Readiness of Health Centers in Southwest Sumba Regency in Implementing Electronic Medical Records Ronaldus Asto Dadut * 1 .
Ayu Trinugrahani Steven 2 1,2 Bakti Sumba Health Polytechnic.
Jl.
Yos Sudarso Ae Ledegiring.
Radamata.
Kota Tambolaka District.
Southwest Sumba Regency.
East Nusa Tenggara, 87255 Author's Email Correspondence ( * ): ronaldasto11@gmail.
ABSTRACT
The implementation of Electronic Medical Records (EMR) is a key strategy to improve the quality, accuracy, and efficiency of healthcare services.
However, its success largely depends on the organizational readiness and technical capacity of health facilities.
East Nusa Tenggara, including Southwest Sumba Regency, faces challenges such as limited internet access, inadequate health information infrastructure, and a shortage of trained health information personnel, making a readiness assessment essential prior to EMR adoption.
This study aims to analyze the readiness of Community Health Centers (Puskesma.
in Southwest Sumba Regency using the DoctorsAo Office QualityAeInformation Technology (DOQ-IT) instrument and to examine differences in readiness across facilities using One-Way ANOVA.
This cross-sectional study involved 79 respondents from 16 Puskesmas.
Data were collected using a validated and reliable DOQ-IT questionnaire and analyzed descriptively and inferentially.
The findings show that overall EMR readiness is at a fairly ready, with strengths in organizational culture, leadership, strategic planning, workflow processes, staff capacity, and IT management.
However, three critical components, information management, accountability, and IT infrastructure, remain insufficiently prepared.
The One-Way ANOVA results indicate no significant differences in readiness between Puskesmas .
> 0.
, suggesting that capacity-building efforts can be implemented uniformly at the district level.
Overall, this study highlights that successful EMR implementation requires strengthening both technical and organizational governance components, particularly in resource-limited settings such as Southwest Sumba Regency.
Keywords : electronic medical record.
DOQ-IT.
health center.
ANOVA.
and Southwest Sumba.
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Article history :
Tadulako University Received : 29 07 2025 Address:
Accepted : 24 12 2025 Jl.
Soekarno Hatta KM 9.
Kota Palu.
Sulawesi Tengah.
Indonesia.
licensed by Creative Commons Attribution-ShareAlike 4.
0 International License.
Phone: 6282197505707 Email: preventifjournal.
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PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR 3
INTRODUCTION
Electronic Medical Record Systems (EMRS) are increasingly being adopted in both developed and developing countries because they are able to improve the effectiveness of services, the accuracy of clinical documentation, and the efficiency of medical decision-making.
In Indonesia, the implementation of EMR has been made mandatory through the Minister of Health Regulation No.
24 of 2022, which requires all health service facilities, including Community Health Centers, to implement EMR no later than December 31, 2023.
However, the realization is still low, namely around 49% of Community Health Centers still record data manually and 21 provinces are below the national average in its implementation.
In eastern Indonesia.
Community Health Centers (Puskesma.
are the most widely used health facilities, including in East Nusa Tenggara (NTT) Province.
Southwest Sumba Regency, which has a high prevalence of stunting, malaria, and diarrhea, relies on Community Health Centers as the frontline of health services.
However, this region also faces limitations in IT infrastructure and internet access, as well as a lack of health workers with health information system competencies, which can hinder the effectiveness of EMR implementation.
Assessing community health center readiness is a key step before implementing EMR to ensure the digitalization process does not create technical or operational One widely used instrument is the Doctors' Office QualityAeInformation Technology (DOQ-IT), which assesses various aspects of organizational and technical readiness, such as culture, leadership, strategy, information management, training, accountability, and IT support.
This instrument has been proven effective in identifying weak components and providing a basis for developing interventions.
The readiness to implement electronic medical records in health services needs to be analyzed so that PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR 3 it does not cause obstacles when electronic medical records are properly .
