Jurnal Sistem Informasi, Teknologi Informasi dan
Komunikasi
DOI: 10.33364/sistematik/v.1-1.2405

Application of Extreme Programming Method for Digitization of the
Integrated Drug Prescribing Process Patient Registration of Bunda Alya
Clinic
Ridwan Setiawan1, Lulu Putri Novianti2
1,2
Department of Informatics, Institut Teknologi Garut, Indonesia
*email: ridwan.setiawan@itg.ac.id
Article Info
Submitted: May 1, 2025
Received: May 14, 2025
Published: May 31, 2025
Keywords:
Extreme Programming;
Patient Data Integration;
Prescription Electronic
Medicine;
Web Application.

1.

ABSTRACT
Digital transformation in the healthcare sector is driving the need for
systems that can improve the efficiency and accuracy of clinic
services. This research develops a web-based electronic drug
prescription application that is integrated with the patient registration
system, with an Extreme Programming (XP) approach. The system is
designed to overcome manual process constraints in the flow of
medical services, from registration to printing drug
recommendations. The test results showed that the application was
able to reduce the service time from an average of 8 minutes to 4
minutes per patient. The User Acceptance Test test of 13 respondents
showed a satisfaction rate of 95%. These findings confirm that the
systems built make a significant contribution to improving the
efficiency of the clinic's work and minimizing the risk of medical data
recording errors. This application is expected to be an applicative and
sustainable digital solution in the context of primary health services.

INTRODUCTION

Digital transformation in the health sector has become an essential need to improve the quality and efficiency
of medical services. One aspect that still relies heavily on manual processes is the patient registration and drug
prescribing system in small and medium clinics. Studies show that about 25% of [1], [2][3]medication errors
occur due to incomplete patient information, such as age or disease history, in manual prescriptions. This poses
a risk to the accuracy of dose, the effectiveness of treatment, and the safety of patients.[4]. The Bunda Alya
Clinic in Garut Regency is a real example of this challenge. The medical service process at this clinic is still
carried out manually, starting from registration, recording doctor's diagnosis, to prescribing and labeling drugs
by pharmacists. These system limitations cause services to be slow, prone to data loss, and require inefficient
cross-section communication. This situation highlights the need for a digital system that not only simplifies the
process, but also ensures the accuracy and integration of patient data across all stages of clinical services.[5],
[6]. Various previous studies have sought digitalization in the context of clinical services. Research developed
a cash-connected electronic prescription app to cut patient payment waiting times. The study proposes a cloudbased system and QR code to avoid misreading doctors' handwriting. While researching and applying the
Extreme Programming (XP) methodology to develop a medical record system with results that are adaptive to
user needs. However, most of these studies only touch part of the clinical service chain without integrating the
flow of registration, doctor diagnosis, prescription, and drug recap and labeling in one unified
system.[7][8][9][10]. The research gap that this study aims to fill lies in the development of a comprehensive
health information system. It takes an approach that is able to integrate the entire service process starting from
patient registration, filling out diagnoses, giving prescriptions, to printing recommendations for the use of drugs
in one web-based platform. Using the Extreme Programming methodology, the system is designed to respond

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to user needs iteratively and flexibly, with the main goal of improving operational efficiency, reducing the risk
of errors, and speeding up the service process in the clinic. This research aims to design and implement a webbased electronic drug prescription application that is integrated with the patient registration system at the Bunda
Alya Clinic. The application is expected to be an end-to-end digital solution that supports the comprehensive
and sustainable digitization of clinical services.
2.

