Introduction
Based on Minister of Health
Regulation no. 24 of 2022, to maximize medical services, each hospital needs to
implement Electronic Medical Records (EMR) as a form of SIRS. The development
of digital technology in society has resulted in the digital transformation of
health services so that medical records need to be held electronically with the
principles of security and confidentiality of data and information. Hospitals
are required to record and report all their activities in the form of SIRS,
this is regulated in Law no. 44 of 2009. So the management and development of
SIRS must be useful for improving and supporting hospital services which
include: 1) Speed, accuracy, integration, improved service, increased
efficiency, ease of reporting in operational implementation; 2) Speed of
decision making, accuracy and speed of problem identification and ease in
formulating strategies in managerial implementation; and 3) Work culture,
transparency, coordination between units, understanding the system and reducing
administrative costs in organizational implementation.
The expected goal of implementing
SIRS is as a new policy for health services, one of which is patient safety as
regulated in Law no. 44 of 2009 that in an effort to improve the quality of
service, hospitals are obliged to implement patient safety standards, for this
reason SIRS is implemented in an effort to support the realization of quality
service in hospital services. As a system, of course the implementation of SIR
records aims to provide accurate patient information, share information more
quickly and safely, help increase productivity, reduce hospital budgets, and
increase patient comfort (Sittig et al., 2020). Implementation of a
technology-based information system will support more effective health service
practices and support the creation of patient safety (Feldman et al., 2018),
information systems are needed for easy access to information, improved
documentation and reduced errors, although the use of this system is faced with
several barriers and constraints. (Dash et al., 2019), and related policy
implementation is formed based on aspects of communication, resources,
disposition and bureaucracy (Edwards, 1980).
Referring to the
policy implementation aspects stated above (Edwards, 1980), Minister of Health
Regulation no. 24 of 2022 applies rules relating to these aspects as follows:
(1) Communication. Referring to article 10 paragraph 1, it is said that the
SIRS used in administering electronic medical records must have
interoperability capabilities. Interoperability is the capability of an
electronic system that can be used for communication. (2) Resources. Referring
to Article 10 paragraph 1, it is said that the SIRS used in administering
electronic medical records must have compatibility capabilities. (3)
Disposition. Referring to disposition issues, it is stated in Article 16
Paragraph 2 that recording on SIRS is carried out completely and clearly. (4)
Bureaucracy. Regarding bureaucracy, Article 29 paragraph 1 regulates that the
SOP for electronic medical records must comply with the principles of
confidentiality, integrity and availability.
Implementing a policy
requires preparation so that its objectives can be optimally realized. One
level of acceptance of the use of information technology is determined by the
perception of benefits. Perceived usefulness is an initial assumption related
to an individual's intention to accept a policy implementation to support
maximizing the use of information technology (Ljubicic
et al., 2020). When individuals think that information technology has benefits
in supporting their work activities, they will easily accept the implementation
of the policy (Bolodeoku et al., 2022). In a health
service, it is important to build a perception of the benefits of health
workers as users of information systems so that they willing to support this
implementation for the effectiveness of services running at the hospital
(Akwaowo et al., 2022).
Information
systems must meet certain standards related to information quality in order to
stimulate user interest in supporting information system implementation
policies implemented by management (Masri et al., 2020). The quality of
information determines the accuracy of the data, so that they are encouraged to
support the implementation of information systems through optimizing their use
(Bagayoko et al., 2020), the quality of information explains the advantages
that users will get, thus determining the success of implementation implemented
by management (Jiang et al., 2021). The existence of quality in the system
maximizes the use of information systems to support their work, and to maximize
the achievement of information system implementation, efforts are needed to
build perceptions of organizational support for its users (Sameer, 2022),
employee perceptions of organizational support, determining the success of
information system implementation through optimizing its use (Sameer, 2022).
Ali et al., 2022).
By implementing SIRS, management hopes that its members can maximize its
use for organizational goals, and its members' support for all policies
implemented by management in the work context, is a condition where individuals
have work engagement (Mazzetti et al., 2023). It is very important to form work
engagement, because it determines the alignment of organizational members to
optimally support all policies implemented by management (Neuber et al., 2022).
