International Journal of Health and Medicine

E-ISSN: 3047-793X
P-ISSN: 3047-7948

Research/Review) Article

Evaluation of Hospital Management Information System
(HMIS) Implementation to Improve Service Quality at
Mother and Child Hospital
Annisa Wahyuni1*, Nurhasanah Nasution2, Riana Oktarina3
1-3Medical Records and Health Information Management, APIKES IRIS, Indonesia

* Corresponding Author: annisawahyuni@apikesiris.ac.id 1
Abstract: The Hospital Management Information System (SIMRS) is a key component in the digital
transformation of healthcare services, aiming to enhance efficiency and service quality. This study
evaluates the implementation of SIMRS at Mutiara Bunda Mother and Child Hospital and explores the
challenges and opportunities for improvement. A qualitative case study approach was employed, with
data collected through in-depth interviews, observations, and document reviews involving five key
informants, including the medical records head, medical service manager, registration officers, and IT
staff. The results show that the SIMRS covers registration, procedure input, laboratory, and pharmacy
functions. However, issues such as delayed data entry by medical staff, limited equipment, lack of
integration across service units, and absence of written user guidelines and regular training persist. The
study concludes that although the SIMRS is in use at RSIA Mutiara Bunda, system optimization, staff
capacity building, and stronger managerial support are crucial to fully realize its potential in improving
service quality.
Keywords: Digital Health; Electronic Medical Records; Hospital Services; SIMRS; System
Evaluation

1. Introduction

Received: 22 September 2025
Revised: 06 October 2025
Accepted: 20 October 2025
Published: 24 October 2025
Curr. Ver.: 24 October 2025

Copyright: © 2025 by the authors.
Submitted for possible open
access publication under the
terms and conditions of the
Creative Commons Attribution
(CC BY SA) license
(https://creativecommons.org/li
censes/by-sa/4.0/)

A hospital is a healthcare service organization that enables various trained and educated
personnel to handle and manage health issues to restore and maintain health. Information
technology plays a crucial role in today’s healthcare services. The quality of information
processing is a key success factor for healthcare service organizations. A good information
system can support clinical workflows in many ways, thus contributing to better patient care
(Pane et al., 2023). In the current digital era, Hospital Management Information Systems
(HMIS) play an essential role in supporting clinical processes, decision-making, and
competitive strategies.
In Indonesia, this is regulated under Law No. 44 of 2009 concerning hospitals, in which
every hospital is required to conduct recording and reporting of all hospital operations in the
form of a Hospital Management Information System (HMIS). Therefore, every hospital is
obligated to implement HMIS using open-source systems (Dewi et al., 2021).
According to the Ministry of Health Regulation No. 82 of 2013, HMIS is an
information technology system that integrates all hospital service processes into a network of
coordination, reporting, and administrative procedures. HMIS aims to ensure fast, accurate,
and precise information. Its functions include collecting, storing, processing, and
documenting data related to patient services and hospital performance. However, the
implementation of HMIS in several hospitals often encounters obstacles such as issues in
standard operating procedures (SOP), unclear roles and organizational functions, and lack of
managerial oversight (Theo et al., 2024).

DOI : https://doi.org/10.62951/ijhm.v2i4.527

https://international.arikesi.or.id/index.php/IJHM

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A hospital accreditation team from the Indonesian Ministry of Health in 1998 found
that 90% of regional general hospitals lacked a reliable management information system. The
existing systems were only used for routine reporting to the health office. Consequently, "the
standard service quality assurance in hospitals could not be consistently applied, making it
impossible to ensure service quality." This caused stagnation in service indicators and
hindered any potential progress (Darmawan, 2021). As of December 2021, the Ministry of
Health reported that 3,120 hospitals were registered; 1,862 hospitals had implemented HMIS
effectively, 169 had implemented it but it wasn’t functioning well, and 1,089 hospitals had not
implemented it yet (Syafira et al., 2024).
A study (Arifin et al., 2023) at Rafflesia Hospital in Bengkulu found that 80% rated the
system performance as good, and 20% rated it as poor. 90% of the generated information
was considered good, while 10% was not. Data security was rated good by 60% and poor by
40%. An initial survey conducted at Mutiara Bunda Hospital showed that the hospital had
already implemented HMIS including the use of electronic medical records, but it was not yet
fully operational or well-integrated. This condition prompted the researchers to conduct this
study.