RESEARCH METHODOLOGY

This research uses the XP approach, one of the agile methodologies that emphasizes software development
iteratively, quickly, and responsively to changing user needs. This methodology was chosen because it is able
to produce a stable and tested system through intensive collaboration between developers and end users. The
XP stages used in this study consist of: planning, design, coding, and testing. The stages of the research method
are shown in Picture1.[11] - [15]

Picture1. Extreme Programming (XP) Methodology Flow
Based on Picture1, the flow of the research method with XP Programming, the explanation of each stage is as
follows:
1) Planning. At this stage, the identification of system needs is carried out through interviews and
observations of business processes in the prescription implementation process at the Bunda Alya Clinic.
This need is formulated in the form of [16]user stories that describe the desired features from the user's
perspective. Each User Story is accompanied by a value and acceptance test criteria. The results of this
stage are presented in the form of a table that lists the user code, a description of the requirements,
important values, and the test scenario. In addition, an iteration plan is prepared to determine feature
development priorities, categorized into high, medium, and low scales.
2) Design. The design stage in XP prioritizes the principle of Keep It Simple (KIS). The design is kept to a
minimum while still meeting the functional needs of the system. Some of the artifacts developed at this
stage include: (1) [17]Use case diagrams depicting the relationship between system actors and their
functions; (2) Class diagrams show the class structure in the system, including attributes and relationships
between entities; (3) CRC Card (Class-Responsibility-Collaborator) which is used to define the
responsibilities of each class and its collaboration in the context of object orientation; and (4) Wireframe
Interface (Spike solution Prototype) which is used to display the system display as an initial validation
tool by the user.
3) Coding. The coding is done based on a pre-made design. This stage implements XP practices such as pair
programming, where two developers work on one code collaboratively to improve quality and reduce
errors. In addition, periodic [14], [18]refactoring is carried out to simplify the code structure without
changing functionality, as well as continuous integration that ensures that the code is always in a condition
that can be run and tested.
4) Testing, this stage is for testing the features on the application so that there are no errors (Error), ensure
the software or system runs as expected, meets set specifications, and meets user needs [19].
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RESULTS AND DISCUSSION

In this part of the results and discussion, the results of the implementation of each stage in the Extreme
Programming (XP) approach used in system development are presented. These stages include Planning,
Design, Coding, and Testing. The main focus is on the interconnectedness between user needs and the technical
solutions being designed, as well as how the system is tested and validated against the functional needs of the
clinic.
3.1 Planning
The planning stage is the initial phase in the user-oriented system development process. At this stage, the
identification of system needs is carried out based on interviews with the main users, namely registration
admins, doctors, and pharmacists. The result of this stage is the documentation of needs in the form of user
stories that contain actors, functional needs, value values, and acceptance criteria. The user stories that have
been identified then become the basis for the preparation of iteration plans and iterative system development
flows. The output of planning activities is in the form of functional specifications of the system in the form of
narratives that are classified based on user roles. This specification describes the interactions, information
needs, and work processes supported by the built-in electronic drug prescription information system. Table 1
presents a comprehensive mapping of user stories and the actors involved, the functional value provided by
each user story (value), and the system acceptance criteria that are the basis for validation during the testing
process.
Table 1. Mapping User Stories, Actors, Values, and Acceptance Criteria
Code
US1

About Shawn Stevens
Users can log in to the system
according to their role

Actor
Admin, Doctor,
Pharmacist

Value
Secure
authentication
and access authorization

US2

Admins can add new patient
data

Admin

Ease of patient data entry

US3

Admins can manage patient
data (view, edit, delete)

Admin

Data
management
flexibility

US4

Admin can fill out the patient
registration form
The system can display a list
of patients who have been
registered
The doctor can input the
patient's diagnosis results
Doctors can access the
patient's medical records
Doctors
may
prescribe
medication after diagnosis

Admin

Efficiency
of
the
registration process
Enrollment
data
visibility and control

Pharmacists
can
recap
prescriptions from doctors
Pharmacists can download
prescription recap data
Pharmacists can fill in the
recommendations for the use
of drugs
Pharmacists can print labels
recommended for use