Work engagement is formed from the enthusiasm, dedication and appreciation of
organizational members, so that when a management information system is
implemented, they support it through the intensity of its use (Maamari & Osta, 2021), and
work engagement determines the success of the organization in implementing the
management information system (Awan et al., 2020), because work engagement
shows individuals who have enthusiasm, dedication and appreciation (Bakker
& Leiter, 2015).
Palangkaraya
City Hospital is a class D hospital located in Palangkaraya City. The hospital
has planned the development of SIRS since 2021, and implementation will begin
in 2023. To examine the problems faced by health workers in 2022 before SIRS
becomes functional, interviews were conducted with the service quality
department, they raised several problems faced by
health workers, such as overcrowding. outpatients which occurs due to the long
registration time, there are often differences in data on the number of
available inpatient rooms and the administration department, resulting in
patients not getting rooms and intensive care in inpatient installations,
errors in giving prescriptions to patients, errors in the results of diagnosing
the disease. Suffered by patients, a lot of patient medical record data is lost
or hidden, so it takes time to find it.
Based on this
information, a preliminary survey was conducted on 10 health workers consisting
of general practitioners, inpatient and outpatient nurses, pharmacy departments
and administrative officers with 2 health workers each on November 30 2022 for
their initial perception regarding the objectives of SIRS implementation. Which
will be implemented comprehensively by management at the end of 2023:
1. There
are 65% of health workers who have problems with communication aspects.
2. There
are 60% of health workers who have problems with resource aspects.
3. There
are 65% of health workers who have problems with the disposition aspect.
4. There
are 65% of health workers who have problems with bureaucratic aspects which
reflect their lack of agreement that SIRS will be implemented.
Referring
to the results of the preliminary survey, the problems of health workers in all
aspects of SIRS implementation illustrate that health workers are doubtful
about the benefits that SIRS can provide to support the effectiveness and
efficiency of their work. Based on the problems that will occur in the year
2022, it is imperative that SIRS be implemented immediately, so that all
aspects of services related to information can run effectively and efficiently,
and referring to the results of the preliminary survey, describing the negative
perception of health workers regarding the purpose of implementing SIRS for
support the effectiveness of their work related to information. Therefore, in
this research, it will be reviewed and analyzed
further regarding perceived benefits, quality of information, organizational
support and work engagement which have an influence on the implementation of
the hospital information system at Palangkaraya City Regional Hospital.
Research
Methods
This
research was conducted at the Palangka Raya City
Regional General Hospital, which is located on Jl. Trans Kalimantan, Kalampangan, Sebangau, Kalampangan, Kec.
Sebangau, Palangka Raya City,
Central Kalimantan 74874. The research was carried out from November 2022 to
January 2023. This type of research is included in quantitative research with a
cross sectional study approach which functions to examine whether there is a
relationship between two separate events. This research consists of 4
independent variables, namely perceived benefits (X1), information quality
(X2), organizational support (X3) and work engagement (X4), which will measure
their influence on the dependent variable, namely the implementation of the
hospital information system (Y). 
Figure
1. Research Constellation
The population in
this study were health workers at the Palangkaraya City Hospital with a total
population of 30 health workers, consisting of 3 general practitioners, 14
nurses, 3 pharmacy staff and 10 administrative officers. The sample size was
determined as 30 respondents by taking samples using purposive sampling, with
(a) Inclusion Criteria: (1) Health workers consisting of general practitioners,
nurses, pharmacy staff and administrative officers. (2) On duty when the survey
was conducted. (b) Exclusion Criteria: (1) Work units that are not related to
SIRS. (2) Management level in the hospital.
The data
collection technique uses a survey method directly to respondents in stages
using a data collection tool in the form of a questionnaire as primary data
using a 4 - 1 point Likert scale. After the questionnaire is formed, the
validity and reliability of the questionnaire formed is tested. The analysis technique
is carried out using SmartPLS
software.