2. Related Word or Literature Review

Research results (Arifin et al., 2023) at Rafflesia Hospital Bengkuli obtained an
evaluation from the system performance aspect showing that the system performance was
good by 80% and considered not good by 20%. The information generated was good by 90%
and not good by 10%. Data security was good by 60% and not good by 40%.
Medical Record
Based on the Regulation of the Minister of Health concerning Medical Records No.
269 of 2008, a medical record is a file containing notes and documents about the patient's
identity, examinations, treatments, procedures, and other services that have been provided to
the patient. According to the Regulation of the Minister of Health of the Republic of
Indonesia No. 24 of 2022 (Kemenkes RI, 2022) regarding medical records, an Electronic
Medical Record is a medical record created using an electronic system intended for the
administration of medical records.
The purposes of maintaining medical records are: 1. to improve the quality of
healthcare services; 2. to provide legal certainty in the administration and management of
medical records; 3. to ensure the security, confidentiality, integrity, and availability of medical
record data; and 4. to realize the administration and management of digital and integrated
medical records (Permenkes RI, 2008).
Hospital Management Information System
Gene E. Thompson and Iva Handelman in 1978 simply described the importance of
information in hospital management by focusing on the medical service management process.
According to them, medical service management is a continuously repeating cycle. Hospital
management essentially consists of three stages: (1) strategic planning conducted by top
management, (2) managerial control carried out by middle managers, and (3) operational
control performed by operational management (Darmawan, 2021).
According to the Standard Accreditation Instrument book, 1st edition, 2022,
information technology systems in healthcare services consist of a set of arrangements that
include data, information, indicators, procedures, technology, devices, and human resources
that are interconnected and managed in an integrated manner to guide actions or decisions
that are useful in supporting the improvement of service quality and health development. To
achieve optimal results in the implementation of a health information system, a Hospital
Information Management System (SIMRS) is required, serving as a medium in the form of
information and communication technology systems that process and integrate all hospital
service workflow processes through coordination networks, data collection, reporting, and
administrative procedures to obtain information accurately and appropriately.
Hospital Management Information System (HMIS) is a system that functions as a
comprehensive information system managing all hospital administrative processes, including
patient diagnosis and treatment services, medical records, pharmacy, drug inventory, billing,
human resource databases, employee payroll, and accounting functions. This system is

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designed to be monitored by management. The implementation of HMIS in hospitals can
address various challenges (Pane et al., 2023).

3. Proposed Method

This research was conducted at Mutiara Bunda Mother and Child Hospital from
February to April 2025. It used a qualitative design. Informants were selected through
purposive sampling. Data collection methods included observation, interviews, and
document review.

4. Results and Discussion

Based on the observations conducted by the researcher, the findings regarding HMIS
implementation at Mutiara Bunda Mother and Child Hospital are summarized in Table 1.
Table 1. Observation Results of the Evaluation of Hospital Management Information
System (HMIS) Implementation at Mutiara Bunda Mother and Child Hospital.
No Variabel yang diteliti Ada Tidak ada
Keterangan
1 Tesks
a. Patient data input
item
Item is available in HMS
b. Diagnosis item
V
Item is available in HMS
c. Procedure item
V
Item is available in HMS
d. Medication item
V
Item is available in HMS
e. Polyclinic
V
HMIS is not yet integrated with the
integration
V
polyclinic unit
2 Technology
a. Server
b. Network
c. Computer
d. Keyboard
e. Mouse
f. Training and
Socialization
g. HMIS user manual
3 Profile Suitability
a. Service status
b. Report
4 Perfomance
a. Fast service
b. Accurate reports

V
V
V
V
V
V
V

Server is available
Network is available
Computer is available
Keyboard is available
Mouse is available
HMIS training and socialization have
been conducted
No HMIS user manual or guidebook
available

V
V

Service status is available in HMIS
Reports are available in HMIS

V
V

Service using HMIS is fast
Reports from HMIS are accurate

Based on the observation results in Table 1 conducted by the researcher at Mutiara
Bunda Mother and Child Hospital, the Hospital Management Information System (HMIS)
used is considered adequate both in terms of menu features that support staff tasks and the
tools required to operate the system. However, the HMIS has not yet been integrated with
several units that are deemed crucial for hospital services, such as the polyclinic unit.
Additionally, there is no user manual available, and no specific training or socialization has
been conducted regarding the use of the HMIS for registration officers who utilize the system
in performing their duties.
Interview Results
This study was conducted at Mutiara Bunda Mother and Child Hospital. There were
five informants interviewed by the researcher, consisting of the Head of Medical Records, the
IT Officer, and three registration staff. The characteristics of the informants in this study are
presented in Table 2 as follows:

International Journal of Health and Medicine 2025 (October), vol. 2, no. 4, Wahyuni, et al.

