Demographic Comparison of Information Security Behavior Toward Health Information System Protection: Survey Study.

BACKGROUND: The health information system (HIS) functions are getting wider with more diverse users. Information security in the health industry is crucial because it involves comprehensive and strategic information that might harm human life. The human factor is one of the biggest security threats to HIS. OBJECTIVE: This study aims to investigate the information security behavior (ISB) of HIS users using a comprehensive assessment scale suited to the information security concerns in health care. Patients are increasingly being asked to submit their own data into HIS systems. As a result, this study examines the security behavior of health workers and patients, as well as their demographic variables. METHODS: We used a quantitative approach using surveys of health workers and patients. We created a research instrument from 4 existing measurement scales to measure prosecurity and antisecurity behavior. We analyzed statistical differences to test the hypotheses, that is, the Kruskal-Wallis test and the Mann-Whitney test. The descriptive analysis was used to determine whether the group exhibited exemplary behavior when processing the survey results. A correlational test using the Spearman correlation coefficient was performed to establish the significance of the relationship between ISB and age as well as level of education. RESULTS: We analyzed 421 responses from the survey. According to demographic factors, the hypotheses tested for full and partial security behavior reveal substantial differences. Education levels most significantly affect security behavior differences, followed by user type, gender, and age. The health workers' ISB is higher than that of the patients. Women are more likely than men to engage in prosecurity actions while avoiding antisecurity behaviors. The older the HIS user, the more likely it is that they will participate in prosecurity behavior and the less probable it is that they will engage in antisecurity behavior. According to this study, differences in prosecurity behavior are mostly impacted by education level. Higher education, on the other hand, does not guarantee improved ISB for HIS users. All demographic characteristics, particularly concerning user type, show discrepancies that are caused mainly by antisecurity behavior rather than prosecurity behavior. CONCLUSIONS: Since patients engage in antisecurity behavior more frequently than health workers and may pose security risks, health care facilities should start to consider information security education for patients. More comprehensive research on ISB in health care facilities is required to better understand the patient's perspective, which is currently understudied.

User Compliance With the Health Emergency and Disaster Management System: Systematic Literature Review.

BACKGROUND: Health-related hazards have a detrimental impact on society. The health emergency and disaster management system (Health EDMS), such as a contact-tracing application, is used to respond to and cope with health-related hazards. User compliance with Health EDMS warnings is key to its success. However, it was reported that user compliance with such a system remains low. OBJECTIVE: Through a systematic literature review, this study aims to identify the theories and corresponding factors that explain user compliance with the warning message provided by Health EDMS. METHODS: The systematic literature review was conducted using Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines. The search was performed using the online databases Scopus, ScienceDirect, ProQuest, IEEE, and PubMed, for English journal papers published between January 2000 and February 2022. RESULTS: A total of 14 papers were selected for the review based on our inclusion and exclusion criteria. Previous research adopted 6 theories when examining user compliance, and central to the research was Health EDMS. To better understand Health EDMS, based on the literature reviewed, we mapped the activities and features of Health EDMS with the key stakeholders involved. We identified features that require involvement from individual users, which are surveillance and monitoring features and medical care and logistic assistance features. We then proposed a framework showing the individual, technological, and social influencing factors of the use of these features, which in turn affects compliance with the warning message from Health EDMS. CONCLUSIONS: Research on the Health EDMS topic increased rapidly in 2021 due to the COVID-19 pandemic. An in-depth understanding of Health EDMS and user compliance before designing the system is essential for governments and developers to increase the effectiveness of Health EDMS. Through a systematic literature review, this study proposed a research framework and identified research gaps for future research on this topic.

The moderating role of trust in government adoption e-service during Covid-19 pandemic: health belief model perspective.

