Interprovincial Inequality in The Implementation of Hospital Electronic Medical Records in Indonesia
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Indonesia's Minister of Health Regulation No. 24 of 2022 (Peraturan Menteri Kesehatan, Permenkes No. 24/2022) required hospitals to implement electronic medical records (EMRs), known in Indonesia as Rekam Medis Elektronik (RME), by December 31, 2023. However, regional disparities in implementation remained insufficiently understood. This study assessed interprovincial inequalities in comprehensive EMR implementation in 2024, examined associated technological, organizational, and environmental factors, and compared implementation levels with SATUSEHAT platform connectivity in 2025. A cross-sectional ecological study was conducted across 38 Indonesian provinces using data from the 2024 and 2025 Indonesian Health Profiles and Statistics Indonesia publications from 2026. The outcome variable was the proportion of hospitals implementing EMRs across six service areas. Data were analyzed using between-region and within-region variance decomposition and multilevel fractional logistic regression with robust standard errors. Among 3,102 hospitals surveyed, 62.83% had fully implemented EMRs, 34.78% had partially implemented them, and 2.39% had not implemented them. Provincial implementation rates ranged from 0% to 88.9%, with a Gini coefficient of 0.228. Approximately 68% of the observed variation occurred between regions, with implementation rates ranging from 72.2% in Java to 28.2% in Maluku–Papua. The lower odds of comprehensive implementation in Maluku–Papua (odds ratio [OR] = 0.21) were no longer statistically significant after adjustment for internet access, the Human Development Index, and hospital characteristics. The proportion of privately owned hospitals was positively associated with comprehensive implementation (OR = 1.17 per 10-percentage-point increase; 95% confidence interval [CI]: 1.07–1.28), but this association was no longer statistically significant after adjustment for the six regional groupings (OR = 1.05; 95% CI: 0.91–1.21). SATUSEHAT connectivity in 2025 was nearly universal but was not significantly associated with the extent of EMR implementation. These findings indicated that interprovincial inequalities in comprehensive EMR implementation were predominantly regional and associated with disparities in digital infrastructure, human development, and hospital ownership composition. Policy monitoring should therefore extend beyond connectivity indicators to assess implementation comprehensiveness at the provincial level, accompanied by targeted support for regions with lower levels of digital health readiness.
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