Strategy for Successful Acceleration of Usage Electronic Health Record

System in Adult Population of Hospitals in Indonesia : A Transition

Theory Application

Ida Farida Komala1, Nau’ul Masdaryah1,

Sri Handayani1, Edy Raharja1, Edy Purwanto1, Satriya Pranata2, Siti Aisah2

1
Student Master of Nursing Program, Universitas Muhammadiyah Semarang, Semarang,
Central Java, Indonesia
2
Department of Nursing, Faculty of Nursing and Health Sciences, Universitas Muhammadiyah
Semarang, Semarang, Central Java, Indonesia

Corresponding Author: Ida Farida Komala, Email: idadindajaya1@yahoo.co.id

ABSTRACT

The era of information disclosure in health services is now progressing. Health information
technology supports the development and improvement of the quality of health services in accordance
with developments in science and technology. One of the theoretical approaches in nursing research
and practice is the Transition theory put forward by Meleis. Transition theory is the result of changes
in life, health, relationships, and the environment). This study aims to analyze the success strategy of
Electronic Health Record Systems (EHRs) in Indonesia through the Meleis Transition theory
approach. Transition theory involves passage from one life phase, condition, or status to another, and
refers to the processes and outcomes of complex person-environment interactions. Transition theory
plays a role in assisting through the transition period, facilitating and developing interventions and
policy support in strategic planning to accelerate the transition of manual documentation recording to
Electronic Health Record Systems (EHRs).

Keywords: Electronic Health Record, Nursing Theory, Transition, Adult

Introduction

In the nursing profession, it is famous for its four levels of theory, namely philosophical theory, grand theory,
middle range theory and practice theory. These theories are classified based on their scope or level of
abstractness, starting from the grand theory as the most abstract, to the practice theory as the more concrete. One
of the grand nursing theories is the transition theory that was coined by Afaf Ibrahim Meleis. The application of
context theory in Meleis's theory is in the transition of humans, environment, health, and nursing in Therapeutic
Nursing. The concept of Transition Theory Application contributes to the development of science and
technology in health services. Technological developments are increasing rapidly along with the advancement
of Industrial Age 4.0 technology with the automatic availability of all relevant information, optimal ability to
obtain results from each important data [1]. The development of this technology is also utilized in hospitals in the
form of Electronic Health Record Systems (EHRs). EHRs can be defined as Electronic health records that
contain detailed records of patient health data including history, physical examination, investigations, and
treatment in a digital format that offers several advantages over paper records [2]. This is in accordance with
Meleis' suggestion that the central concepts of nursing are clients, transitions, interactions, nursing processes,
environment, nursing therapy, and health[3]. The proposition of Meleis theory is that the nature of transitions 'can
facilitate or hinder one's response patterns [4]. Information technology has a significant and fundamental role in
the management, distribution and storage of information in nursing services. Health information is expected to
improve the quality and continuity of patient care and treatment[5]

Transition Theory

Afaf Ibrahim Meleis is a nursing figure who issued a theory about transition [6]. This theory began to be
developed in 1960[7]. Afaf Ibrahim Meleis' transition theory has five main concepts, namely, types and patterns
of transitions, richness of transition experiences, transitional conditions, response patterns, therapeutic nursing.
The definition of transition in nursing refers to changes that occur in health, illness or development, as well as
the consequent efforts of individuals undergoing transition to adapt and regain normality. The meleis theory that
relates to the application of context theory is the environment. According to Meleis, the environment is the
context in which the individual is included, and which can support the conception of conditions favorable to
transition, such as family, community, natural and artificial physical conditions. Interaction with the
environment is influenced by internal and external factors [8]. So that in context theory it is proven that meleis
theory applies environmental and health contexts regarding the nursing process, namely therapeutic nursing.
Nursing therapeutics as three measurement tools that can be widely applied for therapeutic interventions during
transitional periods[7]. Two of the General Concepts in Meleis Theory [7] are transitional conditions (facilitators
and inhibitors), consisting of personal conditions, community, or social factors. Response patterns include
feeling connected, interacting, location and being positioned, and developing confidence and coping. Transition
Theory is significantly suitable to be applied in the Strategy to Accelerate the Successful Use of Electronic
Health Record System (EHRs) in Adult Population Hospitals in Indonesia.

Implementation Of Support Activities

Types and patterns of transitions can be in the form of developmental transitions (growth), health and illness
(health-illness), situational and organizational. Situational and organizational transitions are administrative
changes that lead to changes in recording paper-based documentation to based documentation EHR (Electronic
Health Records). The nature of the transition experience includes awareness, engagement, changes and
differences, period, and critical points and events. The main point is the awareness of every member of the
Hospital to make progressive changes to keep up with the times and advances in science and technology.
Transition conditions (facilitators and inhibitors), namely motivation and innovation from hospital
management in influencing hospital members through the transition process, facilitating a healthy transition [7].
Education is the main modality for creating optimal conditions in transition preparation [8]. Transitional
conditions consist of personal conditions, community, or social factors. This theory aims to provide a
framework for identifying the experiences of people who have to face life and overcome situations that require
the development of new skills and behaviors [8]. Response patterns include feeling connected, interacting,
location and being positioned, and developing confidence and coping. Feeling connected is defined as the need
to connect with each other (personal contact), interacting means that interaction can detect changes in
transitions, location and being situated means that time, space, and relationships are important in transitions, and
developing confidence and coping which is an indicator of someone being able to master abilities and identity [7].
A study conducted in a hospital stated that the influence of human and organizational aspects is the key to the
success of a technology[9]. Electronic Health Records (EHR) system selection by determining the use of the
EHR system (Electronic Health Records) suitable for all activities in Hospitals according to the needs and types
of Hospitals and implementation of phased implementation After carrying out a series of interventions above,
managers implement EHR (Electronic Health Records) in stages so that EHR (Electronic Health Records)
Implementation activities in the field can be accepted and run according to Hospital expectations. It is related to
the need for interpersonal relationships in hospitals to support each other in dealing with transitional changes to
build together to improve service quality through scientific developments so that it will foster a sense of
togetherness and confidence in hospital development. Nursing therapeutics as a communication measurement
tool widely applied to therapeutic interventions during the transition.

Conclusion
The strategy for accelerating the use of the EHR (Electronic Health Record) is a process from the Transition
Theory Meleis regarding the transition from the use of manual documentation to the EHR (Electronic Health
Record). This change will affect the quality of hospital services. It will improve the quality of the nursing
profession by what will be accepted to be applied in the nursing profession. Authority in decision-making for
the use of acceleration EHR (Electronic Health Records) in hospital management by taking into account the
implementation of the use of interventions EHR (Electronic Health Records). Performance of use of EHR
(Electronic Health Records) by conducting training and education, financial support, system selection EHR
(Electronic Health Records) and implementation EHR (Electronic Health Records) gradually
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