Analysis of the Causes of Missfiles in Medical Records at the

Baiturrahmah Oral and Dental Hospital

ABSTRACT
Introduction : Medical record is a document that contains notes regarding patient characteristics,
examinations, actions, treatment and other services for patients in health services. Storage of
medical record files is very important to view the patient's medical history, therefore the method of
storing medical record files must be properly managed. Improper storage system management can
cause file loss ( misfile ) because it is influenced by human resource factors and existing facilities
and infrastructure. If the medical record file is needed but is not available or is not on the storage
shelf, the medical record is said to be in the wrong place or missing ( misfile ). The purpose of this
study was to find out the causes of missfiles in the medical record file storage section of the
Baiturrahmah Oral and Dental Hospital.
Materials and Methods : The type of research used in this research is qualitative research with a
case study design . Qualitative research in this study was used to analyze medical record file
missfiles at the Baiturrahmah Oral and Dental Hospital using 5 elements, namely: man, money,
method, machine, material. The place of research is at RSGM Baiturrahmah. The research time
starts in September 2022 – January 2023.
Research Results: The results of this study were obtained through interviews as follows, Man (HR
at RSGM Baiturrahmah is still not optimal), Method (the storage method at RSGM Baiturrahmah is
already good), Matherial (facilities and infrastructure are already available), Money (funding is
managed by the RSGM foundation Baiturrahmah), and Machine (medical record storage system is
still incomplete).
Conclusion: From the results of this study it can be concluded that the factors that cause missfiles
in the medical record storage room at RSGM Baiturrahmah are man, material and machine .
KEY WORDS . Missfile, Medical record, Element 5M, Hospital

INTRODUCTION
Hospital is a health facility that provides health services to all people. The existence of the hospital is
actually an effort by the Government of the Republic of Indonesia to guarantee the health of its people. The
hospital is also one of the health service institutions and plays a central role in organizing and implementing
health services for people who need them. 1
Medical records are also a manifestation of the quality of medical institution services, and have
administrative value, regulatory value, financial value, research value, educational value, literary value and
other benefits. The contents of the medical record are medical secrets that must be kept confidential from
third parties and belong to the patient. Physically, medical records belong to medical institutions, while
juridically medical records are a part of the data that can describe a malpractice case in court. Medical record
files are documents that show continuity of care or treatment from inpatients to outpatient polyclinics and
also as documents that show communication between the Doctor in Charge of the Patient ( DPJP ) and
consultants or other health workers and who authorize medical or health workers to obtain treatment.
Hospital medical records have relatively important functions, one of which is as a basis for calculating costs.
If the medical record is incomplete, the hospital can suffer losses due to unwritten actions in the medical
record. 2
Improper storage system management can cause file loss ( misfile) because it is influenced by human
resource factors and existing facilities and infrastructure. Missfile is a medical record file that is lost and
misplaced on the medical record file storage rack in the archive. If the medical record file is needed but is not
available or is not on the storage shelf, the medical record is said to be in the wrong place or missing (
misfile ). This may be because the documents that appear in the book are not documented and do not have a
tracking device, so that the documents are lost or misplaced. Missfiles can also cause duplication of medical
record files. 3
Baiturrahmah Oral and Dental Hospital is one of the dental teaching hospitals in Padang, which in its
activities consists of clinical students (young dentists), nurses and Dpjp. In its operations, one of the most
vital is using medical records in rape, if there is no such medical record, students will not be able to perform
medical procedures.
Based on the background above, it can be formulated the formulation of the problem in this study,
namely what is the cause of the occurrence of missfiles in the medical record file storage section of the
Baiturrahmah Dental and Oral Hospital? The purpose of this study was to find out the causes of missfiles in
the medical record file storage section of the Baiturrahmah Oral and Dental Hospital.

MATERIALS AND METHODS

The type of research used in this research is qualitative research with a case study design. The
place of research is at RSGM Baiturrahmah. The time for research starts in September 2022 -
December 2022. The technique for determining the informants in this study is by purposive
sampling. The process of collecting data, researchers used interview techniques.
This research analysis technique uses descriptive analysis, namely describing the data that has
been collected. Qualitative data analysis consisted of data analysis, data reduction, data compilation,
data categorization and determination of data validity. In this study, researchers used a triangulation
technique, namely source triangulation. Triangulation of sources to test the credibility of the data is
given by examining data obtained through various sources.