Conducting a readiness analysis or assessment is fundamental before implementing electronic medical records, because it can help identify processes and priority scales, as well as form operational roles in supporting the optimal implementation of electronic medical records.
The implementation of EMR requires the support of resources, competent health workers, and adequate information technology infrastructure.
However, the Ministry of Health's 2021 mapping shows that there are still 745 Community Health Centers in 229 districts or cities that experience difficulties or even no internet access.
The four provinces with the lowest quality of internet access are East Nusa Tenggara.
North Maluku.
West Sulawesi, and Papua.
In addition, only 2.
19% of Community Health Centers have health workers with special competencies in the field of health information, so that human resource readiness remains a major challenge.
This condition illustrates that Southwest Sumba Regency, which is in an area with limited internet access and a minimum of trained personnel, requires a comprehensive readiness assessment before EMR can be optimally implemented.
Several previous studies have assessed the readiness of health facilities to implement EMR using the DOQ-IT instrument.
Ariani examined the readiness of Community Health Centers in Denpasar City and showed that most DOQ-IT items were in the ready category, with weaknesses in the training and IT infrastructure aspects.
Meanwhile.
Masyfufah assessed the readiness of Community Health Centers in Surabaya and found that accountability and information management were components that needed priority strengthening.
Hastuti's research on Community Health Centers in Boyolali Regency also identified variations in readiness between DOQ-IT items and emphasized the importance of organizational readiness before implementing EMR.
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While these studies provide important insights into RME readiness in various regions, two gaps remain under-explored.
First, the three previous studies were conducted in areas with relatively better infrastructure, thus not reflecting conditions in resource-constrained areas like Southwest Sumba Regency.
Second, previous studies generally focused solely on assessing readiness using the DOQ-IT, but failed to examine differences in readiness across community health centers (Puskesma.
through inferential analysis.
Understanding variations across community health centers is crucial for determining whether intervention strategies should be centralized or unit based.
Thus, this study has new contributions by .
analyzing EMR readiness in the context of underdeveloped areas with high disease burden and limited IT infrastructure, and .
statistically testing differences in readiness between Community Health Centers, so that it can provide more comprehensive empirical evidence for planning the digitalization of health services.
METHODS
Participants and Study Design This type of research is descriptive research with a quantitative approach.
This research was conducted on all health centers in Southwest Sumba Regency, totaling 16 health centers.
The research took place from January 2024 to July 2024.
The population of this study was all health workers in health centers in Southwest Sumba Regency.
Sampling was carried out using simple random sampling, namely samples were taken randomly from health workers in health centers in Southwest Sumba Regency.
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Measurement and Procedures Data collection was conducted using a questionnaire distributed to health workers in health centers via Google Form.
Researchers distributed questionnaires to every health worker in 16 health centers in Southwest Sumba Regency and 79 questionnaires were filled out and eligible for research.
Readiness for implementing electronic medical records in this study was measured using the DOQ-IT instrument, which consists of 2 variables, namely organizational alignment and organizational capacity.
Organizational alignment consists of aspects of cultural readiness, leadership readiness, and strategic readiness.
In organizational capacity, it consists of aspects of information management readiness, clinical and administrative staff readiness, training readiness, workflow process readiness, accountability readiness, financial and budget readiness, patient involvement readiness, information technology support and management readiness, and information technology infrastructure readiness.
In the organizational alignment variable, there are 8 questions, while the organizational capacity variable has 20 questions.
The total research questionnaire consists of 28 questions with answer points ranging from 0 to 5.
These answer points indicate three stages of readiness, namely not ready for answers 01, quite ready for answers 2-3, and very ready for answers 4-5.
The questionnaire used has also passed the feasibility test procedure through a validity test using Pearson correlation and is declared valid if the calculated r> r -table .
at = 0.
The test results for 28 statements show a calculated r value of 525 - 0.
952 which is greater than 0.
221, so that each statement in this study can be declared valid.
In addition, a reliability test was carried out using Cronbach's Alpha, and all indicators showed an value .
