Exploring Stakeholder Experiences with Electronic Medical Records in Indonesia's Digital Health Transformation

Exploring Stakeholder Experiences with Electronic Medical Records in Indonesia's Digital Health Transformation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring Stakeholder Experiences with Electronic Medical Records in Indonesia's Digital Health Transformation Rr Tutik Sri Hariyati, Hanny Handiyani, Muhammad Hanif Amiruddin, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5394530/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Digital literacy plays a pivotal role in accessing and utilizing health services, particularly in Indonesia's diverse and geographically dispersed population. This qualitative study delves into the landscape of digital health implementation in the Indonesian health sector. The results aim to understand the challenges and opportunities of leveraging digital technologies to improve healthcare accessibility and quality. Method : Design research is a descriptive qualitative approach that involves focus group discussion to gather insights from healthcare providers, managers, and policymakers. Purposeful sampling was used to guarantee representation across various positions and demographic groups. Thematic analysis was employed to identify trends and themes associated with digital use. Results : The findings revealed five themes. The findings highlight the varying experiences among stakeholders, which are influenced by factors such as leadership, staff competency, regulation, and technological infrastructure. Many benefits of digital health care for quality of care, such as telemedicine and electronic medical records. Moreover, the study revealed barriers hindering the adoption of digital health solutions, including concerns about data privacy, technological literacy, and ethical preferences. Implications : Recommendations are proposed to enhance digital literacy in the health sector, including tailored training programs, improved leadership, and policy interventions to promote equitable access to digital healthcare services across Indonesia. digital health health services Indonesia healthcare accessibility electronic medical records Figures Figure 1 Introduction The integration of digital technology in the healthcare industry has revolutionized the way patients receive care and medical professionals provide treatment. The integration of digital technology into healthcare systems can completely transform the way health services are provided, opening new opportunities to increase patient accessibility, effectiveness, and quality (Ministry of Health, 2021; World Health Organization, 2020 ). The benefits of digital technology in health from telemedicine, telenursing, wearable devices, electronic health records and artificial intelligence (AI) are vast and impactful. Telemedicine and telenursing refers to the use of telecommunications technology to provide patient care from a distance, allowing for increased access to healthcare services for patients in remote or underserved areas (Kamei, 2022 ; Franco et al., 2023; Sharma et al., 2022 ; Boro et al., 2019). This innovative approach has been shown to e patient outcomes, increase the efficiency of healthcare delivery, and reduce healthcare costs. Telenursing plays a crucial role in promoting patient self-management and adherence to treatment plans, ultimately leading to improved health outcomes. They also serve as a bridge between patients and healthcare providers, facilitating the communication and coordination of care to improve patient outcomes (Armansyah & Hariyati, 2022 ; Nasution & Hariyati, 2018 ; Putrawardana & Hariyati, 2022 ). Increased patient satisfaction is also a notable benefit of telenursing, as patients appreciate the convenience and personalized care they receive through remote monitoring and consultations. Overall, telenursing has the potential to greatly improve patient outcomes and satisfaction while reducing healthcare costs ( Moriyama et al., 2021 ; Shimoyama et al., 2023 ). Electronic medical records in Indonesia are another rapidly evolving technology. Medical records (EMRs) contain information about a patient's diagnosis, prescriptions, treatment plans, immunization dates, allergies, radiographic images, and laboratory test results (Setyadi & Nadjib, 2023 ). EMRs allow medical staff to rapidly access and update patient data and improve patient outcomes and care coordination (Pryor et al., 2020 ; Setyaningrum, 2016 ). The importance of EMRs in healthcare for improving the quality of documentation and patient safety cannot be overstated. By providing a comprehensive and organized view of a patient's health history, EMRs help reduce medical errors, duplicate tests, and unnecessary procedures. Additionally, EMRs enable healthcare providers to make informed decisions and provide personalized care to patients (Ratanto et al., 2021; Wayan et al., 2018 ). EMRs also improve the legal aspects of healthcare by ensuring the accurate and timely documentation of patient care. s also streamline communication between healthcare providers, reducing the risk of miscommunication and improving overall patient safety (Hariyati et al., 2016 ). In conclusion, EMRs play a crucial role in enhancing patient safety and the quality of care in healthcare settings. The integration of EMRs has revolutionized the way healthcare is delivered and managed, ultimately leading to better patient outcomes. The digital transformation has not only improved access to care and patient outcomes but also increased efficiency and reduced healthcare costs (World Health Organization, 2020 ). However, to fully enjoy these advantages, the populace must be technologically savvy and able to use digital health solutions easily. It is imperative to understand the intricacies of digital literacy in health services in Indonesia, a country where healthcare disparities are pervasive in many geographic and socioeconomic situations. Digital literacy plays a pivotal role in accessing and utilizing health services, particularly in Indonesia's diverse and geographically dispersed population (Indonesia Ministry of Health, 2021). Digital literacy in Indonesia remains a challenge, hindering the adoption of electronic medical records. Efforts to improve digital literacy among healthcare professionals and staff are crucial for fully harnessing the benefits of EMRs in Indonesia's healthcare system (Hariyati et al., 2024 ). Currently, digital transformation is taking place in Indonesia. Data on digital literacy in nurses has been studied in Indonesia, where digital literacy results are still below 80. Their scores were not significant to the workplace, duration, and type of technology used. Nursing informatics competency is significantly related to age and work experience (p = 0.001). Previous studies have suggested that the first transition from a traditional system to electronic medical records requires a period of adaptation and training ( Hariyati, et.al, 2024 ). Previous studies have also reported a positive relationship between nurse position and education level, indicating that nurses with higher education obtain higher levels of informatics competency compared to nurses with lower education. Unfortunately, research data on the experiences of nurses, doctors, midwives, and pharmacists in using EMR has not been widely explored. Many convey unstructured information related to obstacles but are still not known in depth. In fact, information about how the experience of using EMR, and the difficulties and benefits felt by users is very useful for the development of EMR systems in the future. The adaptation from paper-based to electronic medical records is a transformation that all healthcare professionals must face and prepare for. Barriers and hurdles are often top of mind for decision- makers, but there is little research on how stakeholders feel about implementing changes to EMRs. There is still no in-depth knowledge about in-depth experiences related to EMR implementation. Research exploring the experiences of early adopters of digital health, such as EMRs, is critical to identifying areas for further improvement. Many questions remain about implementing digital health and the barriers to early adoption, so researchers want to dig deeper into new experiences of using digital technologies in healthcare settings. Research conducted in developing countries can provide lessons for other countries undergoing a digital revolution. Method This study used a descriptive qualitative technique using a focus group. Goal of the study is to investigate the current status and experiences of digitalization in the health sector. This study also explored the possibilities and constraints for the growth of digital health activities. The main characteristic of a focus group is that all participants and the facilitator discuss a topic interactively as a group in one location. According to Morgan (1998), this is the most common and traditional type of focus group discussion. One technique for collecting qualitative data is Focus Group Discussion (FGD), which brings people together to talk about a particular subject. The purpose of open-ended questions is to encourage casual conversation and dig deeper into people's opinions that cannot be reached through surveys. Four questions were asked regarding the use of digital health; 1. Tell us about the digitalization of the health care services that you have used 2. Barriers to digital implementation; 3. Expectations when using digital health; 4. Perceived shortcomings of using digital health (Hariyati, 2024 ). Participant Requirement An FGD typically involves six to twelve people and lasts between sixty and ninety minutes (Yayeh, 2021 ). Focus group conversations should produce enough information to support comparisons as well as the development and testing of theoretical concepts (Barbour 2005). In this study eleven focus group discussion (FGD) participants were selected via purposive sampling. Purposeful sampling was utilized to guarantee representation across various positions and demographic groupings. The inclusion criterion, which involved the use of digital technology in health services, was the identification of participants, including nurses, midwives, pharmacists, and medical recorders. The inclusion criteria were care providers who had worked for more than 5 years in direct patient care and had a role in developing EMRs in the workplace. The way to get participants was by sending a request for research participants to key informant from the institution and then the institution submitted potential participants. Potential participants were then evaluated and all those submitted were in accordance with the inclusion criteria so that they continued to become research participants. The participants’ involvement in FGD’s can provide valuable insights into the practical aspects of using digital health in healthcare settings. The inclusion of a diverse group of participants can offer a comprehensive perspective on the challenges and opportunities related to digital literacy in healthcare. Selecting participants via purposive sampling with criteria on the basis of their expertise and experience in healthcare can ensure that the insights gathered are relevant and actionable for improving EMRs implementation strategies. Additionally, involving a range of professions can help identify potential benefits and barriers to digital literacy and develop targeted solutions to address them effectively. Each participant gave their opinion in turn during the FGD process. The FGD was carried out on online-zoom media provided by the researcher. To prevent noise when participants speak, participants who are not speaking are set to muted mode. If there is signal interference, participants are asked to repeat what was said when the signal is good again. During focus group discussions, the environment can be controlled, and there are no internet connection difficulties. Data Analysis and Trustworthy Since the data was collected through focus group discussions, there is a possibility of response bias, where participants may change their responses based on the opinions of others in the group. To reduce bias, the facilitator provided information at the beginning so that each participant could express their opinion without being influenced by the