Implementation of An Integrated Referral System to Optimize the Quality of Referral Services
DOI:
https://doi.org/10.37287/picnhs.v7i1.2155Keywords:
bureaucracy, communication, integrated referral system (SISRUTE), resources, service qualityAbstract
The Integrated Referral System (SISRUTE) is an information technology-based service innovation aimed at accelerating the referral process and improving service efficiency. At Alimuddin Umar Regional Hospital, the implementation of SISRUTE has not yet reached optimal performance. Internal reports indicate delays in data entry, the absence of dedicated personnel, and network and infrastructure issues that hinder the referral process. This study aimed to analyze factors associated with medication adherence among patients with type 2 diabetes mellitus at Alimuddin Umar Regional Public Hospital in 2025. This study aims to evaluate the implementation of SISRUTE at Alimuddin Umar Regional Hospital. A descriptive qualitative method was used with purposive sampling. Data were collected through in-depth interviews with 13 informants (management, medical, and administrative staff), field observations, and document review conducted in March-April 2025. Data analysis was carried out using an interactive analysis model. Most respondents demonstrated good medication adherence (84.8%). Bivariate analysis showed significant associations between family support (p=0.004), diabetes knowledge (p=0.001), and self-efficacy (p=0.000) with medication adherence. Multivariate analysis identified self-efficacy as the most dominant factor influencing adherence (β=0.612; p=0.000). The findings revealed: (1) Communication between units occurs through formal and informal channels, but gaps in technical understanding still exist; (2) Human resources and technology are available but insufficient due to high workloads, limited budgets, and network disruptions; (3) Staff showed a positive attitude toward the system after training, but motivation remains inconsistent; (4) Bureaucratic structure and SOPs are in place, yet implementation is not uniform, and lengthy procedures slow down the referral process.
The Integrated Referral System (SISRUTE) is an information technology-based service innovation aimed at accelerating the referral process and improving service efficiency. At Alimuddin Umar Regional Hospital, the implementation of SISRUTE has not yet reached optimal performance. Internal reports indicate delays in data entry, the absence of dedicated personnel, and network and infrastructure issues that hinder the referral process. This study aimed to analyze factors associated with medication adherence among patients with type 2 diabetes mellitus at Alimuddin Umar Regional Public Hospital in 2025. This study aims to evaluate the implementation of SISRUTE at Alimuddin Umar Regional Hospital. A descriptive qualitative method was used with purposive sampling. Data were collected through in-depth interviews with 13 informants (management, medical, and administrative staff), field observations, and document review conducted in March-April 2025. Data analysis was carried out using an interactive analysis model. Most respondents demonstrated good medication adherence (84.8%). Bivariate analysis showed significant associations between family support (p=0.004), diabetes knowledge (p=0.001), and self-efficacy (p=0.000) with medication adherence. Multivariate analysis identified self-efficacy as the most dominant factor influencing adherence (β=0.612; p=0.000). The findings revealed: (1) Communication between units occurs through formal and informal channels, but gaps in technical understanding still exist; (2) Human resources and technology are available but insufficient due to high workloads, limited budgets, and network disruptions; (3) Staff showed a positive attitude toward the system after training, but motivation remains inconsistent; (4) Bureaucratic structure and SOPs are in place, yet implementation is not uniform, and lengthy procedures slow down the referral process.
References
Ahkam, Z. A. and Muchlis, N. (2021) 'Implementasi Sistem Rujukan Terintegrasi (SISRUTE) Di RSUD Labuang Baji Kota Makassar', Journal of Muslim Community Health, 2(2), pp. 98–111.
Akmal, S. A. Z. A. (2025). Analisis Implementasi Penggunaan Sistem Rujukan Terintegrasi (SISRUTE) di RSUD H. Abdul Manap Kota Jambi. Disertasi, Universitas Jambi.
Alami, H., Gagnon, M. P., & Fortin, J. P. (2020). Digital Health Adoption: Dispositional Readiness of Healthcare Workers. Health Informatics Journal, 26(2), 1040–1055.
Amalia, A.R., Putri, R.A., Yusuf, R.A., & Haeruddin, H. (2022). Konsistensi komunikasi terhadap pelaksanaan Sistem Informasi Rujukan Terintegrasi (SISRUTE) untuk meningkatkan kualitas pelayanan rumah sakit. Jurnal Ekonomika, 6, pp. 40–47.
Amin, M., Sulaiman, M., & Hardiyanti, H. (2021). Needs-Based Training untuk Penguatan Implementasi Sistem Digital Kesehatan. Jurnal Manajemen Kesehatan Indonesia, 9(1), 50–60.
Antari, P. M. S., Kurniati, N. M., & Putri, K. F. A. (2023). Evaluasi Penerapan Sistem Rujukan Terintegrasi (SISRUTE) dari Puskesmas ke Rumah Sakit Jiwa Provinsi Bali. Jurnal Kesehatan, Sains, dan Teknologi (JAKASAKTI), 2(3).
Aprilia, A. K. D, dkk. (2020). Identifikasi Penyebab Keterlambatan PenyediaanDokumen Rekam Medis Rawat Jalan Di Rumah Sakit Husada UtamaSurabaya Tahun 2020. Jurnal Rekam Medik Dan Informasi Kesehatan (JREMI). 1(4), 630-638
Arikunto, S. (2013). Prosedur Penelitian: Suatu Pendekatan Praktik. Jakarta: Rineka Cipta.
