Digital Health Transformation to Support Clinical Decision-Making in Primary Health Care Facilities

Joko Saputra; Kartika Wijaya; Laras Maulana

Authors

Joko Saputra Universitas Indonesia Author
Kartika Wijaya Universitas Indonesia Author
Laras Maulana Universitas Gadjah Mada Author

Keywords:

Clinical decision-making, Digital health transformation, Primary health care, Sociotechnical system

Abstract

This study aims to explore how digital health transformation supports clinical decision-making in primary health care facilities. The study responds to the growing use of electronic medical records, digital reporting systems, telemedicine platforms, and clinical decision support tools in primary care, while also recognizing persistent challenges related to infrastructure, workload, data integration, and user readiness. A qualitative case study approach was used to examine four primary health care facilities in Bandar Lampung City, Indonesia, from January to April 2026. Data were collected through semi-structured interviews, non-participant observation, and document review involving doctors, nurses, midwives, medical record officers, IT or data officers, pharmacy staff, and facility managers selected through purposive and snowball sampling. Thematic analysis revealed four main themes: digital systems improved access to patient information, digital documentation created both support and burden, health workers balanced digital recommendations with professional judgment, and organizational readiness shaped the effectiveness of digital use. The findings show that digital health transformation is not merely a technical process, but a sociotechnical change that depends on the relationship between technology, clinical workflow, staff competence, organizational support, and patient interaction. This study contributes to digital health literature by explaining how frontline health workers make sense of digital tools in clinical decision-making. The findings imply that policymakers and health facility managers should strengthen system integration, staff training, infrastructure readiness, and patient-centered digital communication. Future research should compare different facility contexts and include patient perspectives.

References

Abernethy, A., Adams, L., Barrett, M., Bechtel, C., Brennan, P., Butte, A., Faulkner, J., Fontaine, E., Friedhoff, S., Halamka, J., Howell, M., Johnson, K., Long, P., McGraw, D., Miller, R., Lee, P., Perlin, J., Rucker, D., Sandy, L., & Savage, L. (2022). The promise of digital health: Then, now, and the future. NAM Perspectives, 2022. https://doi.org/10.31478/202206e

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

Bayor, A. A., Li, J., Yang, I. A., & Varnfield, M. (2025). Designing clinical decision support systems: A user-centered lens of the design characteristics, challenges, and implications. Journal of Medical Internet Research, 27, e63733. https://doi.org/10.2196/63733

Figueirêdo, R. C. D., Silva, Í. D. S., Xavier, P. B., Araújo, A. J. D., Silva, A. J. B. D., Silva, C. R. D. V., Santos, W. S., Silva, J. D. A., & Uchôa, S. A. D. 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

Frisinger, A., & Papachristou, P. (2023). The voice of healthcare: Introducing digital decision support systems into clinical practice: A qualitative study. BMC Primary Care, 24, 67. https://doi.org/10.1186/s12875-023-02024-6

Ginsberg, K. H., Babbott, K., & Serlachius, A. (2024). Exploring participants’ experiences of digital health interventions with qualitative methods: Guidance for researchers. Journal of Medical Internet Research, 26, e62761. https://doi.org/10.2196/62761

Gold, R., Sheppler, C., Hessler, D., Bunce, A., Cottrell, E., Yosuf, N., Pisciotta, M., Gunn, R., Leo, M., & Gottlieb, L. (2021). Using electronic health record-based clinical decision support to provide social risk-informed care in community health centers: Protocol for the design and assessment of a clinical decision support tool. JMIR Research Protocols, 10(10), e31733. https://doi.org/10.2196/31733

He, W., Chima, S., Emery, J., Manski-Nankervis, J. A., Williams, I., Hunter, B., Nelson, C., & Martinez-Gutierrez, J. (2024). Perceptions of primary care patients on the use of electronic clinical decision support tools to facilitate health care: A systematic review. Patient Education and Counseling, 125, 108290. https://doi.org/10.1016/j.pec.2024.108290

Indria, D., Alajlani, M., & Fraser, H. S. F. (2020). Clinicians’ perceptions of a telemedicine system: A mixed-method study of Makassar City, Indonesia. BMC Medical Informatics and Decision Making, 20, 233. https://doi.org/10.1186/s12911-020-01234-7

Jarva, E., Oikarinen, A., Andersson, J., Tomietto, M., Kääriäinen, M., Mikkonen, K., & Oikarinen, A. (2022). Healthcare professionals’ perceptions of digital health competence: A qualitative descriptive study. Nursing Open, 9(2), 1379–1393. https://doi.org/10.1002/nop2.1184

