Mobile E-Health Record, is it a “Frankenstein IT system” ?

This paper is a personal reflection as a part of portfolio assignment on SNPG950- Reflection for practice, UOW School of Nursing

This paper is a personal reflection on Information Technology (IT) in the documentation of nursing care in Indonesia and uses a framework proposed by Rolfe (2001).


A common problem in nursing practice in Indonesia is documentation of nursing care which is still paper- based. Many nurses state that there are too many forms to be completed, demanding a lot of time in their tight schedule (Hariyati et al. 2016, p. 137). I recall my experience during my placement in a hospital where nurses asked nursing students to complete patients’ health records. It was not because I was being asked to finish nurses’ duty that made me feel terrible, but sometimes I must write down something I had no knowledge of. I was not the one providing the care, I did not see the nurses providing the care, but I need to document the care. I realised that nurse practitioners were too busy caring for patients during their shift to document the care. After they had finished attending to patients’ needs, it was already time to handover to the next shift. The documentation was neglected. However, documentation is one of the legal aspects of the nursing profession as well as a significant factor enabling continuity of care and communication between nurses and other health care providers (Berman, Kozier & Erb 2014; Potter & Crisp 2013; Taylor 2008).

When I look back to that experience, I think there were consequences for me, as well as for nurses and patients. I felt that I deceived myself while recording something I did not do. I was not being true to my values. On the one hand, this might decrease nurses’ workload but nurses would never realize their responsibility to do documentation. Lack of documentation may put patients at harm. These potential consequences challenged me to think what I can do to make the situation better.


Nowadays, IT is being applied to solve problems in the healthcare service (Cohen, Coleman, & Kangethe 2016; Kagan et al. 2014; Rogers et al. 2013). In some countries, electronic health records have become the solution, replacing paper- based records. Some pilot studies in the innovation of nursing documentation in Indonesia already support the statement that integration of IT in the documentation of nursing care improves the quality of patient care (Hariyati et al. 2015; Hariyati, Delimayanti, & Widyatuti 2011). The barrier in the implementation of electronic health records in Indonesia is a lack of infrastructure and skilled labour. I feel it is now time for the government to take proper action in solving the infrastructure barrier and for healthcare providers to put more effort to enhance personal knowledge of nursing informatics in order to develop skilled labour.

Developed countries such as Australia and the United States of America already began to implement e-health system decades ago while developing countries are just beginning to. All of the states and territories in Australia have started the initiatives of telehealth since 1996 and in 2002 had already tried to make telehealth accessible even in rural areas (Dearne 2002). The United States introduced the primary version of electronic health records in the 1980s (Cannon, Smith, & Bickford 2006, p. 284). However, China, a developing country, has just begun using nursing informatics in 2014 (Yang et al. 2014, p. 2).  In 2009, researchers were developing a prototype of a nursing management system in Indonesia (Hariyati, Delimayanti, & Widyatuti 2011, p. 9052).

The implementation of IT in health care settings improves patient safety and the efficiency of care. A computerised physician order entry (CPOE) system as a clinical application enhances patient safety by reducing medication error, and supporting workflow and doctor- nurse communication (Saddik & Al-Mansour 2014, p. 149).  In addition, being able to check the up to date status of the patient through an electronic health record helps nurses to be efficient and effective in providing care (Kagan et al. 2014; Rogers et al. 2013).

One of the innovations of IT in health care, is a mobile health application where health care providers or patients access services through a smartphone. There are already more than 100.000 mobile health applications worldwide (Sangsari 2005). A survey also indicated a tendency for nurse practitioners to rely on mobile devices, social media, and the internet for professional purposes as the demands of work increase (PR Newswire 10 September 2014, p. 1). Based on these facts, an electronic health record application on smartphones may be a solution for nurses in Indonesia.



Developing the integration of IT in health care is quite challenging. There are so many factors that should be considered: funding, human resources, IT vendors, and socio- economic- politic situations (Dearne 2002; Dearne 2005). I acknowledge that most of the hospital stakeholders in Indonesia are reluctant to provide expensive tools such as tablets for the implementation of electronic health records. What I have in mine is using nurses’ personal gadgets (smartphones). Most Indonesians use smartphones nowadays. Indonesia will be the fourth largest country in the world in terms of smartphone usage by 2018 (Alivano 2015). I intend to develop a smartphone based electronic health record application (mobile electronic health record).

I realise there will be barriers even after the realisation of this mobile electronic health record application. The most significant barriers in the information system in healthcare delivery are workers’ acceptance and satisfaction (Cohen, Coleman, & Kangethe 2016, p. 82). Will nurses agree to use their personal gadget?  In addition, will nurses be able to use the system effectively and efficiently? There should be a pilot study and training for nurses prior to the implementation of any mobile electronic health system because a study showed inadequate computer literacy among older female nurses even in a developed country such as the United Kingdom (Kagan et al. 2014, p. 882). Another concern is patients’ privacy, safety and security policies as information is manipulated electronically. Clear rules are needed relating to who has access to the patients’ records.


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Mobile E-Health Record, is it a “Frankenstein IT system” ?

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