Strategies for Strengthening Digital Health Information Systems to Optimize Primary Health Care

Gita Lestari; Hendra Putri; Indah Hidayat

Authors

Gita Lestari Institut Teknologi Sepuluh Nopember Author
Hendra Putri Institut Teknologi Sepuluh Nopember Author
Indah Hidayat Universitas Indonesia Author

Keywords:

Digital health information systems, Primary health care, Puskesmas, Digital governance

Abstract

This study aims to analyze strategies for strengthening digital health information systems to optimize primary health care. The study addresses the growing need for integrated, reliable, and user-centered digital systems in Puskesmas, where fragmented applications, double reporting, uneven digital literacy, and data quality issues often affect service delivery. This research used a qualitative case study design conducted in 11 Puskesmas in Denpasar City, Bali Province, Indonesia, from January to March 2025. Data were collected through semi-structured interviews, nonparticipant observation, and document analysis. Participants included heads of Puskesmas, health information system officers, medical record staff, doctors, nurses, midwives, pharmacy staff, program managers, registration officers, and local health office staff selected through purposive and snowball sampling. Data were analyzed using thematic analysis supported by the interactive model of data condensation, data display, and conclusion drawing. The findings identified five main themes: fragmented digital workflows, uneven digital literacy, data quality as a shared organizational responsibility, leadership and peer support as implementation drivers, and the need for integrated digital governance. These findings show that optimizing primary health care requires more than technological adoption. It requires alignment between digital systems, human capacity, organizational routines, and policy support. The study contributes to sociotechnical understanding of digital health implementation and provides practical implications for improving interoperability, training, data governance, and evidence-based decision-making in primary health care.

References

Aisyah, D. N., Setiawan, A. H., Lokopessy, A. F., Faradiba, N., Setiaji, S., Manikam, L., & Kozlakidis, Z. (2024). The information and communication technology maturity assessment at primary health care services across 9 provinces in Indonesia: Evaluation study. JMIR Medical Informatics, 12, e55959. https://doi.org/10.2196/55959

Alharbi, M. F. (2025). Does electronic health record implementation enhance hospital efficiency and patient outcomes? A systematic review. SAGE Open, 15(3). https://doi.org/10.1177/21582440251359791

Braun, V., & Clarke, V. (2021). One size fits all? What counts as quality practice in reflexive thematic analysis? Qualitative Research in Psychology, 18(3), 328–352. https://doi.org/10.1080/14780887.2020.1769238

Damschroder, L. J., Reardon, C. M., Widerquist, M. A. O., & Lowery, J. (2022). The updated Consolidated Framework for Implementation Research based on user feedback. Implementation Science, 17, 75. https://doi.org/10.1186/s13012-022-01245-0

de Figueirêdo, R. C., de Siqueira Silva, Í., de Araújo, A. J., Silva, C. R. D. V., Martiniano, C. S., Brito, E. W. G., & Uchôa, S. A. C. (2024). Preparation and validation of the instrument “QualiAPS digital-Brazil” for assessing digital health care in primary health care: A required tool. Frontiers in Public Health, 12, 1304148. https://doi.org/10.3389/fpubh.2024.1304148

de Siqueira Silva, Í., Xavier, P. B., Dantas, T. H. M., Lopes, R. H., de Araújo, A. J., & Uchôa, S. A. C. (2024). Digital health and quality of care in primary health care: An evaluation model. Frontiers in Public Health, 12, 1443862. https://doi.org/10.3389/fpubh.2024.1443862

Erku, D. A., Khatri, R., Endalamaw, A., Wolka, E., Nigatu, F., Zewdie, A., & Assefa, Y. (2023). Digital health interventions to improve access to and quality of primary health care services: A scoping review. International Journal of Environmental Research and Public Health, 20(19), 6854. https://doi.org/10.3390/ijerph20196854

Fava, V. M. D., & Lapão, L. V. (2024). Provision of digital primary health care services: Overview of reviews. Journal of Medical Internet Research, 26, e53594. https://doi.org/10.2196/53594

Figueirêdo, R. C., Silva, Í. S., Araújo, A. J., Silva, C. R. D. V., Martiniano, C. S., Brito, E. W. G., & Uchôa, S. A. C. (2025). Digital health and primary health care quality: A survey case study. International Journal of Environmental Research and Public Health, 22(7), 1015. https://doi.org/10.3390/ijerph22071015

Finnegan, H., O’Connor, S., Doran, D., & McCarthy, S. (2025). 25 years of electronic health record implementation processes: Scoping review. JMIR Medical Informatics, 13, e60077. https://doi.org/10.2196/60077

Guest, G., Namey, E., & Chen, M. (2020). A simple method to assess and report thematic saturation in qualitative research. PLOS ONE, 15(5), e0232076. https://doi.org/10.1371/journal.pone.0232076

Lobe, B., Morgan, D., & Hoffman, K. A. (2020). Qualitative data collection in an era of social distancing. International Journal of Qualitative Methods, 19, 1–8. https://doi.org/10.1177/1609406920937875

