The Effect of Outpatient Service Digitalization on Patient Waiting Time Among Patients with Diabetes Mellitus at Royal Prima General Hospital Medan
Main Article Content
Abstract
The development of information technology in the healthcare sector has driven the digital transformation of hospital services, including outpatient care. Service digitalization such as online registration, electronic queue systems, and electronic medical records is expected to improve service flow efficiency and reduce patient waiting time. This study aims to empirically analyze the effect of outpatient service digitalization on the waiting time of Diabetes Mellitus patients at Royal Prima General Hospital Medan. This study used a quantitative design with a cross-sectional approach. The study population consisted of 2,940 outpatient Diabetes Mellitus patients, with a sample of 352 respondents determined using the Slovin formula and simple consecutive sampling technique. Data were collected through questionnaires to measure the level of service digitalization and observation of patient waiting time. Data analysis was conducted using univariate and bivariate methods with the Chi-Square test at a 95% confidence level. The results showed that most outpatient service digitalization was categorized as good, and most patient waiting times were within the standard of ≤60 minutes. Bivariate analysis indicated a significant effect between outpatient service digitalization and waiting time of Diabetes Mellitus patients (p-value < 0.05). Outpatient service digitalization at Royal Prima General Hospital Medan has been generally well implemented and significantly influences the waiting time of Diabetes Mellitus patients. The better the implementation of digitalization, the shorter the waiting time experienced by patients. It is recommended to enhance system integration, strengthen human resource capacity, and optimize the use of digital technology to further reduce waiting time and improve service quality.
Article Details

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
References
Abernethy, A. P., Herndon, J. E., Wheeler, J. L., Patwardhan, M., Shaw, H., Lyerly, H. K., & Weinfurt, K. (2008). Improving health care efficiency and quality using tablet personal computers to collect research‐quality, patient‐reported data. Health services research, 43(6), 1975-1991. https://doi.org/10.1111/j.1475-6773.2008.00887.x
Acosta, A. M., & Lima, M. A. D. D. S. (2015). Frequent users of emergency services: associated factors and reasons for seeking care. Revista latino-americana de enfermagem, 23, 337-344. https://doi.org/10.1590/0104-1169.0072.2560
Al Owad, A., Islam, M., Samaranayake, P., & Karim, A. (2022). Relationships between patient flow problems, health care services, and patient satisfaction: an empirical investigation of the emergency department. Business Process Management Journal, 28(3), 684-712. https://doi.org/10.1108/BPMJ-11-2020-0523
Alfiannor, A., Syamsuddinnor, S., & Tusiana, D. (2024). Pengaruh Kepercayaan Pasien Dan Digitalisasi Layanan Terhadap Kepuasan Pasien Umum Dengan Kualitas Pelayanan Sebagai Variabel Intervening (Studi Kasus di RSUD H. Abdul Aziz Marabahan).
Almomani, I., & AlSarheed, A. (2016). Enhancing outpatient clinics management software by reducing patients’ waiting time. Journal of infection and public health, 9(6), 734-743. https://doi.org/10.1016/j.jiph.2016.09.005
Aloke, C., Egwu, C. O., Aja, P. M., Obasi, N. A., Chukwu, J., Akumadu, B. O., ... & Achilonu, I. (2022). Current advances in the management of diabetes mellitus. Biomedicines, 10(10), 2436. https://doi.org/10.3390/biomedicines10102436
Alshalawi, M. A., Almuhlafi, J. M., Alsubiei, S. M., Al-Shamrani, S. E., Alotaibi, M. M., Alenzi, S. M., ... & Alotaibi, A. H. (2024). The Role Of Clinic Development Strategies In Enhancing Care Coordination And Clinical Workflow: A Systematic Evaluation Of Evidence. The Review of Diabetic Studies, 182-190.
Alshararl, F. A., Alsharari, L. H., Alsharari, A. S., Alsharari, M. F. H., Alshararl, M. S. M., Alsudays, A. S., ... & Alsharari, S. F. (2025). Integrating Health Information Systems and Administrative Processes to Improve Patient Care Efficiency: A Comprehensive Review. Vascular and Endovascular Review, 8(5s), 112-120.