Results and Discussion
Results of Descriptive Statistical Analysis
Descriptive statistical analysis
in this research was carried out using three box method analysis, to determine
the condition of each research instrument, a quality range was formed which was
divided into three quality interval ranges with the following calculations:
Index value:{(F1x1)+(F2x2)+(F3x3)+(F4x4) }/4
Keterangan :
F1 = Frequency of respondents who answered 1
F2 = Frequency of respondents who answered 2
F3 = Frequency of respondents who answered 3
F4 = Frequency of respondents who answered 4
(1)
Top stretch =30x4/4=30
(2)
Low stretch =30x1/4=7,5
Table 1. Three Box Method
Quality Interval
|
Index |
Category |
Code |
|
7,5� � 15 |
Low |
R |
|
15.1 � 22,5 |
Currently |
S |
|
22,6 � 30 |
High |
T |
�����������
The respondent's behavior
can be explained in accordance with the applicable indices and theories, as
follows:
1.
The variable perception of benefit
is in the medium category, referring to the opinion that perception of benefit
is the level at which individuals believe that the use of certain technology
will improve performance (Davis et al., 2024), the medium index shows the behavior of health workers who are quite confident in the
benefits that will be obtained from SIRS which will be implemented by
management.
2.
The information quality variable
is in the medium category, referring to the opinion which states that information
quality is a benchmark for determining the quality of output from information
systems in the form of reports, and functions to determine user satisfaction
(Delone & McLean, 2016), the medium index shows behavior
health workers who are quite satisfied with the quality of the information they
will get from SIRS which will be implemented by management.
3.
The organizational support
variable is in the medium category, referring to the opinion which states that
organizational support is employees' perceptions regarding the extent to which
the organization values their contribution, provides support and cares about
their welfare, and individuals who feel they have organizational support will
be encouraged to help the organization achieve its goals ( Eisenberger
& Stinglhamber, 2011), the moderate index shows
the behavior of health workers who are sufficiently
encouraged by the organizational support provided so that SIRS implementation
runs optimally.
4.
The work engagement variable is in
the medium category, referring to the opinion which states that work engagement
is a condition where employees favor their work and
actively participate in it, and consider that the work is important to them
(Robbins & Judge, 2017), the medium index shows energy behavior.
health which is quite active in participating in
supporting SIRS which will be implemented by management.
5.
The SIRS implementation variable
is in the high category, referring to the opinion which states that
implementation is the activity of providing the means to carry out a policy and
the possibility of having an impact or influence on something (Johnson & Easttom, 2020), the medium index shows the behavior of health workers who support SIRS implementation.
will be implemented by management.
Outer Model Results
The tests carried out on this outer model are as follows:
1.
Convergent Validity
At this stage, a validity test will be carried out for
each indicator contained in each variable to determine the validity of each
relationship between indicators and the latent variable construct. SIRS
implementation variables, there are indicators that have a factor loading value
of <0.70, namely the SIRS2 and SIRS3 indicators, so that indicators that
have a factor loading value of <0.70 are not included in further research,
because they cannot describe the relationship between indicators and variable
constructs. latent. Henceforth, these four indicators were not included in the
outer model test.
2.
Construct Validity and Reliability
Test
Test the
validity and reliability of the construct to measure how well the indicator can
be used to measure each latent variable studied.
Table 2. Validity Test and
Construct Reliability
|
Variabel |
Cronbach's Alpha |
CR |
AVE |
|
X1 |
0.936 |
0.947 |
0.692 |
|
X2 |
0.909 |
0.926 |
0.612 |
|
X3 |
0.940 |
0.950 |
0.705 |
|
X3 |
0.968 |
0.974 |
0.863 |
|
Y |
0.889 |
0.915 |
0.644 |
Based on the table above, it
can be seen that all AVE values are > 0.50, in accordance with the decision
making assumptions, so all indicators in each variable are homogeneous from
each research variable. Apart from that, it is known that the Cronbach's Alpha
value and CR value are > 0.70, so it can be concluded that all research
variables are reliable and the indicators of all research variables used are
good constructs in forming a latent variable.
3.