experiences of other participants. At the end of the discussion, all participants were also given time to convey things that had not been covered in the discussion according to their experiences. Focus group saturation occurs when no new information or themes emerge, indicating that data collection has reached its limit. Data saturation is attempted by asking if there are any remaining issues from the focus group. This ensures that a thorough understanding of the topic has been achieved and allows for meaningful analysis of the data collected. Member checks were already configured via feedback from participants to validate the accuracy and interpretation of the data. This iterative process helps ensure the credibility and trustworthiness of the findings through experience using EMRs and digital health. Thematic analysis was employed to identify trends and themes associated with digital use. Data analysis starts with verbatim responses and then progresses to identifying patterns and themes, followed by interpretation and synthesis of the findings (Hariyati, 2024 ). The trustworthiness of the data was ensured through multiple coding. Second techniques were used to gather qualitative data. The facilitator took notes, recorded audio, and transcribed it afterwards. All information was anonymized, and any names mentioned were changed during transcription. For later multiple coding, the second sources were filed together. This systematic approach ensured that all aspects of the data were thoroughly examined and understood, leading to comprehensive and reliable results. To facilitate easy visualization and comparison, all the themes were depicted in the theme tree, enabling a more thorough comprehension of the connections between various data points. This structured method of analysis also helps identify any gaps or inconsistencies in the data, ensuring a robust and accurate final report. In the end, the Standards for Reporting Qualitative Research (SRQR) checklist was used to improve the transparency of all aspects of qualitative research (O’Brien et al., 2014 ). This study was approved by the Ethical Board of the Faculty of Nursing, Universitas Indonesia KET-153/UN2.F12.D1.2.1/PPM.00.02/2023. The Ethical Committee of Nursing Research, Faculty of Nursing, Universitas Indonesia with regards to the protection of human rights and welfare in nursing research, has carefully reviewed the proposal entitled, and all the participants provided written informed consent. The participants were aware of the research goals, advantages, and methods. The researcher maintained anonymity throughout the completion of the questionnaires, guaranteed confidentiality, and discussed their experiences with digital implementation. The authors will adhere to ethical norms in publishing the improvement study’s data by protecting both personal and organizational privacy and data confidentiality when implementing digital health (Hariyati, 2024 a). Results Attendance at focus groups has been an issue of concern, which was also identified in our research. Eleven (11) participants attended the FGD consisting of nurses, doctors, midwives, electronic medical recorder and pharmacists. Our primary objective was to establish the usefulness of groups as an implementation of digitalization in the health system, barriers, expectations and perceived shortcomings of using EMR. Table 1 Table 1 Data characteristics of the participants Kode Age Gender Education Profession P1 28 Female S1 + Profession Pharmacy P2 30 Male S1 + Profession Nurse P3 34 Male S1 + Profession Nurse P4 28 Male S1 + Profession Nurse P5 47 Female S2 Medical recorder P6 32 Female S1 + Profession Nurse P7 30 Female D3 Medical Recorder P8 39 Female S1 + Profession Midwife P9 40 Female S1 + Profession Nurse P10 46 Female S2 Doctor P11 39 Female S1 + Profession Midwife Table 1 shows that the average age of the participants was 36 years, and most of them were women. The participants included nurses, midwives, medical recorders, pharmacists, and doctors. Most of the participants had a bachelor's degree. Table 2 gives details of description themes and sub-themes of conversation description in FGD. The results show the same number of words and the same meaning. We also convey the number of participants who conveyed the words. Table 2 Description of Themes Verbatim descriptions of participants were described in several conversations. Views on how digitization is being used in healthcare (Hariyati, 2024). 1. The type of digital health that has been used “…for example, online services “telenursing”, homecare and so on (P3, P4) “… telemedicine… telehealth (P4, P5, P6) “… teleconsultation…(P5) “…on line reservation…... (P1) “…with electronic medical records for documentation, records, and reports…. (P1, P2, P3, P5, P8, P11) The first theme conveys the types of digital technology that have been used in Indonesia, covering several aspects, including EMR, telehealth, telemedicine, telenursing, tele-homecare, tele-ICU, teleconsultation, and online reservations. 2. Factors to consider when digital health solutions are integrated. “… human resources…. (P5, P6, P11) “….care provider that includes medical doctor, nurse, dietician, pharmacist, physiotherapy’s, and information technology support…(P5, P11) “….This leadership and organization plays a key role in the success of digital use in every health service…” (P9) “…I want to highlight one thing related to the policy regarding….(P5, P6, P7, P9) “…provide adequate human resources... (P9) “….In the field of nursing, digital systems ensure that we maintain proximity/care for patients. (P2, P5, P9, P10) “…Therefore, there needs to be digital literacy education for health workers.” (P4, P9) “….At times, in the event of system sluggishness, it is crucial to input important data promptly, as the system's performance is compromised. Therefore, risk management is essential to ensure that the system can swiftly recover in the event of downtime. (P4, P5) “….The ethics of digital health are just to follow the rules…. (P10) In this study, in addition to describing the experience and benefits, factors for the success of transformation using digital health were also found in the implementation of digitalization, including during the implementation of EMR. Some of the obstacles found were human resource factors, leadership and organization, facilities, policies, the absence of ethical guidelines and risk management. 3. It is important to ensure policies regarding patient confidentiality, access, reporting, and release of information. “…Madam, it is crucial to ensure that you are well informed about the current policies in place, whether they pertain to hospital protocols or government regulations, particularly with regard to patient confidentiality. Additionally, health institutions have specific guidelines for utilizing this digital system, particularly for handling patient information. (P2) “… Protection data… (P5) “…Health facilities must ensure the protection of personal data, particularly patient medical information. Therefore, health facilities must take the necessary steps to prepare their data protection measures to effectively safeguard patient data. (P3) “…Health personnel must be well versed in data confidentiality. When I refer to literacy in this context, I emphasize the importance of understanding that data security begins with us and not just with technology. (P9) “….. It is essential to consider ethics, particularly patient confidentiality, because the data are confidential. Therefore, it is imperative to maintain both patient and data confidentiality, which should be clearly outlined in the policies dictating access. (P4) “…Currently, development is underway in a single health sector, and in the future, there will be a need for regulations to govern the release of data. These regulations will determine whether the patient, guardian, or health facility can access the data, especially in cases where the patient is unconscious.” (P3, P4, P5, P9) This study also highlights the importance of regulation, especially regulations on ethics, and guidelines for the use of digital documentation such as EMR. Issues of data security, privacy, and data confidentiality are very much needed by users. 4. Positive impact of digitalization in health care The participants said that digitalization in health services had a positive effect on services. Some statements from the participants were as follows: “With the advent of digital services, nursing services have become more accessible to users, customers, and individuals needing care.” (P1, P7, P4,P3) “Digitalization is very helpful in this service, such as registration, and documentation ... then there is telenursing or those who participate in telehealth, especially during COVID times, which is very helpful. (P4, P7) “…for example, online services, homecare, and so on are made easy. Users can order it from their respective homes without wasting time and so on… (P1, P3, P5, P6, P7.P8,P9, P10) “…With the shift towards online health services, such as telenursing, we can effectively manage our time during meetings and provide better care to patients. “ (P4, P8, P9) “…Patient information, diagnosis, and medical conditions can be readily accessed to expedite the diagnostic process and enhance service efficiency. By utilizing data from previous hospitals, the new healthcare facility can minimize the learning curve and the associated costs. Consolidating patient data into a single source enables a faster and more streamlined approach.” (P4) “Indeed, digitalization has proven to be extremely beneficial for us in the field of public health. This has greatly contributed to enhancing our efficiency and reducing costs. (P4, P7) “….This collaboration and integration can be observed through the utilization of electronic medical records. (P11) “…By utilizing EMR, we can enhance our collaboration to provide comprehensive care and ensure high-quality service. (P1, P4, P11) “…It is possible to input all medical record information onto a website for research purposes. Considering the potential of patients and other factors, we can use these data to drive innovation. How can we best foster innovation for future services? (P7, P9) “…With digitalization, we can create good marketing (P7) The fourth theme conveys the many benefits that can be obtained from using digital health such as EMRs, including expanding access, being faster, improving quality of care, more efficient, reducing costs, increasing inter-collaboration and becoming a marketing medium. 5. Obstacles that arise in implementing digital health and EMR “….then the problem was the human resources (P5, P6, P11) “….Not all leaders know yet… (P11) “…The infrastructure and network sometimes make things difficult for us...