Pharmacist

US5

US6
US7
US8

US9
US10
US11

US12

Admin

Doctor
Doctor
Doctor

Pharmacist
Pharmacist

Pharmacist

Documentation of the
audit results
Medical
decisionmaking support
Appropriate treatment
recommendations
Access precise recipe
information
Local documentation of
patient prescriptions
Patient
drug
use
education
Effectiveness of drug
distribution

Acceptance Criteria
The system directs users to the role-based
dashboard after username and password
validation
The input form receives the name, NIK,
date of birth, and address; Data stored in a
database
The system displays a list of patients and
provides change and delete functions that
work as expected
The filled in data is stored and connected
directly to the patient's medical records
The admin page displays active patient
data in real-time
Diagnoses are stored in databases and can
be accessed by doctors and pharmacists
Integrated medical records appear in full
on the doctor's page
The active drug input form is as per the
diagnosis, and the data is stored in the
prescription system
The recap page displays prescription data
according to the patients served
The system provides a data export button
in downloadable .xls format
Consumption instruction inputs are
available and stored according to the
relevant prescription
The system generates .pdf files that can be
printed and pasted on drug packaging

As shown in Table 1, it shows that the needs of users have been systematically classified based on their
respective roles, so that the developed system actually accommodates real workflows in the field. For example,
in US1 to US5, the functional needs of the admin are more focused on managing patient data and enrollment.
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While US6 to US8 focuses on the process of diagnosis and prescribing by doctors, while US9 to US12 leads
to the management of prescription information and drug use labels by pharmacists.
3.2 Design
The design stage is an important process in software development that aims to transform the functional needs
of the system into a form of technical visualization that can be used as a reference for implementation. In this
study, the design was carried out with an object-oriented approach using Unified Modeling Language (UML)
and Class Responsibility Collaborator (CRC Card) cards to clarify the responsibilities of each system
component. The design of the system also produces a user interface mockup model that is intended to reflect
the actual needs of each user role.
1) Use Case Diagram. To model the interaction scenario between actors and systems, a Use Case Diagram
as shown in Picture2 is used.

Picture2. Use Case Diagram of Electronic Drug Prescribing System
Based on Picture2, the system interacts with three main actors, namely Admin, Doctor, and Pharmacist.
Admins are in charge of patient data management and enrolment. Doctors use the system to record the
results of the diagnosis and prescribe medications. Pharmacists play a role in the input of drug use
recommendations, as well as the printing of prescription labels based on the information that has been
provided by the doctor. The use cases described include login, patient data management, diagnostic input,
prescription administration, prescription recap, and printing of drug recommendations. This diagram
ensures that all operational needs have been systematically mapped.
2) Class Diagram, To model the logical structure and relationships between entities, use Class Diagrams as
shown in Picture3.

