accidentally when the software was designed

or built (Pressman, 2010).

Software testing is the process of running and

evaluating a software manually or automatically to

test whether the software meets the requirements or

not (Clune,2011) and (Nakagawa and Maldonado,

2011). In short, testing is an activity to find and

determine the difference between expected results

and actual results.

A software test can be done after the engineer

builds the implementation of an abstract software

concept. Software testing is basically meant to

"unload" the software that has been built.

1.7 Research Framework

Systematic thinking framework for problem-solving

related to the object of research, in the form of

relationships between concepts resulting from

theories and various other related/relevant

supporting factors, which have been defined

previously as important problems can be seen in the

figure below.

Figure I Research Framework

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1.8 Hypothesis

Based on the conceptual framework that has been

proposed, this research statement can be formulated

as follows:

Allegedly the quality of the medical record

module prototype was made using SCRUM

development method if it is repeatedly tested every

time the addition of submodules is based on the

black-box technique, by looking more at the

functions needed by the user and combined with the

testing system where the application prototype is,

then the prototype can be used in the Production

environment and can be directly applied to support

the performance of the medical record department.

2 RESEARCH METHODOLOGY

Research on the development of this medical

record module prototype is a type of applied

research. The result of this research can be directly

applied to solve the problems faced (Moedjiono,

2012).

This research will apply Agile development

model using SCRUM system development method

which was documented by collecting all BackLog

(User Needs) to be made into small modules to

determine the priorities to be lateranalyzed and

formed into a basic foundation to build a

continuously developing Medical Record Module to

accommodate hospital needs. The results of each

analysis will later be made into a medical record

application module using the PHP programming

language and SQLSERVER database; then the

application was tested based on the functions

required by the user before being demonstrated to

the end user.

2.1 Sample Selection Method

The sampling method in this study was

purposive sampling. Purposive sampling is a

sampling technique by taking the selected

respondents correctly picked by the researcher

according to the specific characteristics possessed by

the sample (Nasution, 2009).

The criteria for selecting respondents in the

sample of this study are :

1. Having a duty and responsibility as the Head of

Department or a leader at Medical Record

Department in a hospital

2. Having experience in Medical Record field for

more than 3 years

3. Having experience in the field of Hospital

Management for more than 3 years.

Respondents in this study were Head of

Departments and Senior Staffs at Medical Record

Department in Hospitals. The selection of sample

respondents is based on the criteria that have been

explained previously and that the medical record

system prototype developed will be used by the

medical record department in the hospital, so the

sample is very representative.

2.2 Analysis Technique

In the analysis process, there are four analysis steps

conducted :

1. Analysis of ongoing medical record

2. Analysis of users. At this stage, an analysis of

the user's representative is used to use the

application that will become the Product Owner.

3. Analysis of functional and non-functional needs.

And also what functions are usually obtained by

each user by being modeled using Product

Backlog. Functional needs modelingis done with

the Sprint Backlog

4. System Behavior Analysis

5. In this stage, analysis of the system behavior that

will be developed and modeled with the

Document Design which contains the Procedures

contained in the Sprint at the SCRUM stage is

carried out.

2.3 System Design Plan

Medical record module prototype design technique

that will be used in this study is SCRUM

Methodology as a reference in developing

software. Where there are several stages:

1. Collection of all product user needs along with

the priority scale of workmanship and estimating

the time needed to complete this matter called

the Product Back Log stage.

2. The result from the Backlog Product broken

down into more detailed form and tasks that will

be done by the team is called the Sprint Backlog

stage.

Application of Scrum Methodology on Medical Record Development

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3. The third stage is called Sprint, which is the

process of doing all the work that has been

defined. This stage is a recurring stage until all

the needs of the user packaged in the form of a

backlog are met. To find out whether it is in

accordance with the backlog, a demo is needed

for the user everyday.

4. The final stage is called the Deliverable, which is

to combine all the results of the sprint and then

do a thorough test (System Integration Testing)

and see if there’s any backlog left or need to add

more backlog.

In this study, system quality testing is carried out

to test the level of software quality. System testing

techniques carried out in this study used a black-box

testing approach to determine the behavior of

applications externally and testing of web

applications by focusing on the standard dimensions

of web application quality such as Content,

Function, Structure, Usability, Navigability,

Performance, Compatibility, interoperability,

security

[PRE 2010]

in the following ways:

1. Acceptance testing using a questionnaire

distributed to system users with black-box testing

techniques to answer the following questions.

a. Were the existing functions compatible?

b. Were there any errors in UI?

c. Were there any errors in flow data in the

application?

d. How was the application performance?