Informant
No
Code
1

Informant
1 (Inf-1)

2

Informant
2 (Inf-2)

3

Informant
3 (Inf-3)

4

Informant
4 (Inf-4)

5

Informant
5 (Inf-5)

Table 2. Characteristics of research informaant.
Last
Position
Age
Education
Associate
Degree in
Head of Medical Records
24 years
Medical
Records
Medical
and
Nursing
Bachelor of
44 years
Services Manager
Medicine
Associate
Degree in
Registration Officer
25 years
Medical
Records
Associate
Degree in
Registration Officer
25 years
Medical
Records
Bachelor of
IT Officer
23 years
Science (S.Si)

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Gender
Female
Female
Female

Female
Male

This research was conducted at Mutiara Bunda Mother and Child Hospital. Five
informants were interviewed, consisting of the Head of Medical Records, the IT Officer, and
three registration officers. The information obtained from the interviews regarding the
implementation of the Hospital Management Information System (HMIS) at Mutiara Bunda
in 2024 is summarized as follows:

Medical Record Management and Completion Workflow
The workflow starts from patient registration, recording medical data, to archiving—both in
physical and digital forms via HMIS. All informants stated that the medical record completion
procedure has a clear workflow. However, there are still obstacles in its implementation,
particularly regarding delayed documentation and file returns from the treatment rooms due
to the transition from manual to electronic systems.
"The workflow already has an SOP, but the medical team often delays filling out medical records, so we face
difficulties during the archiving process." (Inf-1). "Sometimes doctors prioritize patients, so documentation is
delayed. We often discuss this in meetings." (Inf-2).
The interviews revealed that RSIA Mutiara Bunda already has standard operating
procedures (SOPs) for the medical record workflow, from registration to archiving, manually
and via HMIS. However, delays remain a challenge, especially since the transition from
manual to electronic systems hasn’t been smooth. This is common in health facilities
implementing digital systems, where changing healthcare workers’ behavior becomes a key
challenge (Putri et al., n.d.).
Delays are also affected by the priority given to direct patient care, causing postponed
documentation. This is in line with (Agustina, 2022) who noted that workload and time
constraints are major barriers to timely medical record completion.

Policy, Evaluation, and Monitoring of Medical Records
Policies to ensure the completeness and timeliness of medical record filling have been
implemented, including the obligation to fill in records within a maximum of 2x24 hours after
service. Evaluations are carried out periodically by the medical records team and the quality
team.“Evaluations are carried out every month with indicators of completeness of filling and
return time. If there is anything missing, it is immediately reported to management.” (Inf-1).
However, evaluation efforts have not been fully effective due to limited human
resources and not all units following up on evaluation results optimally. “We sometimes
conduct evaluations, but follow-up from service units is not optimal.” (Inf-1).

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The policy of completing medical records within a maximum of 2x24 hours after
service has been implemented, and evaluations are conducted regularly. However, challenges
in the effectiveness of evaluation follow-up are still evident. Limited human resources (HR)
and a low quality culture in some service units are obstacles to optimizing monitoring (Putri
et al., n.d.). For monitoring to be effective, full support from unit leaders and a rewardpunishment system based on performance indicators are needed (Pane et al., 2023).

Implementation and Functions of SIMR
SIMRS has been used to support service processes ranging from patient registration
and medical data input to archiving. According to Inf-5, this system helps integrate units, but
it is not yet fully optimized due to technical factors and user behavior.
“The main modules, such as registration, laboratory, and pharmacy, are already
running. But there are still units that are not consistent in their data input.” (Inf-5)
Registration officers (Inf-3 and Inf-4) feel that SIMRS has helped speed up the
administrative process: “We used to have to fill out forms manually, but now we just enter
the NIK and the data comes up immediately.” (Inf-3) However, the system sometimes
experiences technical problems such as slow speeds or going offline, which affects patient
queues. “When the network is slow, services are disrupted. Patients often complain.” (Inf-4)
SIMRS at Mutiara Bunda Hospital has supported various service functions such as
registration, laboratory, and pharmacy. However, inconsistent data input by some units and
technical glitches such as slow connections are serious obstacles. This shows that network
infrastructure support and user skills are very important in the successful implementation of
SIMRS (Syafira et al., 2024).
According to Inf-3 and Inf-4, SIMRS can speed up administrative processes, but its
effectiveness is highly dependent on daily technical conditions. System delays can cause
queues and patient complaints, so system reliability and backup plans are crucial to
maintaining service continuity (Marselinus et al., n.d.).