(P2, P6, P11) “….Therefore, when a system is introduced and the people are not trained, it will become an obstacle…(P5, P11) “…However, the problem with our system is that it is a bit slow, either because it is full or the computer is a problem that we are experiencing (P5) “….1. The limitations pertain to both time constraints and the number of applications that need to be added. (P6) In addition to the advantages in the fifth theme, obstacles from the EMR system are presented which are like the influencing factors. The factors that influence the success of digital health will become inhibiting factors. The inhibiting factors for EMR implementation are human resources, policies and organizations, leadership, regulations, facilities, digital literacy, and the absence of regulations including risk mitigation. A theme tree was used to describe the categories and themes developed for the integration of digital health in health services on the basis of participant remarks. Figure 1 Figure 1 describes the experience of digitalization in health services. There are five themes: types of digital health, factors that must be considered when using digital health, obstacles to implementation, and the benefits of using digital health. The uses of digitalization in health services include electronic medical records and telehealth/telenursing. Factors that focus on leadership. Regulations, ethics, human resources, digital literacy education, infrastructure, and risk management. The advantages of digital health include time and cost efficiency. Effectiveness includes ease of access, inter-collaboration, integration, comprehensive care, and user-friendliness. The benefits of this development include marketing, research, and innovation. Discussion Digital health refers to the use of technology to improve healthcare delivery and outcomes. Understanding user experiences in this context is crucial for ensuring that these technologies are effective and user-friendly. By examining the user experience, we can identify areas for improvement and optimize the design of digital health tools to better meet the needs of patients and healthcare providers. The findings in this study indicated that there were five main themes: commonly utilized digital health types, variables influencing digital health implementation, advantages, and perceived barriers to digital health implementation, including EMRs. The electronic medical record was a keyword frequently submitted by the participants. One of the words often uttered by participants when asked about the types of health services that use digital technology in Indonesia is EMRs. From the study, many participants said that EMRs help in communication between health workers, inter-collaboration, and improving the quality of service. The findings of this research are consistent with previous results that EMRs have many advantages, including improved communication and inter-cooperation. EMRs can also improve documentation completeness, service quality, and clinical decision-making (Hariyati, et al., 2018 ; Hariyati et al., 2021; Ngusie et al., 2022). EMRs also improve safety and time efficiency and reduce paper and printing costs (Li et al., 2021; Wayan et al., 2018 ). By the time this study was conducted, the use of EMRs was mandatory in all health facilities in Indonesia (Ministry of Health, 2021). EMRs are needed because they can be implemented in the process of interoperability and the integration of both management and patient data. On the basis of this blueprint, one healthy Indonesian EMR development is controlled by digital transformation with various standardization activities, data integration and the creation of a digital ecosystem (Ministry of Health, 2021). A good EMR is expected to facilitate service continuity and improve the quality and speed of service (AriWinata & Hariyati, 2021; Hariyati et al., 2016 ). Previous research results also revealed that the presence of EMRs can make it easier to supervise and monitor the safety of medication (Ratanto et al., 2021). The implementation of EMR has also reduced documentation time and facilitated inter-cooperation and intra and inter-health communications. This finding also supports previous research suggesting that EMR can bridge service continuity through ease of coordination in the health team (Wayan et al., 2018 ). Time efficiency can also be implemented because EMRs provides checklist facilities and not all are written narratively (Winata & Hariyati, 2021; DeLisle et al., 2010). The use of codes is an important aspect that needs to be regulated so that the standardization of EMR can be ensured (Pryor et al., 2020 ). Compared with a paper base, an EMR can also reduce costs because it can reduce the cost of printing forms. EMR can also improve the quality of the service, with coding standardization, which is expected to be easier and user friendly, so it does not cause misinterpretation due to hard-to-read writing factors. The completeness and quality of documents also improve after EMRs is used so that comprehensive and continuous service can be implemented (Setyadi & Nadjib, 2023 ). This study also highlights the importance of EMRs as a part of marketing (Venkatraman et al., 2008 ). With digital health education also being implemented through technology, the scope of information can be expanded so that it can be a positive marketing tool for health facilities. In addition to marketing, it presents the opportunity to create EMRs big data as part of research and innovation development. With the analysis of big data, EMRs can be used as a source for clinical decisions, education, and research (Agrawal & Prabakaran, 2020 ; Shahid & Sheikh, 2021 ). Apart from EMRs, participants conveyed digital technology that has been used in Indonesia, including telehealth, telemedicine, telenursing, tele-homecare, tele-ICU, teleconsultation, and online reservations. The participants delivered various benefits from digital health. The benefits are related to the efficiency of time and cost in service delivery and follow-up care when home care is implemented. The results of this study are consistent with those of previous studies, which reported that the use of telenursing has an advantage in reducing the cost of travel to health facilities and can also reduce the efficiency of time (Putrawardana & Hariyati, 2022 ; Sharma et al., 2022 ). Telenursing is a technology-assisted service that can be used for follow-up care, monitoring, and making recommendations for patient care (Handiyani et al., 2024 ). Telenursing can improve patient access to health services (Rintyarna et al., 2023). Telenursing is now being developed along with AI, and the use of AI in telenursing will help health care in clinical decision-making as a patient (Kamei, 2022 ; Kurniawan et al., 2024 ; Seibert et al., 2021 ). The digital technologies that have been utilized in this study are telemedicine, teleconsultation, tele-ICU, tele-homecare and telenursing. Participants stated the advantages of telehealth, but also the disadvantages of not being able to have direct contact with health workers. This statement is in line with several studies that have been conducted previously that various experiences using telemedicine during the pandemic can improve services and reduce virus transmission ( Nejadshafiee et al., 2022 ).. Study participants also believed that telemedicine could facilitate patient monitoring ( Handiyani et al., 2024 ; Kamei, 2022 ), thereby providing benefits not only to patients but also to providers ( Marco-Franco et al., 2023 ; Boro et al., 2019). Telenursing can also be used for patient education and health consultations (Martínez et al., 2023). The telemedicine facility saves time and trips to hospitals ( Smith et al., 2020 a). Research has shown that telenursing can be used to carry out follow-ups on patients with newborn babies (Kristiawati, Rustina, Budi, & Hariyati, 2022), and telemedicine with artificial intelligence can also increase the ease of patient consultation with health services. Telemedicine is an opportunity to develop in an era of digitalization ( Kurniawan et al., 2024 ). The factors that influence and hinder the implementation of digital health are almost identical. In this research, leaders should also establish regulations that can provide guidelines for staff, among other things related to how to write, report, and keep patient data confidential. Research previously conducted by a leader should be a role model in the implementation of EMRs (Burgess & Honey, 2022 ; Egarter et al., 2021 ; Laukka et al., 2023 ). Regulations are also needed to regulate ethics, data security, and privacy as well as how to download and repair incorrect data (Ministry of Health, 2022; Laukka et al., 2023 ). The ethical issue of digital use in health services was raised by participants. In detail, the study stated that the suboptimal regulation related to EMR data security risks confuses users. In addition, socialization related to data confidentiality and privacy needs to be socialized. Several previous studies conveyed that ethics also regulates confidentiality and how health forces use social media (Ahmead et al., 2022 ; Dhiman, 2023 ). The practitioner hopes that there is an ethics of digital use to improve the quality of service and patient proximity and not leave the essence of caring (Ahmead et al., 2022 ; Asiri et al., 2014 ; Kuek & Hakkennes, 2020 ). These results are in line with Locsin’s finding that informational nursing is nursing care (Krel et al., 2022 ), which means that technology will improve patient care. Harmonious coherence must exist between the nurse and the patient when using technology (Egarter et al., 2021 ; Hariyati et al., 2024 ; Kongsuwan & Locsin, 2011 ). Studies have shown that as digital health becomes more widely used, attention to the human component becomes more significant. Human resources are the most frequently mentioned word when discussing factors that influence the success of EMRs implementation.The human factor consists of healthcare staff as digital health users and information technology support (Holt et al., 2020 ). According to some studies, digital literacy training is necessary in the healthcare industry. Education impacts how people adjust to digital health (Kuek & Hakkennes, 2020 ; Zaharany et al., 2021 ). The three components of digital health competency are information literacy, computer skills, and information and data management competency (TIGER, 2006 ). Computer skills are essential in implementing EMRs, so training in the use of hardware and software and computer skills are needed by health workers (Gómez Chova et al., 2021 ). There are many obstacles to implementing telenursing and EMRs due to low education levels s (Lee & Tak, 2022 ) and digital literacy skills (Martínez et al., 2023). Low levels of computer literacy make telenursing and EMRs implementation difficult. The study also suggested that training should be provided throughout the early stages of EMRs deployment (Martínez et al., 2023; Woldemariam & Jimma, 2023 ; Zaharany et al., 2021 ). Previous research has shown that literacy digital training improved participants' perceptions of having ethics. attitude, being aware of the security and confidentiality of data, and using social media wisely (Hariyati et al., 2024 ). In addition to user-provided healthcare, experts who can support system development, repair, and maintenance are required for the implementation of digital health. For the submission by Hariyati et al. ( 2018 ), a support system that includes adequately supported qualified resources is necessary (Hariyati et al., 2018 ). Another factor found in research related to barriers to digital health implementation such as EMRs is infrastructure. Factors such as networks, software, computers, and other tools influence the success of digital health use (Hariyati, Hamid, et al., 2018 ; Navarro, et.al, 2023, Olajubu et al., 2014 ). The slow connection factor is still perceived as an obstacle to EMRs implementation, and the plethora of systems that need to be loaded and have no interoperability also complicates healthcare. Integration and interoperability are essential to ensure the continuity of health services (WHO, 2008 , 2021 ). Data integration enables data analysis, which facilitates clinical decision-making. The results of this research support those of previous studies that reported that the obstacles to implementing electronic health records are technical factors, such as slow networks, non-integrated systems, and redundancy in documentation (Boonstra & Broekhuis, 2010 ; Wikansari & Santoso, 2022 ). Limitations This research was an initial study that explored the experiences of digital health user stakeholders in health services. The study used eleven health worker participants and the FGD was only conducted in one round, so the data cannot yet be generalized. Most of the participants were nurses, midwives, doctors, medical recorders, and pharmacists. The participants did not represent all professions, and this weakness can lead to recommendations for further research. However, this research can serve as the initial data on the conditions for digital health implementation and become a basis for its development. Conclusion Exploration of experience in the use of digital health is necessary to understand digital implementation. The expansion results are input to the advanced mining steps of the implementation of digital health. The research results provide five themes: the types of digital health that have been frequently used; the factors that affect digital health implementation; benefits; perceived constraints; and recommendations related to what needs to be prepared in digital health. The research results convey several types of digital health that have been used in Indonesia are EMRs, telehealth, teleconsultation, telehome and online reservation. Many benefits are obtained including ease of