Baker, D. W., Stevens, C. D., & Brook, R. H. (1994). Regular source of ambulatory care and medical care utilization by patients presenting to a public hospital emergency department. Jama, 271(24), 1909-1912. https://doi.org/10.1001/jama.1994.03510480033030
Berry, L. L., Seiders, K., & Wilder, S. S. (2003). Innovations in access to care: a patient-centered approach. Annals of internal medicine, 139(7), 568-574. https://doi.org/10.7326/0003-4819-139-7-200310070-00009
Bhattacharjee, P., & Ray, P. K. (2014). Patient flow modelling and performance analysis of healthcare delivery processes in hospitals: A review and reflections. Computers & Industrial Engineering, 78, 299-312. https://doi.org/10.1016/j.cie.2014.04.016
Bowden, T., & Coiera, E. (2017). The role and benefits of accessing primary care patient records during unscheduled care: a systematic review. BMC medical informatics and decision making, 17(1), 138. https://doi.org/10.1186/s12911-017-0523-4
Brennan, J. J., Chan, T. C., Hsia, R. Y., Wilson, M. P., & Castillo, E. M. (2014). Emergency department utilization among frequent users with psychiatric visits. Academic Emergency Medicine, 21(9), 1015-1022. https://doi.org/10.1111/acem.12453
Buja, A., Francesconi, P., Bellini, I., Barletta, V., Girardi, G., Braga, M., ... & Damiani, G. (2020). Health and health service usage outcomes of case management for patients with long-term conditions: a review of reviews. Primary Health Care Research & Development, 21, e26. https://doi.org/10.1017/S1463423620000080
Chen, Y., Lehmann, C. U., & Malin, B. (2024). Digital information ecosystems in modern care coordination and patient care pathways and the challenges and opportunities for AI solutions. Journal of medical Internet research, 26, e60258. https://doi.org/10.2196/60258
Damayanti, A., & Widiyoko, A. W. (2024). Analisis Kesiapan Penerapan Rme Di Pelayanan Rawat Jalan Rumah Sakit Uns Menggunakan Metode Doctor's Office Quality-Information Technology (DOQ-IT). Journal Health Information Management Indonesian (JHIMI), 3(3), 169-173.
De Lusignan, S., Mold, F., Sheikh, A., Majeed, A., Wyatt, J. C., Quinn, T., ... & Rafi, I. (2014). Patients’ online access to their electronic health records and linked online services: a systematic interpretative review. BMJ open, 4(9), e006021. https://doi.org/10.1136/bmjopen-2014-006021
Fitriyah, Y., Riasetiawan, M., Lazuardi, L., & Sanjaya, G. (2022). Analisis tingkat kesiapan implementasi tanda tangan digital untuk autentikasi dokumen rekam medis elektronik di instalasi rawat jalan RSUD Kota Yogyakarta. Journal of Information Systems for Public Health, 7(2), 52-68.