The present paper discusses the influence of factors in the health belief model (HBM) on adopting government e-services during the Covid-19 pandemic in Indonesia. Furthermore, the present study demonstrates the moderating effect of trust in HBM. Therefore, we propose an interacting model between trust and HBM. A survey of 299 citizens in Indonesia was used to test the proposed model. By using a structural equation model (SEM), this study found that the HBM factors (perceived susceptibility, perceived benefit, perceived barriers, self-efficacy, cues to action, health concern) significantly affect the intention to adopt government e-services during the Covid-19 pandemic, except for the perceived severity factor. In addition, this study reveals the role of the trust variable, which significantly strengthens the effect of HBM on government e-service.

Integrated Personal Health Record in Indonesia: Design Science Research Study.

BACKGROUND: Personal health records (PHRs) are consumer-centric tools designed to facilitate the tracking, management, and sharing of personal health information. PHR research has mainly been conducted in high-income countries rather than in low- and middle-income countries. Moreover, previous studies that proposed PHR design in low- and middle-income countries did not describe integration with other systems, or there was no stakeholder involvement in exploring PHR requirements. OBJECTIVE: This study developed an integrated PHR architecture and prototype in Indonesia using design science research. We conducted the research in Indonesia, a low- to middle-income country with the largest population in Southeast Asia and a tiered health system. METHODS: This study followed the design science research guidelines. The requirements were identified through interviews with 37 respondents from health organizations and a questionnaire with 1012 patients. Afterward, the proposed architecture and prototype were evaluated via interviews with 6 IT or eHealth experts. RESULTS: The architecture design refers to The Open Group Architecture Framework version 9.2 and comprises 5 components: architecture vision, business architecture, application architecture, data architecture, and technology architecture. We developed a high-fidelity prototype for patients and physicians. In the evaluation, improvements were made to add the stakeholders and the required functionality to the PHR and add the necessary information to the functions that were developed in the prototype. CONCLUSIONS: We used design science to illustrate PHR integration in Indonesia, which involves related stakeholders in requirement gathering and evaluation. We developed architecture and application prototypes based on health systems in Indonesia, which comprise routine health services, including disease treatment and health examinations, as well as promotive and preventive health efforts.

Information Security Behavior in Health Information Systems: A Review of Research Trends and Antecedent Factors.

This study aims to review the literature on antecedent factors of information security related to the protection of health information systems (HISs) in the healthcare organization. We classify those factors into organizational and individual aspects. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Academic articles were sourced from five online databases (Scopus, PubMed, IEEE, ScienceDirect, and SAGE) using keywords related to information security, behavior, and healthcare facilities. The search yielded 35 studies, in which the three most frequent individual factors were self-efficacy, perceived severity, and attitudes, while the three most frequent organizational factors were management support, cues to action, and organizational culture. Individual factors for patients and medical students are still understudied, as are the organizational factors of academic healthcare facilities. More individual factors have been found to significantly influence security behavior. Previous studies have been dominated by the security compliance behavior of clinical and non-clinical hospital staff. These research gaps highlight the theoretical implications of this study. This study provides insight for managers of healthcare facilities and governments to consider individual factors in establishing information security policies and programs for improving security behavior.

Assessment of producer's perspective on the production of environmentally friendly fashion products: a case study in Indonesian natural dyes batik craftsmen.

Batik is well known as an intangible cultural heritage. In Indonesia, batik is produced in several areas, with its own characteristics. The batik production process goes through several stages, in which overall processes require the aid of chemicals. Conventionally, the batik production process results in environmental pollution due to direct waste disposal without any significant processing. Along with the increase in public awareness of environmental protection, the batik dyeing process currently backs to natural dyes. The study was conducted to examine the production intention of natural dyes batik. A total of 209 producers of natural dyed batik became respondents in this study. Data collection was carried out directly through filling out paper-based questionnaires as well as using online forms. The findings of this study revealed that producers' attitude and satisfaction gave significant positive influences on the production intention of natural dyes batik products. Moreover, the findings exhibited the significant effects of social value, quality value, and green value on the attitude and satisfaction of the producer. Attitude was also determined by economic value, but satisfaction was insignificantly affected by economic value. Production intention was strongly predicted by satisfaction and also determined by attitude. The results of this study support in enhancing the concept of natural dyes batik production, which also provide an important role toward sustainable production.

