Analysis of the Success of Electronic Medical Record Implementation: A Governance Perspective of Electronic System Providers

In Indonesia, the implementation of Electronic Medical Records (EMR) in healthcare facilities is gaining momentum, spurred by the country’s digital health transformation agenda and the nationwide adoption mandate. The success of EMR implementation depends not only on technological and human resource capability but also on the governance of Electronic System Providers (ESPs) supporting healthcare facilities. This study explores EMR outcomes based on the type of ESP adopted in hospitals: internally developed in-house system versus third-party vendor systems. A qualitative multiple-case descriptive study was conducted in three hospitals in Central Java to provide an in-depth understanding of the processes and contextual factors influencing ESP governance. The findings reveal that in-house systems offer greater flexibility and customization, enabling faster implementation, but require substantial resources for development and maintenance. In contrast, third-party systems provide stronger technical support and regulatory compliance, yet tend to be less adaptable to hospital-specific needs. Recognizing the strengths and limitations of each ESP model helps hospitals make better-informed decisions aligned with their capabilities and requirements. This study highlights that hospitals are encouraged to adopt ESPs that provide flexible customization options, proven interoperability with national health information systems, and robust data protection mechanisms that comply with regulatory standards. In addition, pilot testing prior to full-scale implementation and establishing clear service-level agreements (SLAs) with ESPs are essential steps to ensure long-term reliability and sustainability of EMR systems. Regardless of the ESP model chosen, compliance with regulations, data security, and interoperability must be ensured to support effective and sustainable EMR implementation.