Ou 0.
70 which indicates a reliable instrument.
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Statistical Analysis and Research Ethics The data obtained were analyzed descriptively and inferentially using IBM SPSS Statistics software version 26.
Descriptive analysis was conducted using the Doctor's Office QualityAeInformation Technology (DOQ-IT) method to assess the level of readiness of Community Health Centers in Southwest Sumba Regency in implementing EMR.
Furthermore, inferential analysis was conducted using the One-Way ANOVA test to determine whether there were differences in the level of readiness for implementing EMR among the 16 Community Health Centers in Southwest Sumba Regency.
RESULTS
Respondent Characteristics This study involved health workers from 16 health center in South West Sumba Regency.
Based on the results of the survey conducted, there are 79 questionnaires Of the 79 questionnaires known Kori Health center to become the largest medical personnel, namely a number of 12 medical personnel.
Radamata Health center there are 9 medical personnel involved, then Palla Health center and Waimangura each have 8 medical personnel involved.
If Cenge has 7 medical personnel.
Bondo Kodi and Kawango Hari Health center each have 6 medical personnel involved.
Elopada Health center has 5 medical personnel.
Delu Depa Health center and Walla Ndimu each have 3 medical personnel involved.
Watu Kawula Health center has 2 medical personnel involved, then Tena Teke Health center.
Tenggaba.
Weekombak, and Weri Lolo each have 1 medical personnel involved.
In more detail the characteristics of the 79 medical personnel involved in the study are shown in Table 1 following.
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Table 1.
Characteristics of Respondents Characteristics Number .
Gender Male Female Age 17 Ae 25 years old 26 Ae 35 years old 36 Ae 45 years old 46 Ae 55 years old 56 Ae 65 years old Responsibility Dentist General Practitioner Head of the health center Head of Administration Pharmacy Emergency Installation Laboratory Registration General Inpatient Clinic Outpatient Clinic Length of Work < 1 years 1-3 years > 3 years Education Diploma i Master (S.
Bachelor (S.
Source : Primary Data, 2024 Percentage (%) PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR 3 Based on the descriptive analysis shown in Table 1, medical personnel involved mostly female sexes total 61 people or 77.
2 percent.
The medical personnel involved mostly have a range of ages 26 to 35 years, which is still included in the millennial generation of 49 people or 62 percent.
The responsibility or position of most medical personnel involved in the study are the Head of Administration and the Registration .
each, or 16.
5 percent.
The length of work of most medical personnel involved is more than 3 years a total of 55 people or 69.
The last education of most medical personnel involved in the study was graduates of Diploma i of 46 people or 58.
2 percent.
Therefore, it can be explained that most medical personnel of the Health center in South West Sumba Regency are medical personnel included in millennial generation that are easy to communicate and open with sufficient experience in the positions that are underway.
Analysis of Readiness for Implementation of Electronic Medical Records (EMR) Using DOQ-IT Components This study measures the readiness to implement EMR in community health centers in Southwest Sumba Regency using the DOQ-IT method.
Table 2.
Health center Conditions to Assess EMR Application Readiness Category Score
Range Readiness Health center alignment for RME
16 Ae 30
Quite ready Health center capacity for RME
34 - 66
Quite ready Source : Primary Data, 2024 Based on the DOQ-IT analysis results in Table 2, the level of preparedness of Community Health Centers in Southwest Sumba Regency is categorized as moderately prepared, both in terms of organizational alignment .
and institutional capacity and infrastructure .
This indicates that, in general.
Community Health Centers have a strategic direction and basic resources for EMR implementation, but still need strengthening in technical and managerial aspects.
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Table 3.