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Picture3. Electronic Drug Prescribing System Diagram Class
Based on Picture3. This class of electronic drug prescription system diagrams is designed to represent the
internal structure of an object-based system consisting of several main entities: system users, medical
service processes, drug prescription management, and interface support components. This diagram
presents relationships between classes, attributes, and methods that reflect real processes in web-based
clinical services. On the user side, there are three main classes, namely admin, doctor, and pharmacist,
each of which has authentication attributes in the form of a username and password, as well as the login()
and logout() functions. These three actors interact with other classes according to their roles in the clinical
process. Admins play a role in managing patient data and registration, doctors are responsible for filling
out diagnoses and prescriptions, while pharmacists manage medication usage information and printing
prescription labels. Patient classes store patient identity information such as patient id, name, TTL,
address, and newArt, and are equipped with data management functions such as edit(), view(), and
delete(). The process of adding patient data is facilitated by the add-patient class, which presents a
complete input form with the add() and save() methods. This data is then used in the registration process,
which manages the patient's registration information and initial condition (weight, blood pressure, age)
through the view() function. The diagnosis class serves to record the results of examinations carried out
by doctors on patients. Its attributes include diagnostic results, drugs, and patient ids, while its functions
include add() and save(). The results of this diagnosis will be the basis for making prescriptions, which
contain data such as prescription number, patient ID, age, medication, as well as blood pressure and
weight values. This process supports the integration of medical outcomes with treatment therapy.
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Prescription recapitulation is managed in the prescription recap class, which organizes data for drug
documentation and audit purposes. Meanwhile, the recommended use class allows pharmacists to add
information on drug use such as frequency of consumption, meal time, number of spoons, and additional
information. The print() function in this class is used to generate labels in print-ready format (PDF).
The system also includes a class of medical records that serve as a historical repository of all of the
patient's clinical activities, such as the results of examinations and previous prescriptions. Its functions
include view() and print() to facilitate long-term tracking of medical information. To ensure the separation
of presentation logic from business logic, the system uses a series of interface classes such as <<patient
interface>>, <<interface>>diagnosis, <<interface>> prescription, and <<interface>> usage
recommendations. These classes are in charge of displaying data to users, receiving input, and connecting
to the appropriate modules. This design is in line with the principles of MVC (Model-View-Controller),
where the display logic and processes are controlled through a modular interface. Finally, connections to
the database system are governed through the connectionDB class, which has attributes such as host,
database, username, and password, as well as the open(), execute(), getResult(), and close() methods. This
class is an important foundation for the data transaction process across all system modules. Overall, this
class diagram shows a coherent and modular system architecture. Each class is designed with a single
responsibility, allowing for efficient integration between modules, and supporting future maintenance and
development of the system.
3) CRC Card. To strengthen the design of object-oriented systems, the Class Responsibility Collaborator
(CRC Card) approach is used as a conceptual technique in defining the structure of responsibility and
collaboration between classes. CRC Card is a design analysis method that focuses on three main elements:
Class, which is the entity in the system; Responsibility, which is the main task or function of the class;
and Collaborators, which are other classes that are involved in assisting or interacting with the class to
complete its responsibilities.
In this study, CRC Cards are arranged based on all entities in the diagram class, which includes user actor
classes, business process classes, and supporting components such as database connections and input
forms. Each class is identified as having specific primary responsibilities and only collaborates in case of
data dependencies or process flows between classes.
For the sake of academic presentation in journal articles, the following Table 2 is presented as a form of
narrative summary of the CRC Card that has been analysed. It should be noted that Table 2 is not a literal
representation of the CRC card, but rather a summary describing the elements of the CRC in one unified
tabular format for presentation efficiency and clarity of function mapping between classes.
Table 2. CRC Card Combined Electronic Drug Prescription System
CRC Card Name
Responsibilities
Collaborators
Admin
Authentication as an admin, managing Patient, Registration, AddPatient
patient data and enrolment
Doctor
Authentication as a doctor, input Diagnosis, Prescription, Medical
diagnoses and prescriptions
Records
Pharmacist
Authenticate as a pharmacist, input RecommendedUsage, Recipes,
usage recommendations and print labels RecapRecipes
E-Mail
General structure of user authentication SystemAuth
Patient
Store and display patient identity data
Admin, Registration, Medical
Records
AddPatient
New patient data input form
Patient, Admin
Registration
Record the patient's initial medical Registration Form, Patient
registration and status
FormRegistration
Provide registration input forms for Admin, Registration
admins

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CRC Card Name
Diagnosis

Recipe

Medicine
RecapRecipes
RecommendedUsage
Medical Records
KoneksiDB

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Responsibilities
Record the results of the doctor's
examination and connect it to the
prescription
Stores
prescription
information
provided by the doctor, including
medication data and patient condition
Storing medication and dosage list data
Save and display prescription recaps for
pharmacists
Fill
out
the
medication
recommendations and print labels
Storing and printing data of patients'
historical medical records
Execute database operations (open,
execute, getResult, close)