access, increased quality of service, reduced costs, and research sources. The factors that must be prepared so as not to become a barrier in the implementation of EMRs are human resources, facilities, policies, leadership and literacy education. For the future research can continue to examine the long-term impact of digital health adoption on patient. outcomes. Implication for Practice Healthcare organizations must prepare regulations and ethical guidelines for the use of digitalization in patient care, including guidelines for the use of EMRs. It is necessary to prepare adaptive leaders and prepare adequate infrastructure. Healthcare workers must learn digital literacy to successfully adopt and use electronic medical records, which will ultimately enhance patient outcomes and enable individualized therapy. Healthcare must embrace digital technologies if they are to advance, and prioritizing EMR adoption is a critical first step in that direction. Abbreviations AI : Artificial Intelligent EMRs : electronic medical record FGD : focus group discussion Declarations Ethics approval and consent to participate : This study was approved by the Ethical Board of the Faculty of Nursing, Universitas Indonesia KET-153/UN2.F12.D1.2.1/PPM.00.02/2023 Consent for publication : all the participants provided written informed consent, including for publication Availability of data and materials Fig share. Dataset. https://doi.org/10.6084/m9.figshare.25942420.v1 This project contains the following extended data: ethical approval. Fig share. Dataset. https://doi.org/10.6084/m9.figshare.25962871.v1 This project contains the following extended data: Explanation Sheet For Research procedures . Fig share. Dataset. https://doi.org/10.6084/m9.figshare.25970938 This project contains the following extended data: verbatim and thematic . Fig share. Dataset. https://doi.org/10.6084/m9.figshare.25970956 This project contains the following extended data: Procedure Operating Standard for Group Discussion and Analysis (1) . Fig share. Dataset. https://doi.org/10.6084/m9.figshare.25970920 This project contains the following extended data: Standards for reporting qualitative Research Figshare. Dataset. https://doi.org/10.6084/m9.figshare.27924465.v1 This project contains the following extended data: Question of DMI FGD Competing Interests : No competing interests were disclosed Funding : This work was supported by a PUTI H-I-2024 (NKB- 09/UN2.RST/HKP.05.00/grant from Universitas Indonesia). Authors' contributions All the authors agree to be accountable for all aspects of the work and have contributed Rr Tutik Sri Hariyati * Corresponding Author, Conceptualization, Formal Analysis, Funding Acquisition, Writing – Review & Editing Hanny Handiyani Data Curation, Formal Analysis, Writing – Review & Editing Muhammad Hanif Amiruddin Data curation, translation and grammatical editing Andi Amalia Wildani Project Administration, Writing – Review & Editing Tuti Afriani Data Curation, Review & Editing Min Huei HSU Collaborator, Review & Editing Acknowledgements: Thank you to all the participants, facilitators, Arini, TWG, DTO Kemenkes and WICATERA team who were supported in this study. References Agrawal, R., & Prabakaran, S. (2020). Big data in digital healthcare: lessons learnt and recommendations for general practice. In Heredity (Vol. 124, Issue 4, pp. 525–534). Springer Nature. https://doi.org/10.1038/s41437-020-0303-2 Ahmead, M., Hamamadeh, N., & Iram, I. abu. (2022). 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Providing telenursing care for victims: a simulated study for introducing of possibility nursing interventions in disasters. BMC Medical Informatics and Decision Making , 22 (1). https://doi.org/10.1186/s12911-022-01792-y O’Brien, B. C., Harris, I. B., Beckman, T. J., Reed, D. A., & Cook, D. A. (2014). Standards for reporting qualitative research: A synthesis of recommendations. Academic Medicine , 89 (9), 1245–1251. https://doi.org/10.6084/m9.figshare.25970920 Olajubu, A. O., Irinoye, O. O., & Olowokere, A. E. (2014). Competencies and Barriers to the Use of Nursing Informatics among Nurses in Primary, Sec-ondary and Tertiary Healthcare Facilities in Nigeria . https://doi.org/10.12856/JHIA-2014-v2-i1-85 Pryor, R., Atkinson, C., Cooper, K., Doll, M., Godbout, E., Stevens, M. P., & Bearman, G. (2020). The electronic medical record and COVID-19: Is it up to the challenge? In American Journal of Infection Control (Vol. 48, Issue 8, pp. 966–967). 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Telehealth in Remote Areas: A New Artificial Intelligence-Based Model. In International Journal of Science and Society (Vol. 5). http://ijsoc.goacademica.com Setyadi, D., & Nadjib, M. (2023). The Effect of Electronic Medical Records on Service Quality and Patient Satisfaction: A Literature Review. Journal Research of Social Science, Economics, and Management , 2 (12), 2780–2791. https://doi.org/10.59141/jrssem.v2i12.500 Setyaningrum, I. H. & N. E. (2016). Peningkatan kelengkapan dokumentasi dan kepuasan perawat pada pengawasan hospital acquired infections (HAIs) berbasis komputer. Jurnal Keperawatan Indonesia , 19 (1), 33–40. Shahid, N. U., & Sheikh, N. J. (2021). Impact of Big Data on Innovation, Competitive Advantage, Productivity, and Decision Making: Literature Review. Open Journal of Business and Management , 09 (02), 586–617. https://doi.org/10.4236/ojbm.2021.92032 Sharma, M. M., Sanjay, M., Aiims, S., Himanshu, J. M., Aiims, V., Nipin, J. M., & Aiims, K. (2022). 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Jurnal Kepemimpinan Dan Manajemen Keperawatan , 4 (1). https://doi.org/10.32584/jkmk.v4i1.873 Table 2 Table 2 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table2.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5394530","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":439845239,"identity":"d7fb314f-8752-4d4d-8616-03e6caf87a0c","order_by":0,"name":"Rr Tutik Sri Hariyati","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsUlEQVRIiWNgGAWjYNACgwQ5BgYeopUzMzAcMEgwJlULQ0JiA9FazGefPyb9oSAtfcPxswcffGCwk9NtIKBF5lwym8QBg5zcDWfykg1nMCQbmx0goEWChxmkpSJ3w4EcM2kehgOJ24jVkm5w/g1pWnISDG6QYIuxxRmDNMOZN94YG84wIMovjA9vVPxJluc7n2P44EOFnRxBLXCgAFZpQKxyEJBvIEX1KBgFo2AUjCgAAN6sPNc5V9+NAAAAAElFTkSuQmCC","orcid":"","institution":"Faculty of Nursing, Universitas Indonesia","correspondingAuthor":true,"prefix":"","firstName":"Rr","middleName":"Tutik Sri","lastName":"Hariyati","suffix":""},{"id":439845240,"identity":"08cdb545-1863-48be-bff9-03ceff525d03","order_by":1,"name":"Hanny Handiyani","email":"","orcid":"","institution":"Faculty of Nursing, Universitas Indonesia","correspondingAuthor":false,"prefix":"","firstName":"Hanny","middleName":"","lastName":"Handiyani","suffix":""},{"id":439845242,"identity":"6cf14d72-9ddf-4e61-a1fb-8763f4888a57","order_by":2,"name":"Muhammad Hanif Amiruddin","email":"","orcid":"","institution":"Taipei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Muhammad","middleName":"Hanif","lastName":"Amiruddin","suffix":""},{"id":439845243,"identity":"5e890c71-188c-4a4b-852b-46bdb2e8c691","order_by":3,"name":"Andi Amalia Wildani","email":"","orcid":"","institution":"Faculty of Nursing, Universitas Indonesia","correspondingAuthor":false,"prefix":"","firstName":"Andi","middleName":"Amalia","lastName":"Wildani","suffix":""},{"id":439845245,"identity":"df27b306-f6ee-4139-bf55-747cc8509f91","order_by":4,"name":"Tuti Afriani","email":"","orcid":"","institution":"Faculty of Nursing, Universitas Indonesia","correspondingAuthor":false,"prefix":"","firstName":"Tuti","middleName":"","lastName":"Afriani","suffix":""},{"id":439845247,"identity":"439be1da-0823-4b02-98d8-3d5374fc2528","order_by":5,"name":"Min Huei HSU","email":"","orcid":"","institution":"Taipei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Min","middleName":"Huei","lastName":"HSU","suffix":""}],"badges":[],"createdAt":"2024-11-05 10:23:50","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5394530/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5394530/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80276199,"identity":"2d9b53fb-caae-45f1-8c0a-2ef793b967cd","added_by":"auto","created_at":"2025-04-10 05:03:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":397396,"visible":true,"origin":"","legend":"\u003cp\u003eThemes Tree for the Application of Digital Health\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5394530/v1/7d154ade9ba0b5b2aab56b2f.png"},{"id":98432205,"identity":"9bb683ab-d7f1-4f4d-99a5-2ac38a1c4b3c","added_by":"auto","created_at":"2025-12-17 16:49:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2105293,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5394530/v1/f0cc4168-2dae-4a07-93f3-f7ad5ba642ff.pdf"},{"id":80275804,"identity":"a614bfce-ba8f-44d7-9c40-41a08699a132","added_by":"auto","created_at":"2025-04-10 04:55:32","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":21720,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-5394530/v1/561e1ab0b75e9aae6713adc9.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eExploring Stakeholder Experiences with Electronic Medical Records in Indonesia's Digital Health Transformation\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe integration of digital technology in the healthcare industry has revolutionized the way patients receive care and medical professionals provide treatment. The integration of digital technology into healthcare systems can completely transform the way health services are provided, opening new opportunities to increase patient accessibility, effectiveness, and quality (Ministry of Health, 2021; World Health Organization, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The benefits of digital technology in health from telemedicine, telenursing, wearable devices, electronic health records and artificial intelligence (AI) are vast and impactful.\u003c/p\u003e \u003cp\u003eTelemedicine and telenursing refers to the use of telecommunications technology to provide patient care from a distance, allowing for increased access to healthcare services for patients in remote or underserved areas (Kamei, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Franco et al., 2023; Sharma et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Boro et al., 2019). This innovative approach has been shown to e patient outcomes, increase the efficiency of healthcare delivery, and reduce healthcare costs. \u003cb\u003eTelenursing plays a crucial role in promoting patient self-management and adherence to treatment plans, ultimately leading to improved health outcomes. They also serve as a bridge between patients and healthcare providers, facilitating the communication and coordination of care to improve patient outcomes\u003c/b\u003e (Armansyah \u0026amp; Hariyati, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Nasution \u0026amp; Hariyati, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Putrawardana \u0026amp; Hariyati, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). \u003cb\u003eIncreased patient satisfaction is also a notable benefit of telenursing, as patients appreciate the convenience and personalized care they receive through remote monitoring and consultations. Overall, telenursing has the potential to greatly improve patient outcomes and satisfaction while reducing healthcare costs (\u003c/b\u003eMoriyama et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Shimoyama et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eElectronic medical records in Indonesia are another rapidly evolving technology. Medical records (EMRs) contain information about a patient's diagnosis, prescriptions, treatment plans, immunization dates, allergies, radiographic images, and laboratory test results (Setyadi \u0026amp; Nadjib, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). EMRs allow medical staff to rapidly access and update patient data and improve patient outcomes and care coordination (Pryor et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Setyaningrum, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). The importance of EMRs in healthcare for improving the quality of documentation and patient safety cannot be overstated. By providing a comprehensive and organized view of a patient's health history, EMRs help reduce medical errors, duplicate tests, and unnecessary procedures. Additionally, EMRs enable healthcare providers to make informed decisions and provide personalized care to patients (Ratanto et al., 2021; Wayan et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). EMRs also improve the legal aspects of healthcare by ensuring the accurate and timely documentation of patient care. s also streamline communication between healthcare providers, reducing the risk of miscommunication and improving overall patient safety (Hariyati et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). In conclusion, EMRs play a crucial role in enhancing patient safety and the quality of care in healthcare settings. The integration of EMRs has revolutionized the way healthcare is delivered and managed, ultimately leading to better patient outcomes.