1
ANALYSIS ON THE EFFECT OF
ELECTRONIC MEDICAL
RECORD’S APPLICATION FOR
USER SATISFACTION IN GRHA
KEDOYA HOSPITAL
Lily WidjajaMedical Records and Health Information Study Program, Faculty of Health Sciences, Esa Unggul University, Jakarta, 11510
lilywidjaja@esaunggul.ac.id
1.1.BACK GROUND
Permenkes No. 269 of 2008 has been the regulation of electronic medical records. Thus Permenkes No. 269 of 2008 on medical records have become the legal basis for the implementation of electronic medical records in Indonesia. Electronic medical records are any records, statements and interpretations made by a doctor or other health care worker in the framework of the diagnosis and management of patients who entered and stored in the form of electronic storage (digital) through a computer system. "Electronic Medisal Record (EMR): an electronic system medical automate paper-base record" .According to Article 44 of the Law on Information and Electronic Transaction valid evidence than that imposed the legislation as well as other evidence in the form of electronic information and / or documents electronic. Thus the electronic medical record including the valid evidence in accordance with the provisions of the Act.
Basically the electronic medical record is the use of electronic methods for the collection, storage, processing and accessing medical records of patients in hospitals that have been stored in a multimedia database management system that collects various sources of medical data. Computer-based medical records will collect a variety of patient clinical data, both derived from the results of the doctor's examination, the digitalization of diagnostic tools, conversion of laboratory test results and clinical interpretation (Sabarguna, 2009).
According to Hatta (2008), Electronic medical record must have some capabilities / features, one of which is the ability to prepare all the information the patient to be ready for use by all service providers who work in the health care facilities. The ability to organize or process the amount of data and the speed to search for relevant information is a very important asset for an organization. To obtain large data sets and complex, the user must have the tools (tools) that will simplify the task of data management and extract useful information in a timely manner (Kris, 2003). Yusup research results (2013) mentions that the information contained in electronic information must be accessed, displayed and guaranteed integrity.
Capgemini survey results as described in the Journal of the American Health Information Management Association (AHIMA) in January 2011 that 90% of the leadership of the health service facility plans to implement electronic medical records in the six months to come. More than 50% of respondents said it did internal discussions or meetings that discuss the implementation of electronic medical records as well as the leaders have developed a financial analysis of the impact of the implementation of electronic medical records.
Based on research Susi Andriani (2009) states: "The quality of service has a positive and significant correlation with the level of patient satisfaction at BPK RSU Magelang regency with p = 0.000 <0.05. Spearman correlation analysis with the service quality
patient satisfaction rate of 0,514. This indicates that the level of patient satisfaction level is influenced by the high and low quality of services provided.
connections and reliability to the satisfaction of users there is also a significant influence aspects of ease of application access EMR to the satisfaction of users, there is a significant influence aspects EMR application security to the satisfaction of users, there is a significant influence aspects of EMR application flexibility towards user satisfaction, there is no significant influence aspects of EMR application connections to the satisfaction of users, there is a significant effect on the reliability aspects EMR application user satisfaction. ,(1) "there is significant influence aspects of EMR applications access to user satisfaction (p = 0.001); (2) there is a significant effect on the security aspects of EMR application user satisfaction (p = 0.001); (3) No significant influence aspects of EMR application flexibility towards user satisfaction (p = 0.012); (4) there is no significant influence aspects of EMR application connections to user satisfaction (p = 0.554); (5) there is a significant effect on the reliability aspects EMR application user satisfaction (p <0.001); (6) No significant effect together aspects of ease of access, security, flexibility, and reliability of the connection to user satisfaction (p <0.001).
Medical Record in Grha Kedoya
Hospital supported by electronic
information system-based application using EMR. Based on observations on the implementation of EMR application it can be seen that the response and user satisfaction on EMR applications vary greatly. Some users feel less satisfied with the existing EMR applications, but some users who proposed adding EMR applications for improvement.
1.2. PROBLEM STATEMENT
Is there any influence of Electronic Medical Record application (EMR) to the satisfaction of users (user satisfaction) at the Hospital Medical Record Unit RS Grha Kedoya? ".