Fromer, L. (2011). Implementing chronic care for COPD: planned visits, care coordination, and patient empowerment for improved outcomes. International journal of chronic obstructive pulmonary disease, 605-614. https://doi.org/10.2147/COPD.S24692
Gopal, G., Suter-Crazzolara, C., Toldo, L., & Eberhardt, W. (2019). Digital transformation in healthcare–architectures of present and future information technologies. Clinical Chemistry and Laboratory Medicine (CCLM), 57(3), 328-335. https://doi.org/10.1515/cclm-2018-0658
Hansagi, H., Olsson, M., Sjöberg, S., Tomson, Y., & Göransson, S. (2001). Frequent use of the hospital emergency department is indicative of high use of other health care services. Annals of emergency medicine, 37(6), 561-567. https://doi.org/10.1067/mem.2001.111762
Huabbangyang, T., Sangketchon, C., Piewthamai, K., Saengmanee, K., Ruangchai, K., Bunkhamsaen, N., ... & Tonsawan, R. (2022). Perception and satisfaction of patients’ relatives regarding emergency medical service response times: a cross-sectional study. Open Access Emergency Medicine, 155-163. https://doi.org/10.2147/OAEM.S360114
Johannessen, K. A., & Alexandersen, N. (2018). Improving accessibility for outpatients in specialist clinics: reducing long waiting times and waiting lists with a simple analytic approach. BMC health services research, 18(1), 827. https://doi.org/10.1186/s12913-018-3635-3
Khera, A., Baum, S. J., Gluckman, T. J., Gulati, M., Martin, S. S., Michos, E. D., ... & Shapiro, M. D. (2020). Continuity of care and outpatient management for patients with and at high risk for cardiovascular disease during the COVID-19 pandemic: A scientific statement from the American Society for Preventive Cardiology. American journal of preventive cardiology, 1, 100009. https://doi.org/10.1016/j.ajpc.2020.100009
Latuconsina, A. A. A., Syahril, E., Juhamran, R. P., Latief, S., & Arifuddin, A. T. S. (2023). Faktor Kepuasan Pasien terhadap Pelayanan di Instalasi Radiologi Rumah Sakit Ibnu Sina Makassar. Fakumi Medical Journal: Jurnal Mahasiswa Kedokteran, 3(9), 654-659. https://doi.org/10.33096/fmj.v3i9.204
Lewis, A. K., Harding, K. E., Snowdon, D. A., & Taylor, N. F. (2018). Reducing wait time from referral to first visit for community outpatient services may contribute to better health outcomes: a systematic review. BMC health services research, 18(1), 869. https://doi.org/10.1186/s12913-018-3669-6
Lotfy, M., Adeghate, J., Kalasz, H., Singh, J., & Adeghate, E. (2017). Chronic complications of diabetes mellitus: a mini review. Current diabetes reviews, 13(1), 3-10. https://doi.org/10.2174/1573399812666151016101622
Michael, M., Schaffer, S. D., Egan, P. L., Little, B. B., & Pritchard, P. S. (2013). Improving wait times and patient satisfaction in primary care. The Journal for Healthcare Quality (JHQ), 35(2), 50-60.
Miller Jr, D. P., Latulipe, C., Melius, K. A., Quandt, S. A., & Arcury, T. A. (2016). Primary care providers’ views of patient portals: interview study of perceived benefits and consequences. Journal of medical Internet research, 18(1), e8. https://doi.org/10.2196/jmir.4953
Moe, J., Kirkland, S., Ospina, M. B., Campbell, S., Long, R., Davidson, A., ... & Rowe, B. H. (2016). Mortality, admission rates and outpatient use among frequent users of emergency departments: a systematic review. Emergency Medicine Journal, 33(3), 230-236. https://doi.org/10.1136/emermed-2014-204496
Moscelli, G., Siciliani, L., & Tonei, V. (2016). Do waiting times affect health outcomes? Evidence from coronary bypass. Social Science & Medicine, 161, 151-159. https://doi.org/10.1016/j.socscimed.2016.05.043
Mustari, N. (2026). Implementasi Kebijakan Mobile Jkn Dalam Meningkatkan Efisiensi Rawat Jalan Di Rsud H. Padjonga Daeng Ngalle Kabupaten Takalar: Model Van Meter Dan Van Horn. Didaktik: Jurnal Ilmiah PGSD STKIP Subang, 12(01), 66-77. https://doi.org/10.36989/didaktik.v12i01.11740
Nadhiya, J., Vijayalakshmi, M. K., & Showbharnikhaa, S. (2024). A brief review on diabetes mellitus. Journal of Pharma Insights and Research, 2(1), 117-121.