Collaborators
Doctor, Patient, Prescription

Diagnosis, Doctor, Medication,
Recommended UseUse
Recipe
Prescription, Pharmacist
Pharmacist, Prescription
Patient, Diagnosis, Prescription
All data storage classes

Based on the information in Table 2, it can be seen that each class in the system has focused
responsibilities. For example, the Prescription class not only acts as a container for drug data, but also
serves as a link between diagnostic results and recommended use, so its role is very strategic in the flow
of this digital clinic system. While the Recommended Use class collaborates directly with the Prescription
and Pharmacist, and holds the final function before the information is given to the patient in the form of
drug labels.
4) Spike solution Prototype. As part of the Extreme Programming (XP) practice, the Spike solution was used
in this study to test the technical and functional feasibility of the core features of the system before full
implementation was carried out. The main objective is to evaluate the alternative design and validity of
the frontend and backend technologies to be used, especially the integration between input forms, patient
data storage, and the printing process of drug use recommendations. The spike solution was carried out
in the form of initial interface prototyping using Figma, as well as proof-of-concept data processing on
the NextJS and ReactJS frameworks to ensure responsiveness and compatibility of web displays. The
results of this spike are then used as a reference in the development of the final interface and data storage
structure.
3.3 Coding
The coding stage is the implementation of a system design that has been designed beforehand. At this stage,
all the components that have been identified in the diagram class, CRC Card, and interface mockup are
transformed into real program code using a component-based modular approach. The coding process is carried
out by applying the principle of incremental development according to the Extreme Programming (XP)
approach, where each iteration focuses on specific functional development based on the priority order of user
needs.
The development of this system was carried out using NextJS and ReactJS technology for the frontend side, as
well as Node.js and MySQL for data management on the backend side. This framework was chosen because it
supports the development of web-based applications that are reactive, responsive, and support real-time
component integration.
The coding structure is divided into several main modules according to the user's role, namely the admin
module, the doctor module, and the pharmacist module. Each module includes a login page, a main dashboard,
and an interactive form that supports related business processes. The interface components are built on
prototypes that have been validated at the spike solution stage.

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Picture4. Implementation of Patient Registration Form Page (Admin)

Picture5. Implementation of the Diagnosis and Prescription Page (Doctor)

Picture6. Implementation of Recommendation for Use Page and Prescription Label (Pharmacist)

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Based on Picture4, the admin page allows patient data input and registration through forms that are directly
connected to the database. Validation is done on a client-side and server-side basis to ensure data accuracy.
Picture5 shows the physician interface integrating the diagnosis form and prescription filling. This component
utilizes state management in ReactJS to maintain active synchronization of patient data and diagnostics.
Picture6 shows a page for pharmacists that includes an input form for use as well as a label printing function
in PDF format. The print process is done through the integration of external libraries such as react-to-print or
html2pdf, ensuring compatibility for physical pharmaceutical documentation.
This coding process is also accompanied by writing API functions on the backend side to handle CRUD
(Create, Read, Update, Delete) operations on patient data, prescriptions, and drug recommendations. Each
request from the frontend is sent via HTTP Request and processed by the endpoint on NextJS API routing,
then forwarded to the MySQL database with a secure and efficient structured query.
The development architecture is structured with the principle of separation of concern, where display logic,
business logic, and data storage logic are separated to support code readability and scalability. Code reusability
and componentization practices are also implemented to speed up subsequent iterations and reduce code
redundancy.
3.4 Testing
Testing by determining respondents first using User Acceptance Test conducted to 13 respondents with 7
questions with a questionnaire using Likert Scale[20] with the questionnaire using the Likert Scale, namely
strongly agree (SS), agree (S), strongly agree (CS), disagree (TS) and strongly disagree (STS).
Table 3. User Acceptance
Yes

1
2
3
4
5
6
7

Question

Is this e-drug prescription app easy to use?
Is Display For app already interesting?
Are in-app flows easy to understand?
Does this app help in the healthcare process?
Is this application useful in health services?
Does the app run well?
Do you agree with this application?
Total