\u003c/p\u003e \u003cp\u003eThe digital transformation has not only improved access to care and patient outcomes but also increased efficiency and reduced healthcare costs (World Health Organization, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). However, to fully enjoy these advantages, the populace must be technologically savvy and able to use digital health solutions easily. It is imperative to understand the intricacies of digital literacy in health services in Indonesia, a country where healthcare disparities are pervasive in many geographic and socioeconomic situations. Digital literacy plays a pivotal role in accessing and utilizing health services, particularly in Indonesia's diverse and geographically dispersed population (Indonesia Ministry of Health, 2021). Digital literacy in Indonesia remains a challenge, hindering the adoption of electronic medical records. Efforts to improve digital literacy among healthcare professionals and staff are crucial for fully harnessing the benefits of EMRs in Indonesia's healthcare system (Hariyati et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCurrently, digital transformation is taking place in Indonesia. Data on digital literacy in nurses has been studied in Indonesia, where digital literacy results are still below 80. Their scores were not significant to the workplace, duration, and type of technology used. Nursing informatics competency is significantly related to age and work experience (p = 0.001). Previous studies have suggested that the first transition from a traditional system to electronic medical records requires a period of adaptation and training ( Hariyati, et.al, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Previous studies have also reported a positive relationship between nurse position and education level, indicating that nurses with higher education obtain higher levels of informatics competency compared to nurses with lower education. Unfortunately, research data on the experiences of nurses, doctors, midwives, and pharmacists in using EMR has not been widely explored. Many convey unstructured information related to obstacles but are still not known in depth. In fact, information about how the experience of using EMR, and the difficulties and benefits felt by users is very useful for the development of EMR systems in the future.\u003c/p\u003e \u003cp\u003eThe adaptation from paper-based to electronic medical records is a transformation that all healthcare professionals must face and prepare for. Barriers and hurdles are often top of mind for decision- makers, but there is little research on how stakeholders feel about implementing changes to EMRs. There is still no in-depth knowledge about in-depth experiences related to EMR implementation.\u003c/p\u003e \u003cp\u003eResearch exploring the experiences of early adopters of digital health, such as EMRs, is critical to identifying areas for further improvement. Many questions remain about implementing digital health and the barriers to early adoption, so researchers want to dig deeper into new experiences of using digital technologies in healthcare settings. Research conducted in developing countries can provide lessons for other countries undergoing a digital revolution.\u003c/p\u003e "},{"header":"Method","content":"\u003cp\u003eThis study used a descriptive qualitative technique using a focus group. Goal of the study is to investigate the current status and experiences of digitalization in the health sector. This study also explored the possibilities and constraints for the growth of digital health activities. The main characteristic of a focus group is that all participants and the facilitator discuss a topic interactively as a group in one location. According to Morgan (1998), this is the most common and traditional type of focus group discussion. One technique for collecting qualitative data is Focus Group Discussion (FGD), which brings people together to talk about a particular subject. The purpose of open-ended questions is to encourage casual conversation and dig deeper into people's opinions that cannot be reached through surveys. Four questions were asked regarding the use of digital health; 1. Tell us about the digitalization of the health care services that you have used 2. Barriers to digital implementation; 3. Expectations when using digital health; 4. Perceived shortcomings of using digital health (Hariyati, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003cb\u003eParticipant Requirement\u003c/b\u003e \u003c/p\u003e\u003cp\u003eAn FGD typically involves six to twelve people and lasts between sixty and ninety minutes (Yayeh, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Focus group conversations should produce enough information to support comparisons as well as the development and testing of theoretical concepts (Barbour 2005). In this study eleven focus group discussion (FGD) participants were selected via purposive sampling. Purposeful sampling was utilized to guarantee representation across various positions and demographic groupings. The inclusion criterion, which involved the use of digital technology in health services, was the identification of participants, including nurses, midwives, pharmacists, and medical recorders.\u003c/p\u003e\u003cp\u003eThe inclusion criteria were care providers who had worked for more than 5 years in direct patient care and had a role in developing EMRs in the workplace. The way to get participants was by sending a request for research participants to key informant from the institution and then the institution submitted potential participants. Potential participants were then evaluated and all those submitted were in accordance with the inclusion criteria so that they continued to become research participants.\u003c/p\u003e\u003cp\u003eThe participants’ involvement in FGD’s can provide valuable insights into the practical aspects of using digital health in healthcare settings. The inclusion of a diverse group of participants can offer a comprehensive perspective on the challenges and opportunities related to digital literacy in healthcare. Selecting participants via purposive sampling with criteria on the basis of their expertise and experience in healthcare can ensure that the insights gathered are relevant and actionable for improving EMRs implementation strategies. Additionally, involving a range of professions can help identify potential benefits and barriers to digital literacy and develop targeted solutions to address them effectively. Each participant gave their opinion in turn during the FGD process.\u003c/p\u003e\u003cp\u003eThe FGD was carried out on online-zoom media provided by the researcher. To prevent noise when participants speak, participants who are not speaking are set to muted mode. If there is signal interference, participants are asked to repeat what was said when the signal is good again. During focus group discussions, the environment can be controlled, and there are no internet connection difficulties.\u003c/p\u003e\u003cp\u003eData Analysis and Trustworthy\u003c/p\u003e\u003cp\u003eSince the data was collected through focus group discussions, there is a possibility of response bias, where participants may change their responses based on the opinions of others in the group. To reduce bias, the facilitator provided information at the beginning so that each participant could express their opinion without being influenced by the experiences of other participants. At the end of the discussion, all participants were also given time to convey things that had not been covered in the discussion according to their experiences.\u003c/p\u003e\u003cp\u003eFocus group saturation occurs when no new information or themes emerge, indicating that data collection has reached its limit. Data saturation is attempted by asking if there are any remaining issues from the focus group. This ensures that a thorough understanding of the topic has been achieved and allows for meaningful analysis of the data collected. Member checks were already configured via feedback from participants to validate the accuracy and interpretation of the data. This iterative process helps ensure the credibility and trustworthiness of the findings through experience using EMRs and digital health. Thematic analysis was employed to identify trends and themes associated with digital use.\u003c/p\u003e\u003cp\u003eData analysis starts with verbatim responses and then progresses to identifying patterns and themes, followed by interpretation and synthesis of the findings (Hariyati, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The trustworthiness of the data was ensured through multiple coding. Second techniques were used to gather qualitative data. The facilitator took notes, recorded audio, and transcribed it afterwards. All information was anonymized, and any names mentioned were changed during transcription. For later multiple coding, the second sources were filed together. This systematic approach ensured that all aspects of the data were thoroughly examined and understood, leading to comprehensive and reliable results.\u003c/p\u003e\u003cp\u003eTo facilitate easy visualization and comparison, all the themes were depicted in the theme tree, enabling a more thorough comprehension of the connections between various data points. This structured method of analysis also helps identify any gaps or inconsistencies in the data, ensuring a robust and accurate final report. In the end, the Standards for Reporting Qualitative Research (SRQR) checklist was used to improve the transparency of all aspects of qualitative research (O’Brien et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e This study was approved by the Ethical Board of the Faculty of Nursing, Universitas Indonesia KET-153/UN2.F12.D1.2.1/PPM.00.02/2023. The Ethical Committee of Nursing Research, Faculty of Nursing, Universitas Indonesia with regards to the protection of human rights and welfare in nursing research, has carefully reviewed the proposal entitled, and all the participants provided written informed consent. The participants were aware of the research goals, advantages, and methods. The researcher maintained anonymity throughout the completion of the questionnaires, guaranteed confidentiality, and discussed their experiences with digital implementation. The authors will adhere to ethical norms in publishing the improvement study’s data by protecting both personal and organizational privacy and data confidentiality when implementing digital health (Hariyati, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2024\u003c/span\u003ea).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAttendance at focus groups has been an issue of concern, which was also identified in our research. Eleven (11) participants attended the FGD consisting of nurses, doctors, midwives, electronic medical recorder and pharmacists. Our primary objective was to establish the usefulness of groups as an implementation of digitalization in the health system, barriers, expectations and perceived shortcomings of using EMR.