Monteiro, V. C. M., Silva, C. R. D. V., Lopes, R. H., Araújo, A. J., Martiniano, C. S., & Uchôa, S. A. C. (2025). Digital health technologies in primary health care in rural territories: A qualitative study. PLOS ONE, 20(9), e0331902. https://doi.org/10.1371/journal.pone.0331902

Nathan, J. J., Agarwal, D., Peres, I. T., Bastos, L. S. L., Resende, N., Hamacher, S., Cheyne, A., Jamieson, N., Kawade, A., Khoo, E. M., & Bozza, F. A. (2024). Digital health interventions in primary care in low- and middle-income countries: A systematic scoping review protocol. Journal of Global Health Reports, 8, e2024020. https://doi.org/10.29392/001c.120508

Nurrahma, A. N., Larasati, T. A., Kurniati, I., & Pramesona, B. A. (2023). Electronic medical records in primary health care facilities. Review of Primary Care Practice and Education, 6(2), 22–28. https://doi.org/10.22146/rpcpe.79085

Robles-Aguilar, P., Lee, J. J., & Weller-Newton, J. M. (2025). Digital health experiences of primary care nurses: A qualitative systematic review. International Nursing Review. https://doi.org/10.1111/inr.70069

Scandiffio, J., Bender, J. L., & Wiljer, D. (2024). The role of mentoring and coaching of healthcare professionals for digital technology adoption and implementation: A scoping review. Digital Health, 10, 20552076241238075. https://doi.org/10.1177/20552076241238075

Sieck, C. J., Pearl, N., Bright, T. J., & Yen, P. Y. (2020). A qualitative study of physician perspectives on adaptation to electronic health records. BMC Medical Informatics and Decision Making, 20, 25. https://doi.org/10.1186/s12911-020-1030-6

Silva, C. R. D. V., Lopes, R. H., de Goes Bay, O., Martiniano, C. S., Fuentealba-Torres, M., Arcêncio, R. A., Lapão, L. V., Dias, S., & Uchôa, S. A. C. (2022). Digital health opportunities to improve primary health care in the context of COVID-19: Scoping review. JMIR Human Factors, 9(2), e35380. https://doi.org/10.2196/35380

Skivington, K., Matthews, L., Simpson, S. A., Craig, P., Baird, J., Blazeby, J. M., Boyd, K. A., Craig, N., French, D. P., McIntosh, E., Petticrew, M., Rycroft-Malone, J., White, M., & Moore, L. (2021). A new framework for developing and evaluating complex interventions: Update of Medical Research Council guidance. BMJ, 374, n2061. https://doi.org/10.1136/bmj.n2061

Sukarmayasa, I. M., Farmani, P. I., Wirajaya, M. K. M., & Laksmini, P. A. (2024). Kesiapan integrasi e-Puskesmas dengan SATUSEHAT di Puskesmas Kota Denpasar. Jurnal Kesehatan Vokasional, 9(4), 251–260. https://doi.org/10.22146/jkesvo.99335

Van Tilburg, M. L., Green, L. A., & Little, P. (2024). Barriers and facilitators to the implementation of digital health services for people with musculoskeletal conditions in the primary health care setting: Systematic review. Journal of Medical Internet Research, 26, e49868. https://doi.org/10.2196/49868

Vanderhout, S., Khan, S., & Grimshaw, J. M. (2025). Impacts on quality of care following electronic health record implementation: A qualitative study. BMJ Open, 15, e097646. https://doi.org/10.1136/bmjopen-2024-097646

Vindrola-Padros, C., Chisnall, G., Cooper, S., Dowrick, A., Djellouli, N., Symmons, S. M., Martin, S., Singleton, G., Vanderslott, S., Vera, N., & Johnson, G. A. (2020). Carrying out rapid qualitative research during a pandemic: Emerging lessons from COVID-19. Qualitative Health Research, 30(14), 2192–2204. https://doi.org/10.1177/1049732320951526

Willis, V. C., Craig, K. J. T., Jabbarpour, Y., Scheufele, E. L., Arriaga, Y. E., Ajinkya, M., Rhee, K. B., & Bazemore, A. (2022). Digital health interventions to enhance prevention in primary care: Scoping review. JMIR Medical Informatics, 10(1), e33518. https://doi.org/10.2196/33518

Xiong, S., Berkhouse, H., Schooler, M., Pu, W., Sun, A., Gong, E., & Yan, L. L. (2023). Digital health interventions for non-communicable disease management in primary health care in low- and middle-income countries. NPJ Digital Medicine, 6, 12. https://doi.org/10.1038/s41746-023-00764-4

Yi, S., Kim, J., Tan, M., & Haldane, V. (2024). Perspectives of digital health innovations in low- and middle-income health care systems from South and Southeast Asia. Journal of Medical Internet Research, 26, e57612. https://doi.org/10.2196/57612