ST
5
10
11
9
10
9
11
9
69

S
4
3
2
4
3
4
1
4
21

Responses
C
TS
3
2

STS
1

1
1

a. Calculating the Total Score based on respondents' answers
SS = 69 x 5 = 345
S = 21 x 4 = 84
N=1x3=3
CS= 0 x 0
=0
TS= 0 x 0
=0
Total Value = SS + S + CS + TS + STS
Total Score = 345 + 84 +1 = 432

b. Finding an X value
X = 5 x (SS+S+N+CS+TS)
X = 5 x 91= 455

c. Find a percentage value
The value of X is used as a divisor because the question asked is a positive question.
Index formula = (Total Value)100%
x
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Formula Index = (432) 100% = 95% (Strongly Agree) 455
So it can present the results of the overall percentage by using the UAT testing method, the criteria are very
agreeable with the average of 95 percent. With these results, it can be concluded that users feel very satisfied
with this electronic drug prescription application.
3.5 Discussion
The results of the implementation of the electronic drug prescription system integrated with patient registration
show success in answering the main problems that occur at the Bunda Alya Clinic, especially in terms of the
efficiency of the service process and the accuracy of recording medical information. Based on the results of
the User Acceptance Test (UAT) of 13 respondents, the system obtained a satisfaction rate of 95%, indicating
that the majority of users strongly agreed that the application is easy to use, supports clinical workflows, and
is suitable for continuous implementation. In terms of efficiency, the service time that was originally an average
of 8 minutes per patient can be reduced to 4 minutes after the system is implemented. This is in line with the
findings that developed an electronic prescription application connected to the cashier and was able to cut
patient transaction time. However, the system developed in this study has the advantage of providing
comprehensive integration from registration, diagnosis, prescription, to drug label printing, not only limited to
the final stage of the service process.[7]
From a technical point of view, the use of the Extreme Programming (XP) methodology has proven to be
effective in producing a system that is responsive to user needs, in line with studies and which shows the
success of XP in the development of medical record systems. However, unlike these studies that focus on
medical data management only, this study has succeeded in integrating the entire clinical service cycle into one
web-based digital system.[9][10]
In addition, the system design approach involving user stories, CRC Cards, as well as UML modeling such as
use case diagrams and class diagrams, has been proven to help the development team in translating functional
requirements into modular application modules that can be tested independently. The refactoring and
componentization process applied during coding also strengthens the quality of the system and facilitates the
integration process of interfaces and backends. Compared to cloud-based systems and QR codes as developed
by, this system provides added value through automatic printing of drug recommendation labels, which is very
important to ensure patients get clear medication usage information. This feature also supports more systematic
patient education, which has not been the main focus in previous research.[8] Thus, the system developed in
this study contributes as a comprehensive digital solution for clinics with manual workflows, who want to
adopt web-based electronic systems without losing the workflow that has been running before. This makes the
system not only technically innovative, but also relevant and applicable in the context of primary healthcare at
the local level.
4.

CONCLUSION

This research has succeeded in developing a web-based electronic drug prescription application that is
integrated with the patient registration system at Bunda Alya Clinic. The development process is carried out
with an Extreme Programming (XP) approach, which allows the system to be built iteratively and adaptively
to the needs of the user. The resulting application is able to digitize the entire clinical service process, from
patient registration, diagnostic input, drug prescription, to printing recommended use in the form of labels. The
results of the test using the User Acceptance Test showed a user satisfaction rate of 95%, as well as a reduction
in service time from an average of 8 minutes to 4 minutes per patient. These findings show that the system is
able to improve efficiency, reduce manual recording errors, and speed up the flow of medical services. The
main contribution of this research is the preparation of an integrated clinical information system, with an easyto-use interface that can be implemented directly in the context of primary health services. This system is
expected to be an applicable and sustainable solution for the digitization of clinic services in the future.

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