Knop, M., Weber, S., Mueller, M., & Niehaves, B. (2022). Human factors and technological characteristics influencing the interaction of medical professionals with artificial intelligence-enabled clinical decision support systems: Literature review. JMIR Human Factors, 9(1), e28639. https://doi.org/10.2196/28639

Köhler, S. M., Holtz, S., Neff, M. C., Schaaf, J., von Wagner, M., Müller, B. S., & Schütze, D. (2025). Evaluating the prototype of a clinical decision support system in primary care: Qualitative study. JMIR Formative Research, 9, e69875. https://doi.org/10.2196/69875

Kwan, J. L., Lo, L., Ferguson, J., Goldberg, H., Diaz-Martinez, J. P., Tomlinson, G., Grimshaw, J. M., & Shojania, K. G. (2020). Computerised clinical decision support systems and absolute improvements in care: Meta-analysis of controlled clinical trials. BMJ, 370, m3216. https://doi.org/10.1136/bmj.m3216

Laka, M., Milazzo, A., & Merlin, T. (2021). Factors that impact the adoption of clinical decision support systems for antibiotic management. International Journal of Environmental Research and Public Health, 18(4), 1901. https://doi.org/10.3390/ijerph18041901

Li, E., Tsopra, R., Jimenez, G., Serafini, A., Gusso, G., Lingner, H., Fernandez, M. J., Irving, G., Petek, D., Hoffman, R., Lazic, V., Mallen, C., Koskela, T., Collins, C., Espitia, M., Claveria, A., Nessler, K., O’Neill, B., & Neves, A. L. (2022). General practitioners’ perceptions of using virtual primary care during the COVID-19 pandemic: An international cross-sectional survey study. PLOS Digital Health, 1(5), e0000029. https://doi.org/10.1371/journal.pdig.0000029

Madanian, S., Nakarada-Kordic, I., Reay, S., & Chetty, T. (2023). Patients’ perspectives on digital health tools. PEC Innovation, 2, 100171. https://doi.org/10.1016/j.pecinn.2023.100171

Meunier, P. Y., Raynaud, C., Guimaraes, E., Gueyffier, F., & Letrilliart, L. (2023). Barriers and facilitators to the use of clinical decision support systems in primary care: A mixed-methods systematic review. The Annals of Family Medicine, 21(1), 57–69. https://doi.org/10.1370/afm.2908

Pitaloka, A. A., & Nugroho, A. P. (2021). Digital transformation in Indonesian healthcare. STI Policy and Management Journal, 6(1), 51–66. https://doi.org/10.14203/STIPM.2021.301

Robles-Aguilar, P., Ruiz-Fernández, M. D., & Bermudo-Fuenmayor, S. (2025). Digital health experiences of primary care nurses: A qualitative meta-synthesis. International Nursing Review, 72, e70069. https://doi.org/10.1111/inr.70069

Silva, Í. S., Silva, C. R. D. V., Martiniano, C. S., Araújo, A. J., Figueirêdo, R. C., Lapão, L. V., Moioli, R. C., Brito, E. W. G., & 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

Sturgiss, E., Desborough, J., Hall Dykgraaf, S., Matenge, S., Dut, G., Davis, S., de Toca, L., Kelly, P., & Kidd, M. (2022). Digital health to support primary care provision during a global pandemic. Australian Health Review, 46(3), 269–272. https://doi.org/10.1071/AH21263

Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: Benefits, risks, and strategies for success. NPJ Digital Medicine, 3, 17. https://doi.org/10.1038/s41746-020-0221-y

Sze, K. P., Fong, Q. W., Tan, N. C., & Wong, L. Y. (2024). Exploring physicians’ perceptions of digital health’s impact on the patient-physician relationship in the primary health care setting: Qualitative descriptive study. Journal of Medical Internet Research, 26, e53705. https://doi.org/10.2196/53705

Weiner, S. J., Schwartz, A., Weaver, F., Galanter, W., Olender, S., Kochendorfer, K., Binns-Calvey, A., Saini, R., Iqbal, S., Diaz, M., Michelfelder, A., & Varkey, A. (2022). Effect of electronic health record clinical decision support on contextualization of care: A randomized clinical trial. JAMA Network Open, 5(10), e2238231. https://doi.org/10.1001/jamanetworkopen.2022.38231