Naiker, U., FitzGerald, G., Dulhunty, J. M., & Rosemann, M. (2018). Time to wait: a systematic review of strategies that affect out-patient waiting times. Australian Health Review, 42(3), 286-293. https://doi.org/10.1071/AH16275
Nashrulloh, D., & Anggraini, Y. (2024). Tinjauan Penerapan Rekam Medis Elektronik (Elektronik Medical Record) Pelayanan Rawat Jalan di Rumah Sakit Islam Siti Khadijah Palembang Tahun 2024. Jurnal Kesehatan: Jurnal Ilmiah Multi Sciences, 14(2), 70-78. https://doi.org/10.52395/jkjims.v14i2.448
Pedroto, I., Amaro, P., & Romãozinho, J. M. (2013). Health systems organization for emergency care. Best Practice & Research Clinical Gastroenterology, 27(5), 819-827. https://doi.org/10.1016/j.bpg.2013.08.014
Pratama, A. (2026). Analisis Implementasi Sistem Rekam Medis Elektronik Berbasis Cloud terhadap Efisiensi Pelayanan Rawat Jalan di Rumah Sakit Kota Batam. Jurnal Infomatika Medis, 1(1), 1-13.
Pujiatmika, R., Nugroho, D., & Yoshida, E. (2025). Analisis Pengaruh Penerapan Pendaftaran Online Terhadap Kepuasan Pasien Rawat Jalan Di Rumah Sakit Bhayangkara Tk I Pusdokkes Polri Tahun 2024. Jurnal Teknologi Informasi, 11(2), 161-180. https://doi.org/10.52643/jti.v11i2.6720
Rahiminia, M., Shahrabifarahani, S., Mojaradi, Z., Aghsami, A., & Jolai, F. (2023). A queueing-inventory model to control the congestion of patients and medical waste in the medical centers, a case study. Journal of Management Analytics, 10(2), 416-445. https://doi.org/10.1080/23270012.2023.2211073
Reichert, A., & Jacobs, R. (2018). The impact of waiting time on patient outcomes: Evidence from early intervention in psychosis services in E ngland. Health economics, 27(11), 1772-1787. https://doi.org/10.1002/hec.3800
Risma, A., & Mardahlia, D. M. (2023). Penumpukan Pasien Rawat Jalan Di poli Gigi Rumah Sakit IA Moeis Samarinda. Jurnal Pengabdian kepada Masyarakat Nusantara, 4(3), 1635-1639.
Sharma, G., Kuo, Y. F., Freeman, J. L., Zhang, D. D., & Goodwin, J. S. (2010). Outpatient follow-up visit and 30-day emergency department visit and readmission in patients hospitalized for chronic obstructive pulmonary disease. Archives of internal medicine, 170(18), 1664-1670. https://doi.org/10.1001/archinternmed.2010.345
Sikki, N., Wulandari, D. P., Hidayat, G. R., Fallah, K., Yuzda, R., & Yuni, R. F. (2026). Implementasi Model E-Business Business To Consumer Dalam Digitalisasi Layanan Kesehatan. Jati (Jurnal Mahasiswa Teknik Informatika), 10(1), 1681-1685.
Sun, J., Lin, Q., Zhao, P., Zhang, Q., Xu, K., Chen, H., ... & Liu, Y. (2017). Reducing waiting time and raising outpatient satisfaction in a Chinese public tertiary general hospital-an interrupted time series study. BMC public health, 17(1), 668. https://doi.org/10.1186/s12889-017-4667-z
Wang, C., Kuo, H. C., Cheng, S. F., Hung, J. L., Xiong, J. H., & Tang, P. L. (2020). Continuity of care and multiple chronic conditions impact frequent use of outpatient services. Health informatics journal, 26(1), 318-327. https://doi.org/10.1177/1460458218824720
Wang, Q., Su, M., Zhang, M., & Li, R. (2021). Integrating digital technologies and public health to fight Covid-19 pandemic: key technologies, applications, challenges and outlook of digital healthcare. International Journal of Environmental Research and Public Health, 18(11), 6053. https://doi.org/10.3390/ijerph18116053
Wolff, D. L., Waldorff, F. B., von Plessen, C., Mogensen, C. B., Sørensen, T. L., Houlind, K. C., ... & Rubin, K. H. (2019). Rate and predictors for non-attendance of patients undergoing hospital outpatient treatment for chronic diseases: a register-based cohort study. BMC health services research, 19(1), 386. https://doi.org/10.1186/s12913-019-4208-9