Bancin, L. J., Putri, N. A., Rahmayani, N., Kharisma, R. & Purba, S. W. (2020). Gambaran sistem rujukan terintegrasi (SISRUTE) di RSUD Dr. RM Djoelham Binjai tahun 2019. Jurnal Ilmiah Perekam dan Informasi Kesehatan Imelda (JIPIKI), 5(1), pp. 16–19.
Chandrika, F. D. A., Sampetoding, E. A. M., & Pongtambing, Y. S. (2024). Tinjauan Sistematis Efektivitas dan Implikasi Implementasi Sistem Informasi Rujukan Kesehatan (SISRUTE) di Indonesia. HealthSense: Journal of Public Health Perspective, 1(1), 29-37.
Chen, L., & Lee, T. (2022). Critical Infrastructure in Digital Referral Systems: A Systematic Review of Hospital IT Implementation. Journal of Health Systems Management, 14(3), 210–225.
Dimova, A. (2019). Health System Governance and Policy Implementation: Theoretical and Analytical Perspectives. Health Policy and Planning, 34(7), 483–491.
Direktorat Jenderal Pelayanan Kesehatan Kementerian Kesehatan Republik Indonesia. (2017). Petunjuk Teknis Sistem Informasi Rujukan Terintegrasi (SISRUTE). Jakarta: Kemenkes RI.
Direktorat Jenderal Pelayanan Kesehatan Kementerian Kesehatan Republik Indonesia. (2019). Pedoman Implementasi Sistem Informasi Rujukan Terintegrasi (SISRUTE). Jakarta: Kemenkes RI.
Direktorat Pelayanan Kesehatan Rujukan Kementerian Kesehatan Republik Indonesia. (2020). Laporan Implementasi SISRUTE. Jakarta: Kemenkes RI.
Edwards III, G. C. (1980). Implementing Public Policy. Washington, DC: Congressional Quarterly Press.
El Muammary, M. R. & Hartono, R. K. (2024). Evaluasi Penggunaan Sistem Rujukan Terintegrasi (SISRUTE) Fasilitas Kesehatan di Kabupaten Bengkulu Utara Tahun 2023. Prepotif: Jurnal Kesehatan Masyarakat, 8(2), pp. 4306–4318.
Gagnon, M. P., Ghandour, E. K., Talla, P. K., Simonyan, D., Godin, G., Labrecque, M., & Rousseau, M. (2022). Healthcare Workers' Resistance to Digital Systems: Causes and Management Strategies. BMC Health Services Research, 22(1), 244.
Greenhalgh, T., Wherton, J., Papoutsi, C., Lynch, J., & Hughes, G. (2021). How Bureaucratic Structures Affect Innovation in Digital Health Systems. The Milbank Quarterly, 99(2), 380–423.
Gupta, N., Rathi, P., & Das, S. (2022). Optimizing Interdepartmental Communication for Health Referrals: A Qualitative Study. Journal of Healthcare Informatics Research, 6(1), 35–49.
Ilyas, J. & Darmawan, E. S. (2023). Analisis Efektivitas Sistem Informasi Rujukan Terintegrasi (SISRUTE) dalam Kasus Covid-19 di Semen Padang Hospital. Media Publikasi Promosi Kesehatan Indonesia (MPPKI), 6(2), pp. 321–335.
Irianto, S. E., Djamil, A. & Aryono, A. C. (2021). Pembelajaran Implementasi Sistem Rujukan Terintegrasi (SISRUTE) di Rumah Sakit Umum Daerah X. Jurnal Peduli Masyarakat, 3(4), pp. 527–542.
Kementerian Kesehatan Republik Indonesia (Kemenkes RI). (2023). Laporan Tahunan Sistem Informasi Rujukan Terintegrasi (SISRUTE). Jakarta: Kementerian Kesehatan RI.
Khoirunnisa, N. (2016). Manajemen Sistem Rujukan dalam Pelayanan Kesehatan. Surabaya: Laporan Penelitian D3 RMIK Universitas Airlangga.
Lee, J. H., Park, Y., & Choi, H. J. (2021). Strategic Evaluation of Communication Effectiveness in Hospital Referral Networks. Healthcare Management Review, 46(1), 30–39.
Marina, T., Hasanah, R. & Widodo, H. (2019). SISRUTE: Sistem rujukan berbasis teknologi informasi. Jurnal Sistem Informasi Kesehatan, 10(2), pp. 87–94.
Massie, J. (2012). Teori dan Praktik Kebijakan Publik. Jakarta: Pustaka Pelajar.
Meyer, B., & Smith, A. (2023). Digital Bureaucracy and the Future of Health Communication. Public Management Review, 25(2), 145–162.
Putri, M. F. W. (2023). Analisis Faktor yang Mempengaruhi Perilaku Bidan Menggunakan Aplikasi SISRUTE Berdasarkan Teori TAM. Jurnal Manajemen Kesehatan Yayasan RS. Dr. Soetomo, 9(2), pp. 298–310.
Putri, M. D., & Nugroho, A. (2023). Analisis Efektivitas Komunikasi Informal dalam Pelayanan Kesehatan Digital di Indonesia. Jurnal Administrasi Kesehatan Indonesia, 11(1), 78–89.