Barriers and facilitators of personal health record adoption in Indonesia: Health facilities' perspectives.

BACKGROUND: Personal health record (PHR) has been extensively used in developed countries; however, it has been limitedly adopted in developing countries. This study was conducted in Indonesia: a developing country with the largest population in Southeast Asia. PHR that is integrated with health providers is needed to achieve a transformation from a health provider-centered to a patient-centered healthcare system. OBJECTIVE: To qualitatively analyze barriers and facilitators of PHR adoption by health facilities in Indonesia from the technological, organizational, environmental, and individual factors. METHODS: In this qualitative study, we used semi-structured interviews with three health facility directors, 17 IT heads, eight physicians, and three nurses from 10 primary healthcare facilities, nine government hospitals, and six private hospitals in Indonesia. Interview data were analyzed using thematic analysis in NVivo 12. The analysis stages involved familiarizing data, generating initial codes, searching themes, evaluating themes, defining and naming themes, and writing reports. RESULTS: Regarding technological factors, the barriers to PHR adoption include security and privacy, interoperability, and infrastructure. Organizational support can facilitate PHR adoption in terms of organizational factors, while a lack of human resources is a barrier to PHR adoption. Regarding environmental factors, the lack of government regulations is the barrier to PHR adoption, while competition between health facilities and vendor support could facilitate PHR adoption. Finally, regarding individual factors, perceived usefulness and ease of use can be facilitators of PHR adoption, while user attitudes and e-health literacy can be barriers to PHR adoption. CONCLUSIONS: This study is expected to comprehensively understand PHR adoption in Indonesia and could be applied to other developing countries with similar technological, legal, or cultural characteristics as Indonesia. This study also provides information that can guide health regulators, health facilities, or PHR vendors in planning the implementation of integrated PHR.

The regional and referral compliance of online healthcare systems by Indonesia National Health Insurance agency and health-seeking behavior in Indonesia.

PURPOSE: Whether the provision of online health care referral systems by the Indonesia National Health Insurance Agency has ensured healthcare referral compliance raises much concern due to the continuing deficit. This study examines the pattern of healthcare referral process, regional and referral compliance from 2015 to 2016. To provide comprehensive analysis on how people seek treatment, this study also aims to understand health-seeking behavior in Indonesia, the utilization of alternative treatment, and health information-seeking behavior on social media. METHOD: The data come from three data files, namely the National Health Insurance membership master data, the First Level Health Facilities transaction data and the Advanced Referral Health Facilities transaction data of 1,697,452 individuals. The regional compliance applies a logit regression model, while referral compliance applies descriptive statistics of the referral pathway. This study also follows a quantitative approach using an online questionnaire, with 463 respondents who have National Health Insurance which applies an ordered logit model. RESULT: We found that several demographic variables and regional health facility availability affect regional compliance. Moreover, we found 19.3% of the transactions did not comply with the prescribed referral sequence. The prescribed referral sequence was mostly followed for patients with malignant diseases. We also found men who perceive that their health condition is healthy will less likely seek health services compared to women. Further, the tendency of alternative treatment increases health-seeking behavior, and the tendency of seeking health information on social media increases the frequency seeking health services. CONCLUSION: We recommend the prescribed referral sequence to be re-evaluated especially for patients with malignant disease; the referral process should not be based on hospital classes but on the competency of the healthcare facility which may indirectly address the deficit issue. It is imperative that the government evaluate health promotion approaches to men and women, both direct and indirect through their significant others.

Functionalities and Issues in the Implementation of Personal Health Records: Systematic Review.