Readiness of 12 Items in Health center South West Sumba Regency Category Score
Range Readiness Culture 3,25 2Ae3
Quite ready Leadership
3,15
2Ae3
Quite ready Strategy 3,42 2Ae3
Quite ready Information Management 1,98 0Ae1
Not ready Clinical and administrative staff
2,43
2Ae3
Quite ready Training 2,84 2Ae3
Quite ready Workflow process
2,57
2Ae3
Quite ready Accountability 1,95 0Ae1
Not ready Finance and budget
2,54
2Ae3
Quite ready Patient Engagement
2,08
2Ae3 Quite ready IT support and management 2,58 2Ae3 Quite ready IT Infrastructure 1,90 0Ae1 Not ready Source : Primary Data, 2024 Based on the assessment using the DOQ-IT instrument, the readiness for implementing EMR in Community Health Centers in Southwest Sumba Regency was evaluated through 12 main aspects that describe organizational conditions, work processes, and information technology support.
The analysis results are presented in Table 3 and show variations in the level of readiness between aspects.
In general, the majority of aspects are in the moderately ready category, indicating that most Community Health Centers have the basic foundations for adopting EMR.
These aspects include organizational culture .
, leadership .
, strategy .
, clinical and administrative staff .
, training .
workflow processes .
, finance and budget .
, patient engagement .
, and IT support and management .
These findings indicate that the Community Health Center has a policy direction, planning, and organizational culture that supports the digitalization of services, accompanied by efforts to improve staff competency and operational readiness in implementing the EMR
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However, three critical aspects are categorized as not ready: information management .
, accountability .
, and IT infrastructure .
Low scores in these three aspects indicate that the data management system, internal accountability mechanisms, and information technology facilities and infrastructure are inadequate to optimally run the electronic medical records system.
Weaknesses in the IT infrastructure indicate limitations in hardware, networks, and other technical facilities, while weak information management and accountability indicate the absence of operational standards and good data governance.
Analysis of Differences in Readiness for Implementing Electronic Medical Records (EMR) in Community Health Centers in Southwest Sumba Regency After conducting descriptive analysis using the DOQ-IT, this study continued the analysis process with an inferential test using One-Way ANOVA.
The purpose of this analysis was to determine whether there were differences in the level of readiness for implementing EMR among the 16 Community Health Centers (Puskesma.
that served as the study sites.
Table 4.
Homogeneity Test Results Levene Statistic df1 df2 Sig.
11 63 0.
Source : Primary Data, 2024 The test results showed a Levene Statistic value of 1.
165 with a significance level of 0.
Since the p-value is > 0.
05, it can be concluded that the data has homogeneous variance.
This condition meets the ANOVA assumptions, so the difference test analysis can proceed.
Table 5.
ANOVA Test Results Sum of Squares df Mean Square F Sig.
Between Groups Within Groups Total
Source : Primary Data, 2024
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The ANOVA test results showed an F value of 1.
375 with a p value of 0.
> 0.
This finding indicates that there is no significant difference in the level of RME readiness between Community Health Centers.
Therefore, although there are variations in readiness scores at each Community Health Center, these differences are not statistically significant enough to indicate differences in readiness between regions.
Overall, the ANOVA results strengthen the descriptive findings that the readiness of Community Health Centers is generally at a relatively similar level, so that interventions to improve RME readiness can be carried out evenly across all Community Health Centers.
DISCUSSION
Research aims to know the readiness of implementing electronic medical records in the Health center in South West Sumba Regency.
Electronic medical records or RME is a medical record that uses electronic systems.
In the Regulation of the Minister of Health (Permenke.
No.
24 of 2022 Article 3 paragraph 1 and 2 explained that each health facility has an obligation to organize an electronic medical record, the health facility in question is Health center.
On the other hand, the health center in South West Sumba Regency has not applied electronic medical records.
Therefore, this study was conducted to measure the readiness of the health center in South West Sumba Regency in applying electronic medical records.
The method used is the DOQ-IT method.
The results of the readiness measurement for the implementation of Electronic Medical Records (EMR) in the Community Health Centers of Southwest Sumba Regency using the DOQIT instrument indicate that in general, the community health centers are in the moderately prepared category both in terms of organizational alignment and organizational capacity.
