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Benefits and barriers to using information systems

A. Background
Computer-based management information systems have started to be widely used in the health
environment, especially in the field of nursing, in Indonesia, the process of using computers in
nursing documentation is very slow, so it is necessary to refresh the application of nursing
information systems for the development of nursing education (Prasetyanto & Sukihananto,
2019). According to Smedley in 2005 in (Syam & Sukihananto, 2019), since 1980 the role of
information and communication technology (ICT) in nursing practice has increased. For most
nurses, the use of ICT has given new impetus with the introduction of electronic medical records
and clinical resources that require the use of ward computers and other digital devices.
Evaluation of information technology (IT) in nursing is related to the rapid adoption of IT systems
in health care. According to Paterson & Jelger, 1988 in (Syam & Sukihananto, 2019) Health
information systems for nurses began in the late 1970s and are described as systems designed
with a special focus on receiving and also repatriating patients who carry out a series of
diagnostic tests.

Along with the progress of the information age, management of health information systems (SIK)
based on information and communication technology (ICT) is increasingly popular. Many
hospitals, medical offices, and community health centers use ICT to support organizational
processes, such as hospital information systems, clinical information systems, and health service
information systems (Sanjaya, 2011) in (Nugroho, 2015). The application of a nursing information
system is believed to provide benefits for both nurses and patients, but these benefits are not
perfect because of constraints or obstacles and also limitations in the process of implementing
the information system making the perceived benefits less than optimal.

Formulation of the problem

1. What are the benefits of Nursing information systems?
2. What are the obstacles in implementing a nursing information system?
3. What are the advantages and disadvantages of computerized nursing information
systems?

Writing purpose
1. Knowing the benefits of Nursing information systems
2. Knowing the obstacles in the implementation of nursing information systems
3. Knowing the advantages and disadvantages of computerized nursing information systems

Benefits of Nursing Information Systems

One of the benefits of implementing a hospital nursing information system is to help nurses
document nursing care. Nursing care in meeting the basic needs of patients is provided by
nurses in various health care settings using the nursing process. Nurses use a nursing
information system (SIK) with the aim of clearly assessing patients, preparing nursing plans,
documenting nursing care, and also to control the quality of nursing care.

The benefits of nursing information systems according to (Jubaedi, 2018), namely:

1. More efficient management
2. More cost-effective use of resources (reducing costs)
3. Improve program planning
4. Increase nurse utilization, where nurses spend more time with patients and spend less
time at the nurse's station.
5. Reducing paper usage
6. Nursing documentation automatically
7. The same standard of care (nursing process)
8. The quality of nursing services can be measured

The following are the benefits of a nursing information system according to (Syam &
Sukihananto, 2019), namely:
1. More time spent with patients and less time in the nurse's office
2. Reduce paperwork or paper loss
3. Automated nursing documentation tool
4. Uniform programmed standard of care (nursing process)
5. Cost reduction (Less lost cost) Quality is measurable

B. Supporting and inhibiting factors for the implementation of the Nursing Information
System

Factors supporting the Nursing Information System

1. There is a company (managed by the nursing profession) that offers ready-to-use nursing
SIM products to be applied in hospitals. Even though it has a fairly high price, the
existence of this company can support the implementation of nursing SIM in several
hospitals that have sufficient funds to buy this product.
2. There is Law No. 8 of 1997 which regulates the security of documentation in the form of
sheets of paper. This law is a form of legal protection for documents owned by health
service centers, companies or organizations.
3. Ethical aspects because this system is designed to the maximum extent possible to
maintain the confidentiality of patient data. Only certain people are allowed to access data
through this SIM, for example doctors, nurses, patients themselves.