Uji Fit Model
Table 3. Model Fit Test Results
|
|
Saturated Model |
Estimation Model |
|
SRMR |
0.080 |
0.080 |
Based on the
table above, the SRMR value shows a value of <0.1, so these results explain
that the research model can be said to be fit for measuring the relationship
between latent variables and observed variables.
Iner Model Results
The inner model is evaluated using
SmartPLS. The research model can be seen in the
following picture:
Figure 2. Significance Test
Table 4. Hypothesis Testing
|
Influence |
Rsquare |
TValue |
Conclusion |
|
Perceived benefits, quality of information, organizational
support and work engagement -> SIRS Implementation |
0,755 |
|
H1 Accepted |
|
Perceived benefits -> Implementation of SIRS |
|
2,867 |
H2 Accepted |
|
Information quality -> SIRS implementation |
4,534 |
H3 Accepted |
|
|
Organizational support -> SIRS Implementation |
2,109 |
H4 Accepted |
|
|
Work engagement -> SIRS implementation |
5,446 |
H5 Accepted |
1.
The
simultaneous influence of perceived benefits, quality of information,
organizational support and work engagement of SIRS implementation shows an
Rsquare value of 0.755, which means that perceived benefits, quality of
information, organizational support and work engagement have an influence on
SIRS implementation of 75.5% with a strong level of influence. (Hair et al.,
2014), and falls into the H1 acceptance category.Pada pengaruh persepsi manfaat
terhadap implementasi SIRS menunjukkan perbandingan nilai TValue
2,867 > 1,96 yang berarti bahwa persepsi manfaat berpengaruh signifikan
terhadap implementasi SIRS, sehingga masuk kategori penerimaan H2.
2.
The
influence of information quality on SIRS implementation shows a comparison of
TV value of 4.534 > 1.96, which means that information quality has a
significant effect on SIRS implementation, so it is included in the acceptance
category H3.
3.
The
influence of organizational support on SIRS implementation shows a comparison
of the TV value of 2.109 > 1.96, which means that organizational support has
a significant effect on SIRS implementation, so it is included in the H4
acceptance category.
4.
The
influence of work engagement on SIRS implementation shows a comparison of TV
value 5.466 > 1.96, which means that work engagement has a significant
effect on SIRS implementation, so it is included in the H5 acceptance category.
The Influence of Perceived Benefits, Information
Quality, Organizational Support and Work Engagement on SIRS Implementation
The results of the analysis conclude that perceived
benefits, quality of information, organizational support and work engagement
have a strong influence in influencing the effectiveness of the implementation
of the hospital information system that will be implemented by Palangkaraya
City Regional Hospital at the end of 2023 to support electronic-based
information facilities for health workers. This happens because health workers
show behavior that is quite confident in the benefits generated and quite
satisfied with the quality of information from SIRS that will be implemented.
Apart from that, health workers also feel sufficient encouragement from
organizational support and show quite active behavior to support the
implementation of SIRS at Palangkaraya Regional Hospital.
Referring to the Technology Acceptance Model (TAM)
proposed by Fred Davis in 1989 which states that the level of acceptance of the
use of information technology is determined by several constructs, namely,
perceived benefits, attitudes towards using it, behavior to continue using it,
and real conditions of system use, these results show harmony because with the
formation of health workers' perceptions of the benefits they will get by using
SIRS, their assessment of the quality of the information they will get by using
SIRS, health workers' perceptions of the organizational support that supports
them in mastering the use of SIRS.
Referring to research which concludes that work
engagement is very important to form, because it determines the alignment of
organizational members to optimally support all policies implemented by
management (Neuber et al., 2022), the lack of dedication of health workers to
support the effectiveness of SIRS implementation, shows an attitude of lack of
responsibility as well as the loyalty of health workers to help the
organization achieve its goals through optimizing the use of SIRS, because
dedication is related to the condition of workers who perceive their role as
fully dedicating themselves to carrying out their duties optimally and
achieving organizational goals (Bakker & Leiter, 2015).