1.3. The Objectives General objective:
Analyze the influence of Electronic Medical Record application (EMR) to the satisfaction of users (user satisfaction) in Medical Record Unit Grha Kedoya Hospital
Specifics objectives :
a. Knowing the influence of aspects of ease of access (acessibility) EMR applications to user satisfaction in Medical Record Unit
b. Knowing the influence of EMR application quality aspects of the user satisfaction in Medical Record Unit
c. Knowing the influence of EMR application security aspects of the user satisfaction in Medical Record Unit
d. Knowing the influence of EMR application fleksibility aspects of the user satisfaction in Medical Record Unit. e. Knowing the influence of EMR
application connectivity aspects of the user satisfaction in Medical Record Unit. f. Knowing the influence of EMR
application realibility aspects of the user satisfaction in Medical Record Unit . g. Proving the effect of simultaneous (user
satisfaction, quality, security, fleksibility, connectivity, realibility, expentacy life and growth potencial) to user satisfaction in Medical Record Unit.
LITERATURE REVIEW 2.1. Computer system
3 provided acceptable or not in the
situation and circumstances of the case. The medical record must be filled immediately and directly at the time of the action and in the delivery of instruction by a doctor or nurse at the time of observation has raised a symptom or a change, and when to take action (Guwandi, 2005).
According Simarmata (2006), application (application) is a program used to complete the practical work such as data processing, accounting, or illustration. The system is one unit consisting of parts (called subsystems), the parts are interrelated (interrelation), as well as
the interdependence (interdependence) one another
(Hatta, 2008).
The needs of the system (system requiretment) that must be considered in designing the SIM is (Sutanta, 2003):
1) Reliability, which shows how much the system can be relied upon to carry out a process that is credible and necessary.
2) Availability, the system is easily accessible by the user.
3) Flexibility, ie the system adaptable to satisfy, according the changing needs of users.
4) Schedule installation, which consists of a period of time between when the basis for the organization requires and when this information is applied. During this time, the analysis of the system must be able to design the best system within the required time limit.
5) The expected lifespan and potential growth (life expentacy and growth potencial), the system is designed in the manner intended by the users of the system (eg the desired life of the system shall be at least 5 years)
and were able to grow in the event of changes significantly. 6) Ease maintained, ie the system
should be easy to maintain (eg, there are things that do not work must be corrected, the correction request to be met, an increase in the overall system must be done, and so on). The system should be treated depending on the design. To easily treated, the design must use the name data and standard
programming languages, structured and modular programming, configuration, system standards and complete system documentation standards. 2.2. User satisfaction
User satisfaction is the user response to the use of information system output. Some researchers, such as EinDor and Segev (1978) and Hamilton and Chervany (1981), proposes to use user satisfaction as a measure of the success of the use of information systems. Several studies have found that user satisfaction is closely related to the attitude of a user on the use of information systems (Jogiyanto, 2007).
Lots of measurement used to measure the success of information systems. No single measurement is better than the other. Selection of measurement must consider several aspects such as the objectives of the research, which uses the organizational context, aspects of its information systems and the independent variables were used to assess the success, his research methods and levels of analysis. DeLone and McLean (1992) in Jogiyanto (2007), describes gauges the success of information systems of the dimensions of user satisfaction, among others:
1) satisfaction with the specificity 2) overall satisfaction
5) Satisfaction of information: the difference between the required information with the received 6) Enjoyment
7) Software satisfaction
8) Decision-making satisfaction Jogiyanto (2007), mentions that much research has been conducted to identify the factors that led to the success of the information technology system. One well-known study in this area is done by DeLone and McLean (1992). Based on the theories and the results of previous studies that have been studied, DeLone and McLean then develop a model parsimony called DeLone information systems success model and McLean (D & M IS Success Model) as follows:
Figure 3. DeLone & McLean (D&M IS) Success Model
METHOD
3.1. The location and Time of Research The location of research at the Grha Kedoya Hospital on March- April 2016.
3.2. Type and design research
The study was analytic observational using cross sectional study design. This research is a quantitative correlation, the research aims to determine the influence of Electronic Medical Record application to the User Satisfaction through hypothesis testing that can be drawn conclusions
about the meaning of the data obtained
3.3. Population and Sample
Technique of data collecting and Sampling:
3.3.1 Type of data: it consists of primary data. Primary data is the result of respondents' answers to the questionnaire regarding accessibility, Quality, security,
flexibility, connectivity, realibility, EMR applications and
user satisfaction.