RESULTS AND DISCUSSION

The results of this study were obtained through interviews that the researchers conducted.
Researchers interviewed informants to obtain information about the causes of missfiles at the
Baiturrahmah Oral and Dental Hospital. There are 45 medical record were collected and missfiles 3
(15%) . Based on the results of interviews conducted with research informants using 5 aspects,
namely: man, method, material, money, machine. The results of the study are as follows:
1. man (human)
The results of in-depth interviews regarding the storage of medical records at the Baiturrahmah
Oral and Dental Hospital currently have insufficient medical record staff from medical records
education and there is a need for additional medical record members and can be seen from the
following interview results:
"... Not optimal, there needs to be an additional male medical record officer, because women
have a lot of time off, such as giving birth, breastfeeding, and so on ."
“… So for our medical record workers there are 4 people, 3 basic people with 3 medical
records, and 1 more high school graduate as a courier, according to the job description, it is
still far from enough. Now, because public services are not running yet, later when public
services are running, we will ask for the recruitment of medical recorders.”
"... for the number of personnel, there are 3 people and an additional 1 courier, as for staff, the
number of medical recorders is felt to be insufficient, because in the future we will have 24-
hour service so we need to add medical record officers."
In addition, several informants also said that there was no reward given to medical record
workers, and for punishment a warning was usually given by the direct leadership, as in the
following statement:
" There is no reward here yet, brother, I have been here for 2 years, from 2020 to 2022 no
reward has been given, for violations, a warning is usually given and usually here, if a warning
has been given by the director, it rarely repeats itself. "
"Never before, rewards often get angry."
2. method
 Based on the results of the interview research conducted, it is known that the storage and
retrieval of medical records has been carried out according to hospital SOPs and storage of medical
records at the Baiturrahmah Dental and Oral Hospital using the centralization method, as stated by
the informant as follows:
"...as for the storage method, it's pretty good, the storage flow includes new patients and old
patients, and those are the patients the KOAS students are looking for, new patients will be
registered by the COAS students and then verified, the patient is then sent to the screening
depending on od or action, later the medical record officer will take the medical record up, for
old patients if I'm not mistaken first register with sis Febi, fill in the data first and simrs, then
fill in the small paper in front then give it directly to the storage room, then give it to each lab -
each and for the soup, if it doesn't match the soup, you can't work"
"... now for storage of our medical records at Baiturrahmah Hospital we have 2 places, 1
storage area is active, 2 storage is inactive, active on the 1st floor and inactive on the 3rd floor,
for centralized storage, so wait for the files to be stored in a room."
"... for outpatient treatment this method is good enough according to hospital needs, to serve
professional students, and for inpatient care we cannot evaluate it because it has not worked
yet"
In determining methods and SOPs at work, those who are directly involved in their
determination are medical record officers, nurses and others, and also for setting SOPs according to
conditions in the hospital and must be based on existing provisions, can be seen from the following
interview results :
"... regarding medical records, it depends on the head of medical records, there is Yulise, her
name will be confirmed by the director of service quality."
"..we, each unit, have been able to determine what items are needed and discussed again with
the board of directors, so that we can arrange one by one how to keep medical records good."
"... for the soup, the medical record officer was invited to discuss with the directors and then the
soup was determined."
3. Materials
Facilities and infrastructure really support the implementation of good medical record services,
it is known that the existing facilities and infrastructure at the medical record installation are not
sufficient, such as the place is too small and there is still a lack of storage shelves, as the following
statement states:
".. actually the cupboard maybe, but the space is too small maybe, usually what is needed is
rsgm often get it but the space is still small".
"..the problem is because the storage space is inadequate, maybe because the storage space is
just right, maybe it's not perfect because we also measure the limitations of this rsgm for
example an inactive room cannot be far from the medical records room but due to limitations
we have to be on the 3rd floor"
"... so according to medical record standards, the shelf is a roll o pack, it is in the form of iron
and has a pusher, so why is the roll crumpled because the medical records stored are paper so
we can avoid damage, but we are here because of limitations too We are under the foundation,
so we have to propose ahead of time that we need roll o packs and currently there is one roll o
pack shelf and the rest are wooden cabinets”
4. Money
money has a central function in the management of medical record documents at a health
institution. Interviews conducted by researchers with medical record officers at the Baiturrahmah
Oral and Dental Hospital found that funds for storing medical records depended on the foundation
and were determined jointly by the wadir adm and finance, as stated by the informant as follows:
“... under the foundation, the nature of the allocation of funds is rather private, maybe we can
propose it and the funds depend on whether the foundation can provide it or not. We usually
 make a rab just for the details of the items you want to buy, re-assign them to the wadir adm
and finances later they will arrange them, then submit them to the foundation."
"..for these funds, we are under the Baiturrahmah Oral and Dental Hospital Foundation, all
existing activities or funding are borne by the Baiturrahmah Foundation and appointed by the
Deputy Director for Finance and Admin . "
5. Machine
Based on interviews at the Baiturrahmah Dental and Oral Hospital, the medical record storage
system has not used tracers , expedition books and sorting racks , so the possibility of missing files
at the Baiturrahmah Dental and Oral Hospital is still large, as stated by the informant as follows:
"... we don't have a central medical record that returns from the polyclinic or lab, it's called
here, for example the prosto lab, the medical records are returned to our storage, and we don't
have a central place to place medical records before they are compiled, and Usually it is placed
somewhere and then stacked on a medical record storage rack.
"... now for the tracer, there isn't any, if there isn't an expedition book here either, and what's
one more? Oh, not for the sorting rack either.