\u003c/p\u003e\n\u003cp\u003eTable 1\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eData characteristics of the participants\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eKode\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eProfession\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS1 + Profession\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePharmacy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS1 + Profession\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS1 + Profession\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS1 + Profession\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical recorder\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS1 + Profession\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedical Recorder\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS1 + Profession\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMidwife\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS1 + Profession\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDoctor\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eS1 + Profession\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMidwife\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 1 shows that the average age of the participants was 36 years, and most of them were women. The participants included nurses, midwives, medical recorders, pharmacists, and doctors. Most of the participants had a bachelor's degree.\u003c/p\u003e\n\u003cp\u003eTable 2 gives details of description themes and sub-themes of conversation description in FGD. The results show the same number of words and the same meaning. We also convey the number of participants who conveyed the words.\u003c/p\u003e\n\u003cdiv\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2 Description of Themes\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eVerbatim descriptions of participants were described in several conversations. Views on how digitization is being used in healthcare (Hariyati, 2024).\u003c/p\u003e\n\u003ch3\u003e1. The type of digital health that has been used\u003c/h3\u003e\n\u003cdiv\u003e\n \u003cp\u003e“…for example, online services “telenursing”, homecare and so on (P3, P4)\u003c/p\u003e\n \u003cp\u003e“… telemedicine… telehealth (P4, P5, P6)\u003c/p\u003e\n \u003cp\u003e“… teleconsultation…(P5)\u003c/p\u003e\n \u003cp\u003e“…on line reservation…... (P1)\u003c/p\u003e\n \u003cp\u003e“…with electronic medical records for documentation, records, and reports….\u003c/p\u003e\n \u003cp\u003e(P1, P2, P3, P5, P8, P11)\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eThe first theme conveys the types of digital technology that have been used in Indonesia, covering several aspects, including EMR, telehealth, telemedicine, telenursing, tele-homecare, tele-ICU, teleconsultation, and online reservations.\u003c/p\u003e\n\u003ch3\u003e2. Factors to consider when digital health solutions are integrated.\u003c/h3\u003e\n\u003cp\u003e“… human resources…. (P5, P6, P11)\u003c/p\u003e\n\u003cp\u003e“….care provider that includes medical doctor, nurse, dietician, pharmacist, physiotherapy’s, and information technology support…(P5, P11)\u003c/p\u003e\n\u003cp\u003e“….This leadership and organization plays a key role in the success of digital use in every health service…” (P9)\u003c/p\u003e\n\u003cp\u003e“…I want to highlight one thing related to the policy regarding….(P5, P6, P7, P9)\u003c/p\u003e\n\u003cp\u003e“…provide adequate human resources... (P9)\u003c/p\u003e\n\u003cp\u003e“….In the field of nursing, digital systems ensure that we maintain proximity/care for patients. (P2, P5, P9, P10)\u003c/p\u003e\n\u003cp\u003e“…Therefore, there needs to be digital literacy education for health workers.” (P4, P9)\u003c/p\u003e\n\u003cp\u003e“….At times, in the event of system sluggishness, it is crucial to input important data promptly, as the system's performance is compromised. Therefore, risk management is essential to ensure that the system can swiftly recover in the event of downtime. (P4, P5)\u003c/p\u003e\n\u003cp\u003e“….The ethics of digital health are just to follow the rules…. (P10)\u003c/p\u003e\n\u003cp\u003eIn this study, in addition to describing the experience and benefits, factors for the success of transformation using digital health were also found in the implementation of digitalization, including during the implementation of EMR. Some of the obstacles found were human resource factors, leadership and organization, facilities, policies, the absence of ethical guidelines and risk management.\u003c/p\u003e\n\u003ch3\u003e3. It is important to ensure policies regarding patient confidentiality, access, reporting, and release of information.\u003c/h3\u003e\n\u003cp\u003e“…Madam, it is crucial to ensure that you are well informed about the current policies in place, whether they pertain to hospital protocols or government regulations, particularly with regard to patient confidentiality. Additionally, health institutions have specific guidelines for utilizing this digital system, particularly for handling patient information. (P2)\u003c/p\u003e\n\u003cp\u003e“… Protection data… (P5)\u003c/p\u003e\n\u003cp\u003e“…Health facilities must ensure the protection of personal data, particularly patient medical information. Therefore, health facilities must take the necessary steps to prepare their data protection measures to effectively safeguard patient data. (P3)\u003c/p\u003e\n\u003cp\u003e“…Health personnel must be well versed in data confidentiality. When I refer to literacy in this context, I emphasize the importance of understanding that data security begins with us and not just with technology. (P9)\u003c/p\u003e\n\u003cp\u003e“….. It is essential to consider ethics, particularly patient confidentiality, because the data are confidential. Therefore, it is imperative to maintain both patient and data confidentiality, which should be clearly outlined in the policies dictating access. (P4)\u003c/p\u003e\n\u003cp\u003e“…Currently, development is underway in a single health sector, and in the future, there will be a need for regulations to govern the release of data. These regulations will determine whether the patient, guardian, or health facility can access the data, especially in cases where the patient is unconscious.” (P3, P4, P5, P9)\u003c/p\u003e\n\u003cp\u003eThis study also highlights the importance of regulation, especially regulations on ethics, and guidelines for the use of digital documentation such as EMR. Issues of data security, privacy, and data confidentiality are very much needed by users.\u003c/p\u003e\n\u003ch3\u003e4. Positive impact of digitalization in health care\u003c/h3\u003e\n\u003cp\u003eThe participants said that digitalization in health services had a positive effect on services. Some statements from the participants were as follows:\u003c/p\u003e\n\u003cdiv\u003e\n \u003cp\u003e“With the advent of digital services, nursing services have become more accessible to users, customers, and individuals needing care.” (P1, P7, P4,P3)\u003c/p\u003e\n \u003cp\u003e“Digitalization is very helpful in this service, such as registration, and documentation ... then there is telenursing or those who participate in telehealth, especially during COVID times, which is very helpful. (P4, P7)\u003c/p\u003e\n \u003cp\u003e“…for example, online services, homecare, and so on are made easy. Users can order it from their respective homes without wasting time and so on… (P1, P3, P5, P6, P7.P8,P9, P10)\u003c/p\u003e\n \u003cp\u003e“…With the shift towards online health services, such as telenursing, we can effectively manage our time during meetings and provide better care to patients. “ (P4, P8, P9)\u003c/p\u003e\n \u003cp\u003e“…Patient information, diagnosis, and medical conditions can be readily accessed to expedite the diagnostic process and enhance service efficiency. By utilizing data from previous hospitals, the new healthcare facility can minimize the learning curve and the associated costs. Consolidating patient data into a single source enables a faster and more streamlined approach.” (P4)\u003c/p\u003e\n \u003cp\u003e“Indeed, digitalization has proven to be extremely beneficial for us in the field of public health. This has greatly contributed to enhancing our efficiency and reducing costs. (P4, P7)\u003c/p\u003e\n \u003cp\u003e“….This collaboration and integration can be observed through the utilization of electronic medical records. (P11)\u003c/p\u003e\n \u003cp\u003e“…By utilizing EMR, we can enhance our collaboration to provide comprehensive care and ensure high-quality service. (P1, P4, P11)\u003c/p\u003e\n \u003cp\u003e“…It is possible to input all medical record information onto a website for research purposes. Considering the potential of patients and other factors, we can use these data to drive innovation. How can we best foster innovation for future services? (P7, P9)\u003c/p\u003e\n \u003cp\u003e“…With digitalization, we can create good marketing (P7)\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eThe fourth theme conveys the many benefits that can be obtained from using digital health such as EMRs, including expanding access, being faster, improving quality of care, more efficient, reducing costs, increasing inter-collaboration and becoming a marketing medium.\u003c/p\u003e\n\u003ch3\u003e5. Obstacles that arise in implementing digital health and EMR\u003c/h3\u003e\n\u003cp\u003e“….then the problem was the human resources (P5, P6, P11)\u003c/p\u003e\n\u003cp\u003e“….Not all leaders know yet… (P11)\u003c/p\u003e\n\u003cp\u003e“…The infrastructure and network sometimes make things difficult for us...(P2, P6, P11)\u003c/p\u003e\n\u003cp\u003e“….Therefore, when a system is introduced and the people are not trained, it will become an obstacle…(P5, P11)\u003c/p\u003e\n\u003cp\u003e“…However, the problem with our system is that it is a bit slow, either because it is full or the computer is a problem that we are experiencing (P5)\u003c/p\u003e\n\u003cp\u003e“….1. The limitations pertain to both time constraints and the number of applications that need to be added. (P6)\u003c/p\u003e\n\u003cp\u003eIn addition to the advantages in the fifth theme, obstacles from the EMR system are presented which are like the influencing factors. The factors that influence the success of digital health will become inhibiting factors. The inhibiting factors for EMR implementation are human resources, policies and organizations, leadership, regulations, facilities, digital literacy, and the absence of regulations including risk mitigation.\u003c/p\u003e\n\u003cp\u003eA theme tree was used to describe the categories and themes developed for the integration of digital health in health services on the basis of participant remarks.\u003c/p\u003e\n\u003cp\u003eFigure 1\u003c/p\u003e\n\u003cp\u003eFigure 1 describes the experience of digitalization in health services. There are five themes: types of digital health, factors that must be considered when using digital health, obstacles to implementation, and the benefits of using digital health. The uses of digitalization in health services include electronic medical records and telehealth/telenursing. Factors that focus on leadership. Regulations, ethics, human resources, digital literacy education, infrastructure, and risk management. The advantages of digital health include time and cost efficiency. Effectiveness includes ease of access, inter-collaboration, integration, comprehensive care, and user-friendliness. The benefits of this development include marketing, research, and innovation.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDigital health refers to the use of technology to improve healthcare delivery and outcomes. Understanding user experiences in this context is crucial for ensuring that these technologies are effective and user-friendly. \u003cb\u003eBy examining the user experience, we can identify areas for improvement and optimize the design of digital health tools to better meet the needs of patients and healthcare providers.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe findings in this study indicated that there were five main themes: commonly utilized digital health types, variables influencing digital health implementation, advantages, and perceived barriers to digital health implementation, including EMRs.\u003c/p\u003e\u003cp\u003eThe electronic medical record was a keyword frequently submitted by the participants. One of the words often uttered by participants when asked about the types of health services that use digital technology in Indonesia is EMRs. From the study, many participants said that EMRs help in communication between health workers, inter-collaboration, and improving the quality of service. The findings of this research are consistent with previous results that EMRs have many advantages, including improved communication and inter-cooperation. EMRs can also improve documentation completeness, service quality, and clinical decision-making (Hariyati, et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Hariyati et al., 2021; Ngusie et al., 2022).