These findings indicate that the initial foundation for the transition from paper medical records to EMR has been formed, especially in aspects of organizational culture, leadership, strategy.
PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR 3 training, and IT management support.
However, several gaps remain that could hinder successful implementation if not anticipated.
A more detailed review of the 12 DOQ-IT categories reveals that most aspects are in the moderately prepared category, including culture, leadership, strategy, clinical and administrative staff, training, workflow processes, finance and budgeting, patient engagement, and IT support and management.
However, three aspects remain in the not-ready category:
information management, accountability, and IT infrastructure.
This pattern indicates that the organization's soft-side readiness, consisting of commitment, leadership, and training, is relatively better than its hard-side readiness, which relates to information systems, accountability mechanisms, and the availability of IT infrastructure.
In fact, research results from Ariani et al.
confirm that the availability of reliable infrastructure and information systems is a key factor in the success of RME as the backbone of clinical recording and managerial decision-making.
From a Technology Acceptance Model (TAM) perspective, this situation can be explained by the fact that culture, leadership, strategy, training, and workflow processes are external variables that shape the perceived usefulness and perceived ease of use of EMR among healthcare workers.
When leadership supports, training is provided, and workflows begin to be aligned, healthcare workers tend to perceive EMR as useful and easier to use.
Conversely, weaknesses in information management, accountability, and IT infrastructure have the potential to reduce perceived usefulness and ease of use, as users will doubt the system's reliability, such as data quality, security, and continuity of service, and feel that using the system actually increases their workload.
Within the TAM framework, low perceptions of usefulness and ease of use will ultimately hinder behavioral intentions and actual use of EMR.
The results of the one-way ANOVA analysis showed a relatively even pattern of readiness across all community health centers in Southwest Sumba Regency.
In other words, no one or two community health centers were significantly more prepared or significantly lagging behind
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the others.
This is important from a policy perspective, as it suggests that interventions to improve EMR readiness should be designed at the district level through the Health Office, such as joint policies, integrated infrastructure procurement, .
and cross-community health center training programs, rather than just partial interventions at one or two facilities.
When compared with previous research, these findings are relatively consistent but at a slightly lower level of readiness.
Hastuti et al.
's study at Community Health Centers in Boyolali Regency showed that the level of readiness for RME implementation was in the very ready category with a total score of around 101 points, with the main strengths being human resources, work culture, leadership, and infrastructure that were considered mature.
Meanwhile.
Ariani et al.
who analyzed the readiness for RME implementation at the UPTD Community Health Center i North Denpasar also reported a very ready condition, with an average DOQ-IT score of 116.
1, which fell into the i range.
Specifically, the human resources component was categorized as quite ready, while the organizational work culture, governance and leadership, and IT infrastructure were already in the very ready category.
Compared to these two locations, the community health centers in Southwest Sumba Regency are one level below.
The difference lies primarily in their weak IT infrastructure and information management, while Boyolali and Denpasar already have more established hardware, networks, and information governance.
Furthermore, the lack of accountability in Southwest Sumba indicates that the mechanisms for determining roles, procedures, and contracts with vendors are not as clear as in the cases in Surabaya and Denpasar.
Other research confirms that clear roles and responsibilities are crucial for the sustainability of EHR This research finding also overlaps with Masyfufah and Uktutias' study on the readiness of the Surabaya City Health Office to face the Electronic Health Record (EHR) era.
Using the DOQ-IT approach, the study found an organizational alignment score of 36 and an organizational capacity score of 68 for a total score of 104, which is categorized as quite strong, but still highlights areas for strengthening, such as the uneven use of E-Health and the need to PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR 3 optimize the roles of clinical and IT staff.
A similar pattern was seen in Southwest Sumba Regency, where the culture, leadership, and strategy were quite conducive, but technical and systemic readiness, especially infrastructure, information management, and accountability, still requires stronger policy support and investment at the district level.