The Influence of Perceived Benefits on SIRS
Implementation
The perception of benefits that has developed in the
minds of health workers currently shows a behavior that is quite confident that
SIRS which will be implemented by management at the Palangkaraya City Regional
Hospital has benefits in making their work easier, increasing work
productivity, increasing effectiveness and improving performance, so that this
makes health workers support the implementation of SIRS because they feel that
SIRS is aimed at minimizing the risk of losing patient data, and this situation
is in line with research which concludes that when individuals think that
information technology has benefits in supporting their work activities, they
will easily accept the implementation of the policy (Bolodeoku et al., 2022 ).
In a health service, it is important to build a perception of the benefits of
health workers as users of information systems so that they are willing to
support the implementation for the effectiveness of services running in
hospitals (Akwaowo et al., 2022).
Referring to the opinion which concludes that
perceived usefulness is the level at which individuals believe that the use of
certain technology will improve performance (Davis et al., 2024), meaning that
health workers have the belief that when SIRS is implemented by management,
this will determine its effectiveness in obtaining the information they need,
and this is proven by the opinion of health workers that SIRS will help reduce
errors in patient handling as the most dominant indicator of the perceived
benefit variable.
The Influence of Information Quality on SIRS
Implementation
The quality of information
perceived by health workers forms support for health workers to optimize the
use of SIRS in carrying out their work activities related to information
systems, especially the opinion of health workers that the SIRS that will be
implemented will help search for patient information, so that they will
maximize its use to minimize the risk of losing patient data. , this situation
is in line with research which concludes that information systems must meet
certain standards relating to information quality in order to stimulate user
interest in supporting information system implementation policies implemented
by management (Masri et al., 2020), information quality determines data
accuracy, so that they driven to support the
implementation of information systems through optimizing their use (Bagayoko et
al., 2020), the quality of information explains the advantages that users will
get, thus determining the success of implementation implemented by management
(Jiang et al., 2021).
Refers to the opinion that information quality is a benchmark for
determining the quality of output from an information system in the form of
reports, and functions to determine user satisfaction. (Delone & McLean,
2016), meaning that when the perception of health workers feels that the
information produced by SIRS is in line with their expectations in supporting
service activities, especially those related to information, then satisfaction
will be formed and determine the support of health workers to optimize the use
of SIRS through its optimal use.
The
Influence of Organizational Support on SIRS Implementation
The perception of organizational support felt by
health workers makes them quite motivated to support the SIRS implementation
policy set by the management of Palangkaraya City Regional Hospital. This
result is in line with research which concludes that employee perceptions of
organizational support determine the success of information system
implementation through optimizing its use (Ali et al., 2022), organizational
support changes the behavior of organizational
members to implement policies implemented by the organization (Huang, 2022),
and organizational support is a determining indicator of an organization's
success in implementing an information system as a policy (Abell et al., 2023).
Refers to the opinion which
states that organizational support is an employee's perception of the extent to
which the organization values their contribution, provides support, and cares
about their welfare, and individuals who feel they have organizational support
will be encouraged to help the organization achieve its goals (Eisenberger
& Stinglhamber, 2011), meaning that health workers feel organizational
support, especially support from superiors, to encourage the use of SIRS for
quality services and provide health workers with the opportunity to understand
the actual function of SIRS, so that they are encouraged to maximize the use of
SIRS to minimize the risk of losing patient data when SIRS is implemented in
hospitals.
The Influence of Job Interest on SIRS
Implementation
The work engagement of health workers causes their
support for the implementation of SIRS to decrease, where they feel there is a
problem with their enthusiasm, dedication and appreciation, which makes their
interest in maximizing the use of SIRS in the Palangkaraya City Regional
Hospital decrease, this is contrary to the opinion which concludes that work
engagement is a conditions where individuals have positive thoughts so that
they are able to express themselves physically, cognitively and affectively in
carrying out their work and work engagement is characterized by enthusiasm,
dedication and appreciation for their work (Bakker & Leiter, 2015).