3.3.2 Population and sample: The study population was officer in the Medical Record and Registration in Grha Kedoya Hospital with as many as 45 people.
3.3.3 Sample Size: taken the entire population
3.3.4 The sampling technique by taking all of the population (saturated sample) who worked more than one year acquired as many as 42 people.
3.4. Variable and Operational Definition Research Variable
Independent Variable ; Electronic
Medical Record (EMR) application
including: accessibility, quality,
security, flexibility, connectivity dan
reallibility
And as Dependent Variable terikat is
user satisfaction includes user
satisfaction on the form, content, flexibility, ease of use, timeliness, accuracy of information.
3.5. Instrument and dan Method of collecting Data
The instrument used to collect data related to EMR applications and user satisfaction questionnaire. Questionnaires will be tested the validity and reliability. Data were collected by distributing questionnaires to users who have reliable EMR application. Test the validity of this research using the formula "product moment" (r) and test reliability using Cronbach's Alpha test (Inform
ation Quality)
Penggunaan (Use)
(User Satisfaction)
Individual Impact
(Sistem
Quality) Organizational
5 with the help of the program
Statistical Package for Social Science (SPSS) version 22.0.
RESULTS
4.1ANALYSIS OF REPONDENTS’S DESCRIPTION HARACTERISTICS
Table 4.1
Frequency Distribution of Respondents by Age Group
Freq uenc
y Percent Valid Percen
t
Cumu lative Perce
nt Valid 20-24 11 26,2 26,2 26,2
25-29 15 35,7 35,7 61,9 30-34 11 26,2 26,2 88,1
35-39 2 4,8 4,8 92,9
>39 3 7,1 7,1 100,0 Total 42 100,0 100,0
Figure 4.1 Frequency Distribution of Respondents by by Gender
Figure 4.2 Frequency Distribution of Respondents by Last education
Figure 4.3 Frequency Distribution of Respondents By position on the
working Unit
Figure 4.4 Frequency Distribution of Respondents By working period
Conclusions Characteristics of Respondents
Of the overall indicator was asked respondents about the personal data it can be concluded that:
a. Gender Female respondents (52.4%) more than men (47.6%).
b. Age Group; The highest age group is the 25-29 year age group (35.7%), and at least the age group> 39 years. (7.1%) c. Last Education ;So respondents to D3
RM terbesar13orang (31%).
d. Work Unit; Respondents in the back office as many as 27 people (64.3%), respondents in the back office is greater than that in the front office.
4.2LINEAR REGRESSION ANALYSIS RESULTS
a. Test Regression Coefficients All
aspects (Test F)
Hypothesis test to determine whether the dimension: accesibility. Quality, Security, Connectivity. Flexibility, Reliability, jointly have a significant effect on user satisfaction EMR (EMR user)
Hypothesis
Ho: The regression coefficient is not significant
H1: significant regression coefficient If the probability of> 0.05 Ho is accepted
If the probability of <0.05 Ho is rejected Table 4.2
F Test Results ANOVAa 1 Regressi
on 72,850 6 12,142
a. Dependent Variable: Satisfaction
b. Predictors: (Constant), Reliability, Accesibiity, Connectivity, Flexibility, Security, Quality
From the table above, we can know the level of significance of the effect of all the variables simultaneously to the user satisfaction of the RKE the simultaneous test results show that:
F count = 2,466
F table = (V1 = K, V2 = N-K-1) = with one-sided test (5%)
K = number of independent variables then obtained F count = 2.372
So F count > table F 2.466> 2.372, too p 0.043 <0.05 then Ho is rejected, so simultaneously there are accessibility influence. Quality, Security, Connectivity. Flexibility, Reliability of application EMR against user satisfaction in Grha Kedoya Hospital
Conclusion: dimensions: Accessibility. Quality, Security, Connectivity. Flexibility, Reliability simultaneously
have a significant influence on user satisfaction EMR
Tabel 4.3 a. Dependent Variable: Kepuasan
The regression equation above can be explained as follows:
- Constants of 13.117; meaning that if
the dimensions Accesibility. Quality, Security, Connectivity. Flexibility, Reliability, its value is 0, then the value is user satisfaction 13,117- existence of a positive relationship between the independent variable with the "user satisfaction" The existence of a positive relationship between the independent variable on the dimensions of Quality, Flexibility, Connectivity and Reliability with "user satisfaction"
- Accesibility variable regression
coefficient of -0.106; meaning that if another independent variable value is fixed and Accesibility applications increased 1%, then the user satisfaction will be decreased by 0.106 times. The coefficient is negative means going negative relationship between Accesibility with a satisfied user, getting up Accesibility of EMR application then getting down user satisfaction.