2. Web application testing divided into 7 parts :

a. Test the content of the web application to see

if there’s an error

b. Test the display to ensure that all cases can be

accommodated

c. Test the navigation link in the application

d. Test the existing functions

e. Testing compatibility in different

environments such as operating systems,

browsers, and different hardware.

f. Test the security of a web application to find

out if there’s a gap that can be bypassed

g. Test the application’s performance

2.4 Research Steps

Research steps planned by researchers in order to

researchby the conceptual framework/mindset of

problem-solving as shown in the figure below.

Figure 2. Research Steps

2.5 Analysis of Human Resource Needs

To develop this medical record module prototype, it

takes human resources to be allocated in several

sections as follows.

1. Scrum Master

Scrum Master Acts as a bridge between

application users (StakeHolder) in providing

multiple user stories and comments on every work

that can be conveyed, Aside from that, the Scrum

Master is responsible for defining the estimated

work that will be given to the developer. Here the

researcher himself is the Scrum Master.

2. Scrum Team (Developer)

This team is divided into 3 parts :

A Database Administrator that functions to

analyze existing resource database tables, design a

new table, then create a query to put in a model that

will be accessed by the Programmer's backend, this

Database Administrator will also be assigned to

create reports.

Backend Programmer is responsible for creating

a logic application which utilizes the data from the

dba before finally being thrown into the frontend

developer.

Frontend Development is tasked with presenting

a defined application interface by using a mockup

sketch. Frontend Development must have an

thorough backend understanding because every data

on the user's screen comes from a function created

by the Backend developer.

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3. StakeHolder/ Product Owner

The StakeHolder / Product Owner here is the end

user of the application. Their job is to define each

user story according to the needs they need. Then

comment on all the results given.

2.6 Work Weight Decision

Table IV.2 Work Weighting (backlog)

Work Weight

Can see all patient data registered in the hospital

10

Can see patient’s detailed information. Age, Active

Status, Residence, Gender, Last Doctor

10

Can input Visiting Patient’s Diagnosis Data based

on the data provided by doctors

10

The system provides ICD 10 diagnostic data and

ICD 9 CM according to the latest WHO format so

that there will be no errors when inputting the data

10

Input diagnosis is required for every episode in the

system. It is mandatory

10

Can find out about new patients

10

Can see list of patients who have made an

appointment that day

10

Can see detail of patient visitation history which are

based on medical record numbers

10

Can see what services are being performed to the

patient, so that they can enter the Action Code (ICD

9CM) accordingly

7

Can input SOAP in the system. If SOAP is in the

paper, then the system will automatically be

inputted. Subjective is available on paper.

7

System can conduct daily census of inpatients

7

Can conduct census reports everyday

7

In the registration system, screen to send documents

will be prepared by clicking on documents

receiving

6

Can make diagnostic reports per time period.

6

Can see the doctor's prescription complete with

consumed medication and the notes given per

episode

5

Can view laboratory examination report complete

with detailed reference range per episode

5

Can see results of radiology examinations made by

radiology doctors per episode

5

Can see patient visitation report based on LOB

based on the time range

4

Can display information confirming BPJS patients

4

Can input data to INACBG from medical record

system, thus no need for many applications

4

Can print participant eligibility letters from medical

record modules per episode

4

Can see BPJS patient reports completely with their

SEP number

4

Can display and confirm BPJS patients

3

Can issue document delivery Turn round Time

Report

2

2.7 Architectural Design

The application architecture that will be used for

the development of this module is the PHP

programming language using the CodeIgniter

Framework that has adapted the modular MVC

concept and can adopt web service technology. By

using the MVC concept, the team can focus on

working on the field. For DBA all queries are placed

in one file packaged in the Model. Then for the

backend programmer, will only consume data from

the model provided by the DBA and writes all logic

in the controller. For frontend programmer, will only

work in the view folder by coordinating to all the

functions in the controller. Both in the form of

POST parameters and GET parameters.

For the development of the architecture display,

we used Twitter Bootstrap framework which is

combined with Jquery that handles every AJAX

request and the additional Data tables plugin to

access the JSON data provided by the controller.

Aside from that, with this jquery on the client side, it

will be able to process data before it is stored in the

database. The reason for using this architecture is an

effort to streamline bandwidth usage in accessing

web pages.

For the needs of the architectural report, we used

open source software with Jaspersoft Report. This

software is web-based and can run only by providing

a template report that has been inserted with a query

and configured to connect to the database.

Figure 3. Medical Record Module Prototype System

Architecture

Application of Scrum Methodology on Medical Record Development

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3 SOFTWARE TESTING

3.1 Black Box Testing

For this test, the Backlog approval form is

distributed to 2 hospitals, and 4 respondents consist

of 2 Head of Department of Medical Records and 2

Senior Medical Record Staff who will represent the

rest of the staffs. The points tested are the backlog

that has been defined based on the results of the

collective agreement. The contents of the backlog

form contain the approval from the user story which

was previously described. One backlog will be

declared Pass or accepted if all user stories are

declared appropriate. Moreover, each form will be

signed by the respondent.