\u003c/p\u003e\u003cp\u003eEMRs also improve safety and time efficiency and reduce paper and printing costs (Li et al., 2021; Wayan et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). By the time this study was conducted, the use of EMRs was mandatory in all health facilities in Indonesia (Ministry of Health, 2021). EMRs are needed because they can be implemented in the process of interoperability and the integration of both management and patient data. On the basis of this blueprint, one healthy Indonesian EMR development is controlled by digital transformation with various standardization activities, data integration and the creation of a digital ecosystem (Ministry of Health, 2021). A good EMR is expected to facilitate service continuity and improve the quality and speed of service (AriWinata \u0026amp; Hariyati, 2021; Hariyati et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Previous research results also revealed that the presence of EMRs can make it easier to supervise and monitor the safety of medication (Ratanto et al., 2021).\u003c/p\u003e\u003cp\u003eThe implementation of EMR has also reduced documentation time and facilitated inter-cooperation and intra and inter-health communications. This finding also supports previous research suggesting that EMR can bridge service continuity through ease of coordination in the health team (Wayan et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Time efficiency can also be implemented because EMRs provides checklist facilities and not all are written narratively (Winata \u0026amp; Hariyati, 2021; DeLisle et al., 2010). The use of codes is an important aspect that needs to be regulated so that the standardization of EMR can be ensured (Pryor et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Compared with a paper base, an EMR can also reduce costs because it can reduce the cost of printing forms.\u003c/p\u003e\u003cp\u003eEMR can also improve the quality of the service, with coding standardization, which is expected to be easier and user friendly, so it does not cause misinterpretation due to hard-to-read writing factors. The completeness and quality of documents also improve after EMRs is used so that comprehensive and continuous service can be implemented (Setyadi \u0026amp; Nadjib, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study also highlights the importance of EMRs as a part of marketing (Venkatraman et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). With digital health education also being implemented through technology, the scope of information can be expanded so that it can be a positive marketing tool for health facilities. In addition to marketing, it presents the opportunity to create EMRs big data as part of research and innovation development. With the analysis of big data, EMRs can be used as a source for clinical decisions, education, and research (Agrawal \u0026amp; Prabakaran, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Shahid \u0026amp; Sheikh, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eApart from EMRs, participants conveyed digital technology that has been used in Indonesia, including telehealth, telemedicine, telenursing, tele-homecare, tele-ICU, teleconsultation, and online reservations. The participants delivered various benefits from digital health. The benefits are related to the efficiency of time and cost in service delivery and follow-up care when home care is implemented. The results of this study are consistent with those of previous studies, which reported that the use of telenursing has an advantage in reducing the cost of travel to health facilities and can also reduce the efficiency of time (Putrawardana \u0026amp; Hariyati, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Sharma et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Telenursing is a technology-assisted service that can be used for follow-up care, monitoring, and making recommendations for patient care (Handiyani et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Telenursing can improve patient access to health services (Rintyarna et al., 2023). Telenursing is now being developed along with AI, and the use of AI in telenursing will help health care in clinical decision-making as a patient (Kamei, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Kurniawan et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Seibert et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003cb\u003eThe digital technologies that have been utilized in this study are telemedicine, teleconsultation, tele-ICU, tele-homecare and telenursing. Participants stated the advantages of telehealth, but also the disadvantages of not being able to have direct contact with health workers. This statement is in line with several studies that have been conducted previously that various experiences using telemedicine during the pandemic can improve services and reduce virus transmission (\u003c/b\u003eNejadshafiee et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).. \u003cb\u003eStudy participants also believed that telemedicine could facilitate patient monitoring (\u003c/b\u003eHandiyani et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Kamei, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2022\u003c/span\u003e\u003cb\u003e), thereby providing benefits not only to patients but also to providers (\u003c/b\u003eMarco-Franco et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; \u003cb\u003eBoro et al., 2019). Telenursing can also be used for patient education and health consultations (Martínez et al., 2023). The telemedicine facility saves time and trips to hospitals (\u003c/b\u003eSmith et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2020\u003c/span\u003ea). \u003cb\u003eResearch has shown that telenursing can be used to carry out follow-ups on patients with newborn babies\u003c/b\u003e (Kristiawati, Rustina, Budi, \u0026amp; Hariyati, 2022), \u003cb\u003eand telemedicine with artificial intelligence can also increase the ease of patient consultation with health services. Telemedicine is an opportunity to develop in an era of digitalization (\u003c/b\u003eKurniawan et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe factors that influence and hinder the implementation of digital health are almost identical. In this research, leaders should also establish regulations that can provide guidelines for staff, among other things related to how to write, report, and keep patient data confidential. Research previously conducted by a leader should be a role model in the implementation of EMRs (Burgess \u0026amp; Honey, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Egarter et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Laukka et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Regulations are also needed to regulate ethics, data security, and privacy as well as how to download and repair incorrect data (Ministry of Health, 2022; Laukka et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe ethical issue of digital use in health services was raised by participants. In detail, the study stated that the suboptimal regulation related to EMR data security risks confuses users. In addition, socialization related to data confidentiality and privacy needs to be socialized. Several previous studies conveyed that ethics also regulates confidentiality and how health forces use social media (Ahmead et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Dhiman, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). The practitioner hopes that there is an ethics of digital use to improve the quality of service and patient proximity and not leave the essence of caring (Ahmead et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Asiri et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Kuek \u0026amp; Hakkennes, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). These results are in line with Locsin’s finding that informational nursing is nursing care (Krel et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), which means that technology will improve patient care. Harmonious coherence must exist between the nurse and the patient when using technology (Egarter et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Hariyati et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Kongsuwan \u0026amp; Locsin, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eStudies have shown that as digital health becomes more widely used, attention to the human component becomes more significant. Human resources are the most frequently mentioned word when discussing factors that influence the success of EMRs implementation.The human factor consists of healthcare staff as digital health users and information technology support (Holt et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). According to some studies, digital literacy training is necessary in the healthcare industry. Education impacts how people adjust to digital health (Kuek \u0026amp; Hakkennes, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Zaharany et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The three components of digital health competency are information literacy, computer skills, and information and data management competency (TIGER, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2006\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eComputer skills are essential in implementing EMRs, so training in the use of hardware and software and computer skills are needed by health workers (Gómez Chova et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). There are many obstacles to implementing telenursing and EMRs due to low education levels s (Lee \u0026amp; Tak, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) and digital literacy skills (Martínez et al., 2023). Low levels of computer literacy make telenursing and EMRs implementation difficult. The study also suggested that training should be provided throughout the early stages of EMRs deployment (Martínez et al., 2023; Woldemariam \u0026amp; Jimma, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Zaharany et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePrevious research has shown that literacy digital training improved participants' perceptions of having ethics. attitude, being aware of the security and confidentiality of data, and using social media wisely (Hariyati et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In addition to user-provided healthcare, experts who can support system development, repair, and maintenance are required for the implementation of digital health. For the submission by Hariyati et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), a support system that includes adequately supported qualified resources is necessary (Hariyati et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAnother factor found in research related to barriers to digital health implementation such as EMRs is infrastructure. Factors such as networks, software, computers, and other tools influence the success of digital health use (Hariyati, Hamid, et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Navarro, et.al, 2023, Olajubu et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). The slow connection factor is still perceived as an obstacle to EMRs implementation, and the plethora of systems that need to be loaded and have no interoperability also complicates healthcare. Integration and interoperability are essential to ensure the continuity of health services (WHO, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2008\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Data integration enables data analysis, which facilitates clinical decision-making. The results of this research support those of previous studies that reported that the obstacles to implementing electronic health records are technical factors, such as slow networks, non-integrated systems, and redundancy in documentation (Boonstra \u0026amp; Broekhuis, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Wikansari \u0026amp; Santoso, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003cb\u003eLimitations\u003c/b\u003e \u003c/p\u003e\u003cp\u003e \u003cb\u003eThis research was an initial study that explored the experiences of digital health user stakeholders in health services. The study used eleven health worker participants and the FGD was only conducted in one round, so the data cannot yet be generalized. Most of the participants were nurses, midwives, doctors, medical recorders, and pharmacists. The participants did not represent all professions, and this weakness can lead to recommendations for further research. However, this research can serve as the initial data on the conditions for digital health implementation and become a basis for its development.