Discussion
1. Man
Factors that cause missfiles at the Baiturrahmah Oral and Dental Hospital are based on the "
Man " factor, namely the lack of medical record officers. so officers are often exhausted because
they have to provide and return quite a lot of medical record files. the number of files that must be
provided and returned, the officer tends to be exhausted. Work fatigue felt by officers will result in
decreased performance and loss of focus on officers in carrying out their duties.
This research is in line with what Suci Aulia has done, that there are many medical record
documents that must be provided and returned, so officers tend to get tired. Work fatigue can hinder
and disrupt stability in carrying out work and can reduce the performance of officers in carrying out
their duties. This was made possible due to the lack of concentration of the officers, so the officers
misaligned the medical record documents and could be the cause of missfiles . 1
2. method
The method or procedure implemented by the Baiturrahmah Dental and Oral Hospital uses a
centralized storage system, where the patient's medical record documents are stored in the same
place in the medical record unit and for SOPs there are clear SOPs regarding storing these medical
records and in making SOPs as well has involved all people who work at the Baiturrahmah Dental
and Oral Hospital so that this method is not considered a cause of missfiles at the Baiturrahmah
Dental and Oral Hospital.
This research is in line with Rohman Taufiq's research that Standard Operating Procedures
(SOP) are guidelines or references for carrying out work assignments in accordance with the
functions and tools for assessing hospital performance based on technical, administrative and
procedural indicators in accordance with the work procedures concerned. 4
3. Materials
The material factor found that the medical record storage room was small. The impact that
arises from a small room resulting in many files piled up close together, making it difficult for
officers to find medical record files where officers have to look for medical record numbers one by
one.
This research is in line with research at the Arosuka Hospital on the evaluation of the
implementation of inpatient medical records at Arosuka Hospital that the facilities and
infrastructure for implementing medical records at Arosuka Hospital are still incomplete. The need
for computers is still not sufficiently available, storage space is still inadequate and medical record
sheets are sometimes incomplete. 5
4. Money
 Provision of funds or budget at the Baiturrahmah Oral and Dental Hospital has been going well.
The procedure for submitting funds is also clear, with the head of medical records discussing with
members in advance what is needed regarding the storage of baiturrahmah medical records, then the
head of medical records discusses with gdh`jjj wadir adm and finance regarding the budget plan and
then the wadir adm and finance will convey it directly to the foundation so that this money does not
cause missfiles in the medical record storage of the Baiturrahmah Oral and Dental Hospital.
The results of this study are also in line with Pujilestari who said that the allocation of funds for
the implementation of facilities and infrastructure in the Hospital filing was met, including for the
procurement of new medical record documents, both the allocation of funds from the Hospital itself
and the private sector created services that were as expected. 6
5. Machine
The factors that cause missfiles at the Baiturrahmah Dental and Oral Hospital are based on the "
machin e" factor, namely there is still no tracer, expedition books, sorting racks at the Baiturrahmah
Dental and Oral Hospital, resulting in medical records piled up in piles because there is no place to
put medical records after leaving lab.
This research is in line with what Rudi did that the absence of a tracer in the storage rack caused
difficulties in returning medical record documents to their original place. Because the tracer
functions to make it easier to retrieve medical record documents on the appropriate shelf, thereby
reducing the occurrence of missfiles . 7