Coordination Between Units and Management Support
Coordination between the medical records unit and the SIMRS installation is
considered to still need improvement. Some informants mentioned that cross-unit
collaboration is still limited to times when technical problems occur or there are delays in data
entry."Coordination only happens when there is a problem; it should be more proactive." (Inf-2)
Management support is considered important in the form of providing training, adequate
computer equipment, as well as strict policies regarding delays in filling out forms. "We need
regular training and additional equipment because computers are still limited in some rooms." (Inf-2) "There
needs to be commitment from management to discipline units that are often late in entering data." (Inf-5))
Coordination between units is still limited, mainly carried out only when facing
technical issues. Ideally, coordination should be proactive and structured, for example
through regular cross-unit communication forums. Management support in the form of
training, equipment procurement, and strict policies is very important to strengthen the
implementation of the Hospital Information System (SIMRS) (Putri et al., n.d.).
The limited availability of computers in some rooms hinders smooth workflow, and
regular training becomes one of the solutions hoped for by the staff to improve their
competence in using the Hospital Information System (SIMRS)(Waruwu et al., 2024).

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Constraints on System Usage and Maintenance
Some common challenges include limited equipment, lack of training, and delays in
data entry by medical personnel. In addition, there are issues with access authorization
systems and the availability of real-time data. “Sometimes the data we need has not been entered yet,
even though it is required for services.” (Inf-3) “SIMRS helps, but if the users do not understand it, it still
remains slow.” (Inf-5) To address this issue, some informants suggested the development of a simpler system
interface and work unit-based training. “The user interface should be more user-friendly and in accordance
with the workflow of each unit.” (Inf-1)
The issues that arise include delays in data input, device limitations, and a less intuitive
user interface. In addition, access authorization systems and real-time data availability remain
weaknesses. It is necessary to develop a more user-friendly interface that aligns with the
workflow of the unit so that users can operate the system efficiently (Yudarmawan et al.,
2020).
The key to the success of SIMRS lies not only in its technology but also in high user
adoption. Therefore, a training approach based on work units and strengthening change
management is greatly needed to build a digital culture within the hospital organization
(Yudarmawan et al., 2020).

5. Conclusions
Overall, the management of medical records and the implementation of the Hospital
Information Management System (SIMRS) in this hospital have been running fairly well, but
improvements are still needed in terms of data entry discipline, optimization of SIMRS
functions, and cross-unit coordination. Management support in the form of training,
additional equipment, and strict oversight policies is highly needed to enhance the efficiency
and effectiveness of the medical records management information system.
Author Contributions: Conceptualization, A.W., N.N., and R.O.; Methodology, A.W.;
Validation, A.W., N.N., and R.O.; Formal analysis, A.W.; Investigation, A.W.; Resources,
N.N. and R.O.; Data curation, A.W.; Writing—original draft preparation, A.W.; Writing—
review and editing, N.N. and R.O.; Visualization, A.W.; Supervision, N.N.; Project
administration, R.O. All authors have read and agreed to the published version of the
manuscript.
Funding: This research was funded by LPPM Apikes Iris
Data Availability Statement: The data supporting the findings of this study were obtained
from interviews, observations, and internal hospital documents at RSIA Mutiara Bunda. Due
to privacy and institutional policy restrictions, the data are not publicly available but may be
obtained from the corresponding author upon reasonable request.
Acknowledgments: The authors would like to express their sincere gratitude to the
management and staff of RSIA Mutiara Bunda for their assistance and participation in this
study. The authors also acknowledge the use of AI-assisted tools under human supervision
for language refinement and formatting support.
Conflicts of Interest: The authors declare no conflict of interest. The funders had no role in
the design of the study; in the collection, analyses, or interpretation of data; in the writing of
the manuscript; or in the decision to publish the results.

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