Test results have been conveyed in the design of

the backlog. The following is a summary of the

Medical Record Module Work based on the

previously defined backlog.

Table IV.4 Summary of Test Results for the Blackbox

for each Backlog

Task Name

igh

Delivery Date Testing Pass

Status

Can see all

patient data

registered in the

hospital

10 05/11/2014 Pass

Can see patient

detail

information. Age,

Active Status,

Residence,

Gender, Last

doctor.

10 05/11/2014 Pass

Can input

Visiting Patient’s

Diagnosis Data

based on the data

provided by

doctors

10 07/11/2014 Pass

System provides

ICD 10

diagnostic data

and ICD 9 CM

according to the

latest WHO

format so that

there will be no

errors when

inputting the data.

10 07/11/2014 Pass

Can find out

about new

patients

10 07/11/2014 Pass

Can see list of

patients who have

made an

appointment that

day

10 07/11/2014 Pass

Can see detail of

patient visitation

history which are

based on medical

record numbers

10 07/11/2014 Pass

Can see what 7 10/11/2014 Pass

Task Name

igh

Delivery Date Testing Pass

Status

services are being

performed to the

patient, so that

they can enter the

Action Code

(ICD 9CM)

accordingly

Can input SOAP

in the system. If

SOAP is in the

paper, then the

system will

automatically be

inputted.

Subjective is

available on

paper.

7 07/11/2014 Pass

System can

conduct daily

census of

inpatients

7 10/11/2014 Pass

Can conduct

census reports

everyday

System can

conduct daily

census of

inpatients

7 10/11/2014 Pass

The system can

give the status

that the patient's

document came

out

7 10/11/2014 Pass

In the registration

system, screen to

send documents

will be prepared

by clicking on

documents

receiving

6 17/11/2014 Pass

Can make

diagnostic reports

per time period.

6 12/11/2014 Pass

Can see the

doctor's

prescription

complete with

consumed

medication and

the notes are

given per episode

5 12/11/2014 Pass

Can view

laboratory

examination

report complete

with detailed

reference range

per episode

5 12/11/2014 Pass

Can see results of

radiology

examinations

made by

radiology doctors

per episode

5 12/11/2014 Pass

Can see patient

visitation report

based on LOB

based on the time

range

4 12/11/2014 Pass

Can display

information

confirming BPJS

patients

4 28/11/2014 Pass

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Task Name

igh

Delivery Date Testing Pass

Status

Can input data to

INACBG from

medical record

system, thus no

need for many

applications

4 28/11/2014 Pass

Can print

participant

eligibility letters

from medical

record modules

per episode

4 28/11/2014 Pass

Can see BPJS

patient reports

completely with

their SEP number

4 02/11/2014 Pass

Can issue

document

delivery Turn

round Time

Report

2 02/11/2014 Pass

4 WEB APPLICATION TESTING

a. Web application content testing to see if there is

an error and to look at the console log error in

the web browser (Content dimension)

b. Compatibility testing in different environments,

both operating systems, browsers and different

hardware. To test this, what is done is trying to

load applications in different browsers and

different devices. (Compatibility dimension)

c. Testing the security of a web application to find

out if there is a gap that can be broken. For this

test, application Havij SQL Injection, and

Accunetic is used to see if there is a gap that can

be bypassed (Security dimension).

5 CONCLUSION

Based on the descriptions in the previous

chapters, some conclusions can be conveyed as

follows:

1. The use of SCRUM methodology for the

development of Medical record modules in

Siloam Hospital hospitals in TB Simatupang and

Bali units is the right step because it can adapt to

currently used applications. Also, the ability to

capture all the needs of the user and then move

them to the application form in stages and can be

tested quickly by the user is something that is

more valuable than the use of this methodology.

2. With SCRUM Methodology the focus of

development is no longer on the analysis.

However,rather present an application that suits

the needs of users even though it is presented in

stages and has a very high success rate.

3. Based on its implementations. SCRUM

Methodology has the following advantages;

being able to adapt in every environment as a

whole, regarding flexibility and creativity the

methodology team can provide freedom in each

iteration and terms of knowledge transfer,

dissemination can be done quickly throughout

the development journey.

4. The quality level of medical record module

prototype after being tested using blackbox

testing techniques that emphasize the standard

dimensions of web application quality such as

Content, Function, Structure, Usability,

Navigability, Performance, Compatibility,

Interoperability, and security can achieve Very

Good criteria. Good.

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