Integration of Health Technology into Primary Care Systems to Improve Service Quality and Efficiency
Keywords:
Digital health, Primary care, Service quality, EfficiencyAbstract
This study aims to explore how health technology is integrated into primary care systems to improve service quality and efficiency. The study addresses the growing use of digital tools in primary care, including electronic medical records, online registration, digital referral systems, and service reporting platforms. A qualitative exploratory case study design was used. The research was conducted from July to September 2026 at three primary care facilities in Bandar Lampung City, Indonesia: Puskesmas Kedaton, Puskesmas Sukarame, and Puskesmas Way Halim. Participants included doctors, nurses, midwives, administrative officers, medical record officers, facility managers, IT support staff, and patients who had experience using digital health services. Data were collected through semi-structured interviews, non-participant observation, and document review. Thematic analysis identified five main themes: digital technology as a tool for administrative acceleration, workflow adaptation among health workers, unequal digital readiness among patients, fragmented system integration, and the changing meaning of service quality and efficiency. The findings show that digital health can improve primary care performance when it supports user needs, service routines, and patient-centered interaction. However, poor interoperability, double documentation, unstable infrastructure, and low patient digital literacy can limit its benefits. This study contributes to socio-technical understanding of digital health implementation and offers practical guidance for designing more inclusive, efficient, and responsive primary care systems.
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., & Valdes, K. (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., Mayadewi, C. A., Lokopessy, A. F., Kozlakidis, Z., & Manikam, L. (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
Alotaibi, N., Wilson, C. B., & Traynor, M. (2025). Enhancing digital readiness and capability in healthcare: A systematic review of interventions, barriers, and facilitators. BMC Health Services Research, 25, Article 500. https://doi.org/10.1186/s12913-025-12663-3
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
Erku, D., 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., Lapão, L. V., Moioli, R. C., & 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
Figueirêdo, R. C., Silva, Í. S., Silva, C. R. D. V., Martiniano, C. S., Lapão, L. V., Moioli, R. C., Brito, E. W. G., & Uchôa, S. A. C. (2024). Preparation and validation of the instrument “QualiAPS Digital-Brazil”: Methodological study. Frontiers in Public Health, 12, 1304148. https://doi.org/10.3389/fpubh.2024.1304148
Finnegan, H., Acharya, S., & Sheikh, A. (2025). Twenty-five years of electronic health record implementation and optimization: Scoping review. Journal of Medical Internet Research, 27, e60077. https://doi.org/10.2196/60077
Jimenez, G., Matchar, D. B., Koh, C. H. G., van der Kleij, R., Chavannes, N. H., & Car, J. (2021). The role of health technologies in multicomponent primary care interventions: Systematic review. Journal of Medical Internet Research, 23(1), e20195. https://doi.org/10.2196/20195
Khanassov, V., Ilali, M., Ruiz, A. S., Rojas-Rozo, L., & Sourial, R. (2024). Telemedicine in primary care of older adults: A qualitative study. BMC Primary Care, 25, Article 259. https://doi.org/10.1186/s12875-024-02518-x
Kiger, M. E., & Varpio, L. (2020). Thematic analysis of qualitative data: AMEE Guide No. 131. Medical Teacher, 42(8), 846-854. https://doi.org/10.1080/0142159X.2020.1755030
Nadav, J., Kaihlanen, A. M., Kujala, S., Laukka, E., Hilama, P., Koivisto, J., Keskimäki, I., & Heponiemi, T. (2021). How to implement digital services in a way that they integrate into routine work: Qualitative interview study among health and social care professionals. Journal of Medical Internet Research, 23(12), e31668. https://doi.org/10.2196/31668
Neve, G., Fyfe, M., Hayhoe, B., & Kumar, S. (2020). Digital health in primary care: Risks and recommendations. British Journal of General Practice, 70(701), 609-610. https://doi.org/10.3399/bjgp20X713837
Pagliari, C. (2021). Digital health and primary care: Past, pandemic and prospects. Journal of Global Health, 11, 01005. https://doi.org/10.7189/jogh.11.01005
Pogorzelska, K., Chlabicz, S., & Kurpas, D. (2023). A qualitative study of primary care physicians’ experiences with telemedicine during the COVID-19 pandemic in Poland. International Journal of Environmental Research and Public Health, 20(3), 1963. https://doi.org/10.3390/ijerph20031963
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
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
Singh, H., Tahsin, F., Nie, J. X., McKinstry, B., Thavorn, K., Upshur, R., Harvey, S., Wodchis, W. P., & Steele Gray, C. (2021). Exploring the perspectives of primary care providers on use of the electronic patient-reported outcomes tool to support goal-oriented care: A qualitative study. BMC Medical Informatics and Decision Making, 21, Article 349. https://doi.org/10.1186/s12911-021-01734-0
Stoumpos, A. I., Kitsios, F., & Talias, M. A. (2023). Digital transformation in healthcare: Technology acceptance and its applications. International Journal of Environmental Research and Public Health, 20(4), 3407. https://doi.org/10.3390/ijerph20043407
Sutan, R., Ismail, S., & Ibrahim, R. (2025). Evaluating the development, reliability, and validation of the Tele-Primary Care Oral Health Clinical Information System questionnaire: Cross-sectional questionnaire study. JMIR Human Factors, 12, e53630. https://doi.org/10.2196/53630
Sze, K. P., Lee, J. J., & Tan, N. C. (2024). Exploring physicians’ perceptions of digital health’s impact on the patient-physician relationship: Qualitative study. Journal of Medical Internet Research, 26, e53705. https://doi.org/10.2196/53705
Tsai, C. H., Eghdam, A., Davoody, N., Wright, G., Flowerday, S., & Koch, S. (2020). Effects of electronic health record implementation and barriers to adoption and use: A scoping review and qualitative analysis of the content. Life, 10(12), 327. https://doi.org/10.3390/life10120327
Turner, A., Morris, R., Rakhra, D., Stevenson, F., McDonagh, L., Hamilton, F., Atherton, H., Farr, M., Banks, J., Lasserson, D., & Salisbury, C. (2022). Unintended consequences of online consultations: A qualitative study in UK primary care. British Journal of General Practice, 72(715), e128-e137. https://doi.org/10.3399/BJGP.2021.0429
Willis, V. C., Thomas Craig, K. J., 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., Lu, H., Peoples, N., Duman, E. K., Najarro, A., Ni, Z., Gong, E., Haldane, V., Wu, S., Jindal, R. M., & Leung, G. M. (2023). Digital health interventions for non-communicable disease management in primary health care in low- and middle-income countries. npj Digital Medicine, 6, Article 12. https://doi.org/10.1038/s41746-023-00764-4
Yew, S. Q., Lai, N. M., Ng, C. J., & Hadi, M. A. (2025). Facilitators and barriers to the implementation of digital health technologies in hospital settings in lower- and middle-income countries since the onset of the COVID-19 pandemic: Scoping review. Journal of Medical Internet Research, 27, e63482. https://doi.org/10.2196/63482
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