Hubungan Struktur, Proses, dan Outcome dalam Penerapan Rekam Medis Elektronik Terhadap Kualitas Pelayanan di RSUD Bali Mandara Provinsi Bali

Abstract

Background: Improving the quality of healthcare services depends on the availability of quality medical information. Minister of Health Regulation Number 24 of 2022 requires every healthcare facility to organize Electronic Medical Records (EMR). However, the implementation of EMR still faces challenges such as infrastructure and human resource readiness, which is reflected in the fluctuating achievement of quality indicators at Bali Mandara Regional Hospital. This study aims to analyze the relationship between structure, process, and outcome in the implementation of EMR using Donabedian theory. Method: This quantitative research with an explanatory survey approach was conducted at Bali Mandara Regional Hospital, Bali Province in May–June 2026. The study sample consisted of 274 healthcare workers using EMR selected using stratified proportional sampling technique. Data were collected through questionnaires and observations, then analyzed using the Spearman correlation test with SPSS software. Results: The results of the univariate analysis showed that the majority of respondents rated the structure component as being in the sufficient category (62.8%), the process as being in the good category (79.9%), and the outcome as being in the good category (67.9%). The results of the bivariate analysis showed no significant relationship between the structure and the service process (Sig = 0.964) or between the structure and the service outcome (Sig = 0.318). However, a significant positive relationship was found between the EMR implementation process and the service outcome (Sig = 0.041; r = 0.124) with a very weak relationship strength. Conclusion: The availability of an adequate structure does not guarantee optimal service processes and outcomes directly because it only serves as a prerequisite for implementation. Conversely, the quality of the process in filling out and utilizing the EMR was proven to be significantly related to the success of medical documentation outcomes. Hospital management needs to improve user training, strengthen the stability of the internet network, and conduct regular monitoring of the timeliness of EMR filling out.