7 satisfaction will be increased by 0.190
times. The coefficient is positive, it means there is a positive relationship between Quality with user satisfaction, getting up Quality then increasing user satisfaction. EMR application available that have been able to give access to doctors and nurses but only some doctors and nurses use them.
- Security variable regression coefficient of -0.164; meaning that if another independent variable value is fixed and Security applications increased 1%, then the user satisfaction will be decreased by 0.164 times.
- Flexibility variable regression
coefficient of 0.502; meaning that if another independent variable value is fixed and Flexibility increased 1%, then the user satisfaction will be increased by 0.502 times. The coefficient is positive, it means there is a positive relationship between Flexibility with user satisfaction, the greater the Flexibility hence increasing user satisfaction.
- Connectivity variable regression
coefficient of 0.187; meaning that if another independent variable value is fixed and Connectivity increased 1%, then the user satisfaction will be increased by 0.187 times. The coefficient is positive, it means there is a positive relationship between Connectivity with user satisfaction, the rise Connectivity then increased user satisfaction
- Reliability variable regression
coefficient of 0.477; meaning that if another independent variable value is fixed and Reliability increased 1%, then the user is satisfied will be increased by 0.477 times. The coefficient is positive, it means there is a positive relationship between the Reliability with user satisfaction, the rise Reliability hence increasing user satisfaction
From the table above were obtained that sig is 0.048 <0.05 then Ho is rejected also in table t (df = n-1
two-tailed) = 2.020 and t = 2,048> t table, so Ho rejected so that there is
flexibility EMR influence on user satisfaction
For other variables that count sig> 0.05 also on the table t (df = n-1 two-tailed) = 2,020 and t count> 2,020 so there is in the area of Ho accepted that "there is no effect of each dimension
Accesibility. Quality, Security,
Connectivity, Reliability EMR to user satisfaction "
From the table above output obtained coefficient of determination (R Square) of 0. 297, which means a 29.7% user satisfaction can be explained by dimensions: Accesibility. Quality, Security, Connectivity. Flexibility, Reliability, while 70.3% is explained by other dimensions that are not included in this study.
Multiple correlation analysis
Multiple correlation analysis was used to determine the relationship between the dimensions Accesibility. Quality, Security, Connectivity. Flexibility, Reliability EMR to user satisfaction simultaneously
According Sugiyono (2007) guidelines to provide interpretation of the correlation coefficient as follows:
0.00 to 0.199 = very low 0.20 to 0.399 = low 0.40 to 0.599 = moderate 0.60 to 0.799 = Strong 0.80 to 1.000 = very strong
From the results of the regression analysis, a look at the output model summary and presented as follows:
Table 4.4
The results of multiple correlation analysis
Model Summary
Model R the Estimate 1 ,545a ,297 ,177 2,21871 a. Predictors: (Constant), Reliability, Accesibiity,
According to the table above were obtained figures R of 0.545. This shows that there is a relationship being between the dimensions Accesibility. Quality, Security, Connectivity. Flexibility, Reliability EMR to user satisfaction
R square = 0.297
From the table above output obtained coefficient of determination (R Square) of 0.297, which means a 29.7% mean user satisfaction can be determined / dideterminasikan by Accesibility. Quality, Security, Connectivity. Flexibility, Reliability EMR applications, while 70.3% is explained by other variables not included in this study
DISCUSSION
According to the Institute of Medicine (IOM), there are six elements related to patient care data and information storage so that the primary function health record maintained its quality, among others): Ease of access, meaning that the data acquisition system is available at all times for 24 hours and can only be opened by authorized personnel, quality, security , flexibility, efficiency, can be connected to various resources (connectivity) (Hatta, 2008)
Based on the results of research by Irmina Lusia Gey (2010) there was a significant effect simultaneously aspects of ease of access, security, flexibility, and reliability of the connection to user satisfaction. Also individually, there is a significant influence aspects of EMR applications access to user satisfaction (p = 0.001). There was a significant influence on the security aspects of EMR application user satisfaction (p = 0.001). There is significant influence aspects of EMR application flexibility towards user satisfaction (p = 0.012). There is no significant influence aspects of EMR application connections to user satisfaction (p = 0.554). There was a significant influence on the reliability aspects EMR application user satisfaction. (P <0.001)
