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. 2025 Feb 14;25(1):249.
doi: 10.1186/s12913-025-12399-0.

An exploratory study of electronic medical record implementation and recordkeeping culture: the case of hospitals in Indonesia

Md Khalid Hossain  1 , Juliana Sutanto  2 , Putu Wuri Handayani  3 , Anasthasia Agnes Haryanto  2 , Joy Bhowmik  2   4 , Viviane Frings-Hessami  2
Affiliations

An exploratory study of electronic medical record implementation and recordkeeping culture: the case of hospitals in Indonesia

Md Khalid Hossain et al. BMC Health Serv Res. .

Abstract

Background: The digitization of healthcare, through electronic medical records (EMRs), is recognized globally as a transformative initiative. Indonesia mandated all healthcare facilities to adopt EMRs by December 31, 2023. However, this transition is complicated by diverse technological, cultural, and infrastructural challenges, with little research addressing the recordkeeping culture's impact on EMR adoption. This study investigates the electronic recordkeeping culture in Indonesian hospitals following a government mandate to adopt Electronic Medical Records (EMRs). It aims to understand the readiness and challenges in implementing EMRs across hospitals on Java and Sulawesi islands, focusing on infrastructure, staff digital skills, and varied adoption approaches.

Methods: A qualitative case study approach was utilized, involving focus groups and semi-structured interviews with 150 staff from 12 hospitals. Conducted between November 2023 and June 2024, the study applied thematic analysis based on Oliver and Foscarini's (2020) recordkeeping culture framework to explore organizational readiness, technological infrastructure, and healthcare professionals' skills in managing electronic records.

Results: The findings reveal significant differences in EMR adoption between the islands. Hospitals on Java exhibited proactive engagement, supported by better technological infrastructure and staff training programs, while Sulawesi hospitals adopted EMRs primarily to meet regulatory requirements. Challenges included inconsistent internet connectivity, low digital literacy among staff, and ongoing reliance on paper records during the transition. Some Java hospitals have begun fostering a culture conducive to electronic recordkeeping by focusing on developing staff skills in EMR management.

Conclusions: The effectiveness of EMR adoption in Indonesia relies on addressing technological infrastructure issues and enhancing staff digital literacy. While progress has been made, particularly in more developed regions, a cohesive national strategy emphasizing technological support and targeted training is essential to fully realize the benefits of EMRs in improving healthcare and recordkeeping standards across Indonesia.

Keywords: Electronic medical record; Hospitals; Indonesia; Information; Recordkeeping culture; Regulation.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the principles outlined in the Declaration of Helsinki. Permission to conduct this study was granted by the Monash University Human Research Ethics Committee (MUHREC). Potential participants were recruited via email and phone to participate in the study. During the recruitment, explanatory statement was shared with the participants. Informed consent was obtained from all the participants to participate in the research and to record the interview/focus group. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Information culture framework [14]
Fig. 2
Fig. 2
Electronic medical recordkeeping culture of hospitals in Indonesia
See this image and copyright information in PMC

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