Analisis Penerapan Standar Interoperabilitas Data Simrs dan BPJS Kesehatan Dalam Implementasi Rekam Medis Elektronik
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Interoperabilitas data kesehatan menjadi tantangan kritis dalam pertukaran data antara fasilitas kesehatan dan BPJS Kesehatan di Indonesia, dengan ketidakseragaman format data, inkonsistensi terminologi medis, dan fragmentasi sistem informasi menyebabkan inefisiensi bagi lebih dari 242 juta peserta Jaminan Kesehatan Nasional. Penelitian ini bertujuan menganalisis penerapan standar HL7 FHIR untuk meningkatkan interoperabilitas data antara SIMRS dan sistem BPJS Kesehatan dalam konteks Rekam Medis Elektronik (RME), serta merumuskan roadmap implementasi operasional. Penelitian menggunakan pendekatan kualitatif deskriptif-analitis dengan studi kasus di RS Primaya, meliputi studi literatur, analisis standar (FHIR R4, ISO/IEC 25012, 27001, 27799, ISO 8000), observasi, wawancara dengan 12 informan lintas fungsi, dan analisis log transaksi VClaim selama enam bulan (>15.000 klaim/bulan), dianalisis melalui pemetaan BPMN, gap analysis terhadap FHIR R4/ISO, dan FHIR Maturity Model pada lima dimensi kesiapan. Temuan menunjukkan error rate klaim BPJS 18-22% (mismatch ICD-10 34%, data tidak lengkap 27%, identitas tidak sesuai 17%), duplikasi rekam medis 14,4%, verifikasi kepesertaan rata-rata 4 menit 32 detik, skor FHIR readiness 2,9 dari 5, dan kepatuhan ISO/IEC 27001 baru 58,8%. Dari 140+ resource FHIR R4, teridentifikasi 18 resource inti pada tujuh fase siklus pelayanan. Proyeksi integrasi FHIR memangkas waktu verifikasi menjadi <8 detik (naik 97%), error rate <3%, duplikasi <1%, dengan ROI tahun pertama ~105% dan payback period delapan bulan. Roadmap empat fase (Fondasi, Pilot, Ekspansi, Maturitas) diusulkan bagi Kemenkes, BPJS Kesehatan, rumah sakit, dan vendor SIMRS, mencakup blueprint adopsi FHIR, Master Patient Index nasional berbasis NIK, migrasi API VClaim/PCare ke FHIR R4 native, pembentukan Health Data Governance Committee, dan pelatihan coding ICD-10.
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