CONCLUSION
From the results of the study it can be concluded that the factors that cause missfiles in the
medical record storage room of the Baiturrahmah Dental and Oral Hospital indicate that human
resources ( man ), material ( material ), and tools ( machine ) are the causes of missfiles in the
hospital. This. This is because there is still a lack of medical record officers so that the workload
borne by medical record officers is quite a lot and the medical record storage room is still small,
resulting in the lack of availability of storage racks which will make the medical records coincide,
and there is no tracer, expedition book and sorting racks so that there is a high probability that
missfiles will still occur in the medical records.
To reduce the occurrence of missfiles at the Baiturrahmah Oral and Dental Hospital, the
authors suggest the following thing: It is advisable to add medical record officers so that they can
reduce the workload of medical record officers, so that medical record officers can focus more on
work and can reduce the occurrence of missfiles at the Baiturrahmah Oral and Dental Hospital
lulusan rekam medis. It is better to add a larger room so that there are lots of storage shelves and no
more medical records piling up. Additional storage shelves are also needed so that officers have no
trouble taking or returning files. He made a tracer for medical record files that came out of the
storage rack and made expedition books and sorting racks. It is better to provide rewards in the
medical record department itself to medical record officers so that the performance and work
motivation of the officers will increase and a sense of responsibility for their respective duties will
emerge such as awarding a charter or certificate of appreciation to medical record officers.

REFERENCES
1. Ramadhanti, SA, Nurhizriyati, W. and ... 'Review of the Causes of a Missfile in the Storage
Section to Support the Implementation of Management Elements at Kencana Hospital Serang',
Cerdika, Indonesian scientific journal , 1(8), pp. 1068–1078. (2021)
2. Nugraheni, R. 'Analysis of Medical Record Services at X Kediri Hospital, East Java Analysis
Services Medical Record at Bhayangkara Hospitals Kediri-East Java', Wiyata Journal , 2(2), pp.
169–175. (2015)
3. Wati, TG and Nuraini, N. 'Analysis of Case Missfile Events Outpatient Medical Records at the
Bangsalsari Health Center', J-REMI: Journal of Medical Records and Health Information , 1(1),
 pp. 23–30. Available at: https://doi.org/10.25047/j-remi.v1i1.1932. (2019)
4. Taufiq, AR 'Implementation of standard operating procedures (SOP) and hospital performance
accountability', Profita Journal , 12(1), p. 56. Available at:
https://doi.org/10.22441/profita.2019.v12.01.005.
5. Sari, D. and Dharma 'Analysis of medical record document management in dr. reksodiwiryo
padang', Journal of Health Lantern 'Aisyiyah , 2(2), pp. 174–184. (2019)
6. Pujilestari, A. 'Implementation of medical record file storage based on 5M management
elements at RSKIA Permata Bunda', Scientific Journal of the Faculty of Health Sciences,
Muhammadiyah University Surakarta [Preprint]. (2016)
7. Putra, YF and Rudi, A. 'Review of efforts to overcome missfile incidents where medical record
documents are stored at the Melawi District Hospital', Journal of Medical Records and Health
Information , 3(1), pp. 1–5. Available at: http://stikara.ac.id/jupermik/index.php/JK. (2020)