5.1The results of Regression Coefficients test that the independent variables with the dimensions: Accessibility. Quality, Security, Connectivity. Flexibility, Reliability, jointly have a significant effect on user satisfaction EMR. Means the existence of a positive relationship between the independent variables simultaneously with the "user satisfaction". Taken together EMR applications that are easily accessible, high quality, provide security of data, easily connectable both intranet and internet, flexible and reliable will the results / reports it produces provide satisfaction to the users. The existence of a positive relationship between the independent variable on the dimensions of Quality, Flexibility, Connectivity and Reliability with "user satisfaction" It is important to maintain and enhance the EMR application and receive input from the user in order to meet user satisfaction and managerial interests RSGK
5.2However, if the dimensions of EMR applications stand alone then:
5.2.1 Significant influence "user satisfaction" only the dimensions of flexibility (p = 0048> 0.05), while the other dimensions had no effect (p> 0.05). It has been suggested that these applications are easy, simple work so that the new user though no difficulty in using it. This application is also designed according to user demand and always make changes in accordance with user demand. 5.2.2 Other dimensions such as
accessibility, quality, security, reliability and connectivity alone did not have a significant influence on the "user satisfaction” .
9 consistently in order to produce a
complete EMR electronically. 5.2.4 From the output table above
obtained coefficient of determination (R Square) of 0.297, which means a 29.7% user satisfaction can be determined simultaneously by Accessibility dimension. Quality, Security, Connectivity. Flexibility, Reliability EMR applications,
while 70.3% is explained by other variables not included in this study. No mean of 70.3% of other variables that affect the User Satisfaction. Further research is needed to determine other variables that affect user satisfaction on EMR application
CONCLUSIONS AND SUGGESTIONS
6.1CONCLUSIONS
6.1.1 Conclusions f Respondents Caracters
Of the overall indicator was asked respondents about the personal data it can be concluded that:
a. Gender
Female respondents (52.4%) more than men (47.6%).
b. Age group
The highest age group is the 25-29 year age group (35.7%), and at least the age group> 39 years. (7.1%)
c. Last education
So respondents to D3 RM terbesar13orang (31%).
d. Work unit
Respondents in the back office as many as 27 people (64.3%), respondents in the back office is greater than that in the front office.
e. Working Period
Duration of work most is the group that worked 3-5 years as many as 29 people (69%).
6.1.2 Linear Regression Analysis Results
a. The independent variables consisting of Dimensions: Accesibility. Quality, Security,
Connectivity. Flexibility, Reliability application EMR, simultaneously have a significant influence and positive impact on user satisfaction
b. Flexibility Dimension EMR applications have a significant influence on user satisfaction ". It has been suggested that these applications are easy, simple so that users who laymen have no difficulty in using it. This application is also designed according to user demand and always make changes in accordance with user demand. c. But there is no effect of each
dimension Accesibility. Quality,
Security, Connectivity. Flexibility, Reliability EMR
applications to user satisfaction " d. R figures obtained by 0.545. This
shows that there is a relationship being between the dimensions Accesibility. Quality, Security,
Connectivity. Flexibility, Reliability EMR applications to
user satisfaction
e. 29.7% user satisfaction can be explained by dimensions: Accesibility. Quality, Security,
Connectivity. Flexibility, Reliability, application EMR while 70.3% is explained by other dimensions that are not included in this study.
6.2 SUGESSTIONS
a. For the leadership in Grha Kedoya Hospital :
It is important to maintain and enhance the EMR application to receive input from the user in order to meet user satisfaction and managerial interests RSGK
b. It should be a firm policy to doctors and nurses to use the EMR applications consistently in order to produce a complete EMR electronically.
c. Need to do more research to determine other variables that affect user satisfaction on EMR application
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