When linked back to the TAM, the combined DOQ-IT and ANOVA test results provide a more comprehensive picture of healthcare workers' perceptions of the usefulness and ease of EMR, which are not solely determined by application features but also by the surrounding ecosystem, from community health center leadership and training availability to infrastructure support and the certainty of work procedures.
In Southwest Sumba, organizational aspects that are already sufficiently prepared have the potential to be important capital for building perceived usefulness.
EMR is considered capable of accelerating reporting and improving data However, weaknesses in information management, accountability, and infrastructure can reduce perceived ease of use because healthcare workers are at risk of encountering a slow, unstable system or unclear procedures.
If this condition is not immediately intervened, there is concern that the actual adoption of RME will not be optimal, even though national regulations require RME implementation in healthcare facilities.
Implication Practically, the results of this study imply that the strategy for strengthening RME readiness in Southwest Sumba Regency is not sufficient to focus only on end-user training, but must also include: .
the development of clear accountability policies and procedures .
ncluding roles, vendor contracts, and evaluation mechanism.
, .
adequate and equitable IT infrastructure investment among community health centers, and .
strengthening the information management system so that RME data is truly utilized for planning, monitoring, and improving service quality.
Improvements that can be made include establishing clearer work procedures and role allocations, developing contracts and vendor performance PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR 3 evaluation mechanisms, strengthening data management and validation standards, and providing more stable hardware and internet connections across all community health centers.
By improving these three areas of concern, it is hoped that perceptions of usefulness and ease of use will increase, which in turn will encourage healthcare workers' intentions and behavior to use EMR consistently and sustainably.
Theoretically, this study also strengthens the Technology Acceptance Model (TAM) framework, where factors in the DOQ-IT act as external variables that influence perceived usefulness and perceived ease of use.
When information infrastructure and management are weak, perceptions of usefulness and ease of use also decrease, thus affecting healthcare workers' intentions to adopt EMR.
The results of the t-test conducted showed no differences in readiness between Community Health Centers (Puskesma.
, providing theoretical insight that digital readiness can be analyzed as a collective phenomenon at the district level, not just at the individual facility level.
Thus, this study enriches the literature on organizational readiness and health technology adoption in primary care facilities.
This study has several limitations.
Among them, it only assessed readiness based on the DOQ-IT instrument.
Therefore, other aspects that could potentially influence the success of RME implementation, such as regulatory readiness, the districtAos digital ecosystem, regional budget support, and vendor capacity, were not analyzed in depth.
Although the sample included all Community Health Centers (Puskesma.
in Southwest Sumba Regency, the number of respondents per Puskesmas was not balanced.
The cross-sectional design of the study did not allow researchers to observe changes in readiness over time or measure the impact of specific CONCLUSIONS AND RECOMMENDATIONS This study shows that overall.
Community Health Centers in Southwest Sumba Regency are in the moderately prepared category for implementing Electronic Medical Records (EMR).
PREVENTIF: JURNAL KESEHATAN MASYARAKAT VOLUME 16 NOMOR 3 both in terms of organizational alignment and institutional capacity.
Most DOQ-IT aspects have demonstrated adequate readiness, such as organizational culture, leadership, strategy, training, work processes, patient engagement, and IT support and management.
However, there are three critical components that are still in the unprepared category: information management, accountability, and IT infrastructure, which have the potential to hinder the successful implementation of EMR if not immediately addressed.
The results of the inferential test using One-Way ANOVA indicate that the level of readiness between Community Health Centers does not differ significantly, so that improvements can be addressed through a policy approach at the district level.
This study confirms that readiness for EMR implementation is not only influenced by technical aspects, but also organizational factors, governance, and the digital ecosystem that supports the sustainable use of EMR.
Several practical recommendations that can be carried out by the Community Health Center and the Southwest Sumba District Health Office are strengthening information management, improving Information Technology infrastructure, strengthening organizational accountability, carrying out district-based interventions, not per health center, the Health Service can create policies and programs to increase readiness in an integrated manner, including joint training, centralized procurement, and cross-health center monitoring.
BIBLIOGRAPHY