Harahap Nabila Clydea, Handayani Putu Wuri, Hidayanto Achmad Nizar
Faculty of Computer Science, University of Indonesia, Depok 16424, Indonesia.
Int J Med Inform. 2022 Mar 22;162:104750. doi: 10.1016/j.ijmedinf.2022.104750.
Personal health record (PHR) has been extensively used in developed countries; however, it has been limitedly adopted in developing countries. This study was conducted in Indonesia: a developing country with the largest population in Southeast Asia. PHR that is integrated with health providers is needed to achieve a transformation from a health provider-centered to a patient-centered healthcare system.
To qualitatively analyze barriers and facilitators of PHR adoption by health facilities in Indonesia from the technological, organizational, environmental, and individual factors.
In this qualitative study, we used semi-structured interviews with three health facility directors, 17 IT heads, eight physicians, and three nurses from 10 primary healthcare facilities, nine government hospitals, and six private hospitals in Indonesia. Interview data were analyzed using thematic analysis in NVivo 12. The analysis stages involved familiarizing data, generating initial codes, searching themes, evaluating themes, defining and naming themes, and writing reports.
Regarding technological factors, the barriers to PHR adoption include security and privacy, interoperability, and infrastructure. Organizational support can facilitate PHR adoption in terms of organizational factors, while a lack of human resources is a barrier to PHR adoption. Regarding environmental factors, the lack of government regulations is the barrier to PHR adoption, while competition between health facilities and vendor support could facilitate PHR adoption. Finally, regarding individual factors, perceived usefulness and ease of use can be facilitators of PHR adoption, while user attitudes and e-health literacy can be barriers to PHR adoption.
This study is expected to comprehensively understand PHR adoption in Indonesia and could be applied to other developing countries with similar technological, legal, or cultural characteristics as Indonesia. This study also provides information that can guide health regulators, health facilities, or PHR vendors in planning the implementation of integrated PHR.
个人健康记录（PHR）在发达国家已得到广泛应用；然而，在发展中国家其采用程度有限。本研究在印度尼西亚开展，该国是东南亚人口最多的发展中国家。为实现从以医疗服务提供者为中心向以患者为中心的医疗体系转变，需要与医疗服务提供者整合的PHR。
从技术、组织、环境和个人因素方面，对印度尼西亚医疗机构采用PHR的障碍和促进因素进行定性分析。
在这项定性研究中，我们对来自印度尼西亚10家初级医疗机构、9家政府医院和6家私立医院的3名医疗机构主任、17名信息技术主管、8名医生和3名护士进行了半结构化访谈。访谈数据在NVivo 12中采用主题分析法进行分析。分析阶段包括熟悉数据、生成初始编码、搜索主题、评估主题、定义和命名主题以及撰写报告。
在技术因素方面，采用PHR的障碍包括安全与隐私、互操作性和基础设施。在组织因素方面，组织支持可促进PHR的采用，而人力资源短缺是采用PHR的障碍。在环境因素方面，政府法规缺失是采用PHR的障碍，而医疗机构之间的竞争和供应商支持可促进PHR的采用。最后，在个人因素方面，感知有用性和易用性可促进PHR的采用，而用户态度和电子健康素养可能是采用PHR的障碍。
本研究有望全面了解印度尼西亚PHR的采用情况，并可应用于其他在技术、法律或文化特征上与印度尼西亚相似的发展中国家。本研究还提供了可指导卫生监管机构、医疗机构或PHR供应商规划综合PHR实施的信息。