According to (Putri et al., 2017) the obstacles experienced by puskesmas are:

 1. Barriers in Infrastructure
Many Community Health Centers only have one or two computers, and this is usually not
sufficient for day-to-day use at the Puskesmas. Many reports must be written using a computer.
Computers generally function more as a substitute for a typewriter. In addition, obstacles from
the side of the power source are also often a problem in information systems. Puskesmas in
certain areas or other areas are used to experiencing power outages so that the use of
computers is disrupted. In terms of security, there are many puskesmas buildings that are not
secure, which often happens to puskesmas, namely the loss of computer devices.

2. Barriers in Management
It is still rare to find employees or officials or even work units that specifically handle data/
computerization. This can be found at the community health center level or at the district or city
health office level.
Under these conditions, it will be difficult to determine who is responsible for the data that will
be made available, both for data processing and maintenance and for coordination between
services.

3. Obstacles in the field of Human Resources

In the field of human resources, it is often found in health centers. Many puskesmas employees
are not optimal in running computers.
Ability in computer operations is obtained by self-taught learning, so it is not optimal. Computer
use by staff that sometimes does not function properly.

According to (Nugroho, 2015) various factors inhibiting the implementation of health information
systems in Indonesia
1. Health Service Information System in Hospitals (Wajirah, 2010)
● Human resource skills/abilities
● Adaptation of Human Resources from manual processes to computer systems
● Availability of cost or budget
● Operational system problem

2. Puskesmas Management Information System (SIMPUS). (Rahmanita, 2014)

● Lack in the number of computer devices
● Lack of quality human resources because they are usually not in accordance with their
fields
● Lack of budget or costs

C. Strengths and Weaknesses of Computerized Nursing Information Systems

According to (Stubenrauch, 2009 & Mcbride et al., 2018) in (Tarigan & Handiyani, 2019) The
benefits of this computerized document are that nurses work more efficiently, effectively and
optimally in providing accurate, real-time, paperless nursing care services, making it easier to
test nursing staff. In addition, nursing care is more integrated, improving service quality and
expanding access to nursing care. Other benefits are that it can increase the security of care
systems, enable more reliable exchange of information between practitioners and clients, and
significantly improve the way care will be provided, improve nursing initiatives, capture and
deliver implemented nursing implementations more quickly and create more efficient patient-
centered services.

According to (Permenkes RI No 82, 2013 & Mcbride et al., 2018) in (Tarigan & Handiyani, 2019)
The drawback is that it requires a large initial budget, will depend heavily on technology, and
requires data storage capacity. Very large data area, the risk of exposing confidential data about
patient privacy. Another downside is the risk that nurses' critical thinking skills will be less
complex than using technology to care for patients, which requires time away from direct patient
care.

D. Data Management in Hospitals

Some problems that may occur in data management in hospitals, namely:

1. Data Redundancy
● data duplication
● Data is inconsistent
● filling capacity
● Slow access

2. Integrated data
● Data is out of sync
● Different assumptions according to individual needs

3. human error
● Data manipulation

4. Late information
● old summary
● Old data presentation

E. Efforts to overcome obstacles

1. System build
2. Procurement of facilities and infrastructure
3. Policy setting
 4. Determination of reward and punishment
5. Socialization
6. Training
7. Maintenance

A. Conclusion
In the application of a nursing information system, it is felt that it can provide benefits for nurses
and also patients, such as being more efficient and also effective in implementing nursing in
hospitals and health centers, but these benefits are not perfect because there are obstacles or
constraints such as incomplete devices, human resources and others in the process of applying
the information system, which can make the perceived benefits not so optimal. The advantages
and disadvantages of a computerized nursing information system, namely being able to obtain
information quickly and so on, of course there are disadvantages, namely leakage of patient data
and others.

B. Suggestion
Each system must be flexible enough to fit the culture of care givers and organizations in any
area rather than imposing its own method of organizing. Training is needed to make the system
more effective, so that nurses do not spend much time in front of a computer screen compared
to being with patients. In addition, support should be provided by top level management, so that
system maintenance and development can also be carried out in order to expedite the operation
of the existing system in an institution.