\u003c/b\u003e \u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eExploration of experience in the use of digital health is necessary to understand digital implementation. The expansion results are input to the advanced mining steps of the implementation of digital health. The research results provide five themes: the types of digital health that have been frequently used; the factors that affect digital health implementation; benefits; perceived constraints; and recommendations related to what needs to be prepared in digital health. The research results convey several types of digital health that have been used in Indonesia are EMRs, telehealth, teleconsultation, telehome and online reservation. Many benefits are obtained including ease of access, increased quality of service, reduced costs, and research sources. The factors that must be prepared so as not to become a barrier in the implementation of EMRs are human resources, facilities, policies, leadership and literacy education. For the future research can continue to examine the long-term impact of digital health adoption on patient. outcomes.\u003c/p\u003e\u003cp\u003e \u003cb\u003eImplication for Practice\u003c/b\u003e \u003c/p\u003e\u003cp\u003e Healthcare organizations must prepare regulations and ethical guidelines for the use of digitalization in patient care, including guidelines for the use of EMRs. It is necessary to prepare adaptive leaders and prepare adequate infrastructure. Healthcare workers must learn digital literacy to successfully adopt and use electronic medical records, which will ultimately enhance patient outcomes and enable individualized therapy. Healthcare must embrace digital technologies if they are to advance, and prioritizing EMR adoption is a critical first step in that direction.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;: Artificial Intelligent\u003c/p\u003e\n\u003cp\u003eEMRs\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;: electronic medical record\u003c/p\u003e\n\u003cp\u003eFGD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;: focus group discussion\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate : This study was approved by the Ethical Board of the Faculty of Nursing, Universitas Indonesia KET-153/UN2.F12.D1.2.1/PPM.00.02/2023\u003c/p\u003e\n\u003cp\u003eConsent for publication : all the participants provided written informed consent, including\u003c/p\u003e\n\u003cp\u003efor publication\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eFig share. Dataset. https://doi.org/10.6084/m9.figshare.25942420.v1\u003c/p\u003e\n\u003cp\u003eThis project contains the following extended data: ethical approval.\u003c/p\u003e\n\u003cp\u003eFig share. Dataset. https://doi.org/10.6084/m9.figshare.25962871.v1\u003c/p\u003e\n\u003cp\u003eThis project contains the following extended data: \u003cem\u003eExplanation Sheet For Research\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;procedures\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003eFig share. Dataset. https://doi.org/10.6084/m9.figshare.25970938\u003c/p\u003e\n\u003cp\u003eThis project contains the following extended data: \u003cem\u003everbatim and thematic\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003eFig share. Dataset. https://doi.org/10.6084/m9.figshare.25970956\u003c/p\u003e\n\u003cp\u003eThis project contains the following extended data: \u003cem\u003eProcedure Operating Standard for\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;Group Discussion and Analysis (1)\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003eFig share. Dataset. https://doi.org/10.6084/m9.figshare.25970920 This project contains the following extended data: Standards for reporting qualitative Research\u003c/p\u003e\n\u003cp\u003eFigshare. Dataset. https://doi.org/10.6084/m9.figshare.27924465.v1\u003c/p\u003e\n\u003cp\u003eThis project contains the following extended data: Question of DMI FGD\u003c/p\u003e\n\u003cp\u003eCompeting Interests : No competing interests were disclosed\u003c/p\u003e\n\u003cp\u003eFunding : This work was supported by a PUTI H-I-2024 (NKB-\u003c/p\u003e\n\u003cp\u003e09/UN2.RST/HKP.05.00/grant from Universitas Indonesia).\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eAll the authors agree to be accountable for all aspects of the work and have contributed\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eRr Tutik Sri Hariyati *\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cem\u003eCorresponding Author, Conceptualization, Formal Analysis, Funding Acquisition, Writing \u0026ndash; Review \u0026amp; Editing\u003c/em\u003e\u003c/p\u003e\n\u003col start=\"2\"\u003e\n \u003cli\u003eHanny Handiyani\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cem\u003eData Curation, Formal Analysis, Writing \u0026ndash; Review \u0026amp; Editing\u003c/em\u003e\u003c/p\u003e\n\u003col start=\"3\"\u003e\n \u003cli\u003eMuhammad Hanif Amiruddin\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cem\u003eData\u0026nbsp;\u003c/em\u003e\u003cem\u003ecuration, translation\u003c/em\u003e\u003cem\u003e\u0026nbsp;and grammatical\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eediting\u003c/em\u003e\u003c/p\u003e\n\u003col start=\"4\"\u003e\n \u003cli\u003eAndi Amalia Wildani\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cem\u003eProject Administration, Writing \u0026ndash; Review \u0026amp; Editing\u003c/em\u003e\u003c/p\u003e\n\u003col start=\"5\"\u003e\n \u003cli\u003eTuti Afriani\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cem\u003eData Curation, Review \u0026amp; Editing\u003c/em\u003e\u003c/p\u003e\n\u003col start=\"6\"\u003e\n \u003cli\u003e\u003cu\u003eMin Huei HSU\u003c/u\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cem\u003eCollaborator,\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eReview \u0026amp; Editing\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAcknowledgements: Thank you to all the participants, facilitators, Arini, TWG, DTO Kemenkes and WICATERA team who were supported in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAgrawal, R., \u0026amp; Prabakaran, S. 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Six strategies for electronic medical records systems. \u003cem\u003eCommunications of the ACM\u003c/em\u003e, \u003cem\u003e51\u003c/em\u003e(11), 140\u0026ndash;144. https://doi.org/10.1145/1400214.1400243\u003c/li\u003e\n\u003cli\u003eVianney Boro, M. F., Tutik, R., \u0026amp; Hariyati, S. (2019). The Use of Telenursing through The Nursing Care. In \u003cem\u003eJENDELA NURSING JOURNAL\u003c/em\u003e (Vol. 3, Issue 2). http://ejournal.poltekkes-smg.ac.id/ojs/index.php/jnj/about/submissions#authorGuidelines\u003c/li\u003e\n\u003cli\u003eWayan, I., Saraswasta, G., Tutik, R., \u0026amp; Hariyati, S. (2018). The Implementation of Electronic-Based Nursing Care Documentation on Quality of Nursing Care: A Literature Review. In \u003cem\u003eInternational Journal of Nursing and Health Services (IJNHS)\u003c/em\u003e (Vol. 1, Issue 2).\u003c/li\u003e\n\u003cli\u003eWHO. (2008). \u003cem\u003eFramework and standards for country health information systems\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eWHO. (2021). \u003cem\u003eGlobal strategy on digital health 2020-2025\u003c/em\u003e. http://apps.who.int/bookorders.\u003c/li\u003e\n\u003cli\u003eWikansari, N., \u0026amp; Santoso, D. B. (2022). WHAT ARE THE BARRIERS TO THE IMPLEMENTATION OF ELECTRONIC MEDICAL RECORDS? A REVIEW OF RECENT STUDIES. \u003cem\u003eJurnal Riset Kesehatan\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e(2), 83\u0026ndash;88. https://doi.org/10.31983/jrk.v11i2.8611\u003c/li\u003e\n\u003cli\u003eWoldemariam, M. T., \u0026amp; Jimma, W. (2023). Adoption of electronic health record systems to enhance the quality of healthcare in low-income countries: A systematic review. \u003cem\u003eBMJ Health and Care Informatics\u003c/em\u003e, \u003cem\u003e30\u003c/em\u003e(1). https://doi.org/10.1136/bmjhci-2022-100704\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (2020). \u003cem\u003eGlobal Strategy on Digital Health\u003c/em\u003e. \u003cem\u003eMarch 2019\u003c/em\u003e. https://extranet.who.int/dataform/upload/surveys/183439/files/Draft Global Strategy on Digital Health.pdf\u003c/li\u003e\n\u003cli\u003eYayeh, F. A. (2021). Focus Group Discussion as a data collection tool in Economics. \u003cem\u003eDaagu International Journal of Basic and Applied Research (DIJBAR)\u003c/em\u003e, \u003cem\u003e3\u003c/em\u003e(1), 52\u0026ndash;61. https://dagujournal.org/index.php/dijbar/article/view/34\u003c/li\u003e\n\u003cli\u003eZaharany, T. A., Hariyati, R. T. S., \u0026amp; Anisah, S. (2021). Pengembangan Literasi Digital Keperawatan Dimasa Pandemi Covid-19: Case Study. \u003cem\u003eJurnal Kepemimpinan Dan Manajemen Keperawatan\u003c/em\u003e, \u003cem\u003e4\u003c/em\u003e(1). https://doi.org/10.32584/jkmk.v4i1.873\u003cstrong\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 2","content":"\u003cp\u003eTable 2 is available in the Supplementary Files section.\u003c/p\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"digital health, health services, Indonesia, healthcare accessibility, electronic medical records","lastPublishedDoi":"10.21203/rs.3.rs-5394530/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5394530/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eDigital literacy plays a pivotal role in accessing and utilizing health services, particularly in Indonesia's diverse and geographically dispersed population. This qualitative study delves into the landscape of digital health implementation in the Indonesian health sector. The results aim to understand the challenges and opportunities of leveraging digital technologies to improve healthcare accessibility and quality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e: Design research is a descriptive qualitative approach that involves focus group discussion to gather insights from healthcare providers, managers, and policymakers. Purposeful sampling was used to guarantee representation across various positions and demographic groups. Thematic analysis was employed to identify trends and themes associated with digital use.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The findings revealed five themes. The findings highlight the varying experiences among stakeholders, which are influenced by factors such as leadership, staff competency, regulation, and technological infrastructure. Many benefits of digital health care for quality of care, such as telemedicine and electronic medical records. Moreover, the study revealed barriers hindering the adoption of digital health solutions, including concerns about data privacy, technological literacy, and ethical preferences.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications\u003c/strong\u003e: Recommendations are proposed to enhance digital literacy in the health sector, including tailored training programs, improved leadership, and policy interventions to promote equitable access to digital healthcare services across Indonesia.\u003c/p\u003e","manuscriptTitle":"Exploring Stakeholder Experiences with Electronic Medical Records in Indonesia's Digital Health Transformation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-10 04:55:28","doi":"10.21203/rs.3.rs-5394530/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f442956e-020a-42f5-8c13-933d24393307","owner":[],"postedDate":"April 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-15T10:24:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-10 04:55:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5394530","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5394530","identity":"rs-5394530","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}