Work engagement is formed from
the enthusiasm, dedication and appreciation of organizational members, so that
when a management information system is implemented, they support it through
the intensity of its use (Maamari & Osta, 2021), and work engagement
determines the success of the organization in implementing the management
information system (Awan et al., 2020 ), for this reason, the dedication of
health workers must be built so that health workers can support the
implementation of SIRS through optimizing its use, because dedication is
related to the condition of workers who feel their role is to fully dedicate
themselves to carrying out their duties optimally and achieving organizational
goals (Bakker & Leiter , 2015).
Conclusion
Based on the research results
and discussions that have been presented, the conclusions in this research are
as follows:
1.
Perceived
benefits, quality of information and organizational support have a positive
influence on the implementation of SIRS, while work engagement has a negative
influence, so that by increasing the perception of benefits, quality of
information and organizational support, as well as improving the level of work
engagement of health workers, the implementation of SIRS can run effectively.
2.
Perceived
benefits have a positive influence on SIRS implementation, so that by
increasing health workers' perceptions of the usefulness of SIRS, the
effectiveness of SIRS implementation can increase.
3.
Information
quality has a positive effect on SIRS implementation, so that by increasing the
knowledge of health workers about the quality of SIRS information, the
effectiveness of SIRS implementation can increase.
4.
Organizational
support has a positive effect on SIRS implementation, so that by building
health workers' perceptions of organizational support, the effectiveness of
SIRS implementation can increase.
5.
Work
engagement has a negative effect on the implementation of SIRS, so that with
efforts to improve the enthusiasm, dedication and appreciation of health
workers, the effectiveness of SIRS implementation can be achieved.
Implication
1. Theoretical Implications
Perceived benefits is the
initial assumption that the SIRS to be implemented has useful value in making
work easier, increasing productivity, increasing effectiveness and improving
performance. Information quality describes that the information produced by
SIRS is in accordance with what health workers expect through its use, so that
they get information that is relevant, accurate, timely and trustworthy.
Organizational support is a form of organizational support to enable health
workers to master the use of SIRS in the form of fairness, superior support, organizational
appreciation and conducive working conditions, so that with a positive
perception of organizational support, health workers are willing to make the
implementation of SIRS a success through optimizing its use.
Work engagement determines the level of dedication of
health workers to support the achievement of effective SIRS implementation
through optimizing its use. The implementation of SIRS will run effectively
when users feel that there are positive benefits from SISR compared to working
manually without an electronic-based information system, and the perception of
SIRS' superiority in informing what health workers are stuck on, will stimulate
health workers' interest in using it, and the level of perception of health
workers. on organizational support and the level of work engagement,
determining their alignment to support the implementation of SIRS through
optimizing its use.
2.� Managerial Implications
a.
The
aspect of making work easier is the weakest in the perception of benefits
variable, so improvements need to be made to the training system.
b.
The
accuracy aspect is the weakest in the information quality variable, so
improvements need to be made to the competency development system by carrying
out cross training between health workers.
c.
The
working conditions aspect is the weakest in the organizational support
variable, so improvements need to be made to the non-physical work environment
system in order to create effective cooperative relationships between work
units.
d.
The
dedication aspect is the weakest in the work engagement variable, so
improvements need to be made to the leadership system by taking an approach to
build the commitment of health workers.
e.
The
bureaucratic aspect is the weakest in the SIRS implementation variable, so
improvements need to be made to the work culture system by instilling a
digital-based work culture.
Suggestion
Berdasarkan hasil penelitian dan kesimpulan, adapun saran dalam penelitian
ini adalah sebagai berikut:
1.
It
is recommended that management carry out outreach and promotion regarding the
objectives of SIRS implementation.
2.
It
is recommended that management provide separate training between work units
using SIRS.
3.
It
is recommended that management build a conducive work environment by
implementing fairness so that SIRS is required to be used by all work units.
4.
It
is recommended that management begin to form SOPs regarding the obligations of
health workers to maximize the use of SIRS.
5.
It
is recommended that management conduct simulations of SIRS users in each work
unit on a regular basis, in order to build health workers' perceptions about
the usefulness of SIRS.
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Copyright holder: Sri Astuti, Fransiskus
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