Digital Competence, Organizational Support, and Proxy Compliance in Electronic Medical Record Use: An Explanatory Sequential Mixed-Methods Study
Keywords:
Electronic Medical Records, Digital Competence, Healthcare Workers, Mixed Methods, Technology AdoptionAbstract
Electronic Medical Record (EMR) implementation depends not only on organizational readiness but also on healthcare workers’ digital competence and their everyday experience of using the system. This study examined digital competence, perceived organizational support, and lived experiences of EMR implementation among healthcare workers at an Indonesian private hospital using an explanatory sequential mixed-methods design. Phase 1 involved a cross-sectional survey of 76 of 109 eligible healthcare workers using a DigComp 2.2-adapted questionnaire, with data analyzed descriptively in IBM SPSS Statistics 31. Phase 2 involved semi-structured interviews, non-participant observations, and document review with 19 purposively selected participants across clinical, support, and management/IT groups, followed by a six-phase thematic analysis. Overall, 85.5% of respondents demonstrated high digital competence, although competence was lower among workers aged over 45 years, non-clinical health workers, and those reporting lower organizational support. Qualitative analysis identified four themes: reactive implementation and training gaps; technical infrastructure instability and downstream effects; field-level compromise and interprofessional role shifts; and prolonged hybrid transition with profession-specific motivation. A cross-cutting finding, termed proxy compliance, revealed that EMR documentation was sometimes entered by individuals other than the registered account holder with managerial tolerance. These findings indicate that apparent EMR compliance may not reflect genuine individual competence or technology acceptance. Sustainable EMR implementation requires targeted competency development, reliable infrastructure, accessible procedural guidance, and governance mechanisms that verify authentic system use and accountability.
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