BACKGROUND: Functionalities of personal health record (PHR) are evolving, and continued discussions about PHR functionalities need to be performed to keep it up-to-date. Technological issues such as nonfunctional requirements should also be discussed in the implementation of PHR. OBJECTIVE: This study systematically reviewed the main functionalities and issues in implementing the PHR. METHODS: This systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search is performed using the online databases Scopus, ScienceDirect, IEEE, MEDLINE, CINAHL, and PubMed for English journal articles and conference proceedings published between 2015 and 2020. RESULTS: A total of 105 articles were selected in the review. Seven function categories were identified in this review, which is grouped into basic and advanced functions. Health records and administrative records were grouped into basic functions. Medication management, communication, appointment management, education, and self-health monitoring were grouped into advanced functions. The issues found in this study include interoperability, security and privacy, usability, data quality, and personalization. CONCLUSIONS: In addition to PHR basic and advanced functions, other supporting functionalities may also need to be developed based on the issues identified in this study. This paper provides an integrated PHR architectural model that describes the functional requirements and data sources of PHRs.

Information security cultural differences among health care facilities in Indonesia.

BACKGROUND: Health information security (IS) breaches are increasing with the use of information technology for health care services, and a strong security culture is important for driving employees' information asset protection behavior. OBJECTIVE: This study aimed to analyze differences in information security cultures (ISCs) across health care providers based on factors drawn from the ISC model. METHODS: We used twelve factors to measure the ISCs of health care providers. This research applied a survey method with the Kruskal-Wallis H Test and the Mann-Whitney U Test as data analysis techniques. We collected the data through a questionnaire distributed to 470 employees of health care facilities (i.e. hospitals, community health centers, and primary care clinics) in Indonesia. RESULTS: The results revealed the differences between health care provider types for 9 of the 12 security culture factors. Top management support, change management, and knowledge were the differentiating factors between all types of health care providers. Organizational culture and security compliance only differed in primary care clinics. Meanwhile, security behavior, soft issues and workplace independence, information security policies, training, and awareness only differed in hospitals. CONCLUSION: The results indicated that each type of health care provider required different approaches to develop an ISC considering the above factors. They provided insight for top management to design suitable programs for cultivating ISCs in their institutions.

Barriers in Health Information Systems and Technologies to Support Maternal and Neonatal Referrals at Primary Health Centers.

OBJECTIVES: This study explored health workers' perceptions and experiences regarding the maternal and neonatal referral system, focusing on barriers of health information systems and technologies (IS/IT) at primary health centers (PHCs) in South Tangerang, Indonesia. METHODS: This qualitative study was conducted using semi-structured interviews, which were conducted at the South Tangerang District Health Office and three PHCs. Interviews were conducted with nine participants responsible for maternal and neonatal referrals in their organizations. The data were analyzed using qualitative content analysis. RESULTS: In South Tangerang, the Primary Health Care Information System (SIMPUS) is used to register patients and record data on medical treatment. To facilitate referrals, the PHCs currently use the Integrated Referral Information System (SISRUTE), P-Care, and the Integrated Emergency Management System (SPGDT). The following four IS/IT barriers to support maternal and neonatal referrals were found: technology, human resources, organizational support, and the referral process and implementation. CONCLUSIONS: The barriers in technology, human resources, and organizational support cause problems in the maternal and neonatal referral process and in the implementation of referrals. Barriers to referrals can influence patients' ability to receive appropriate care in a timely fashion and lead to inefficiency in maternal and neonatal referrals. This study contributes knowledge about IS/IT implementation in maternal and neonatal referral systems and provides recommendations to health regulators and application developers for the implementation of IS/IT in Indonesia.

Reviewer's communication style in YouTube product-review videos: does it affect channel loyalty?

Product-review videos can be a promising marketing method. The popularity of using videos as a medium for product reviews is evidenced by the number of channels that are used to provide product reviews on multiple platforms. Reviewers can use various strategies to attract wider audiences and make these audiences loyal to their channels. This study analyzes the effect of the reviewer's communication style on the audience's loyalty to the channels that provide product reviews, especially on the YouTube platform. Communication-style analysis is associated with hedonic and utilitarian motivation theory, which can be used to explain communication style effect on channel loyalty. This study uses a quantitative approach using questionnaire to obtain data. The data in this study are analyzed using covariance-based structural equation modeling in AMOS 21.0. The results show that communication styles (social-oriented and task-oriented), perceived transparency, perceived enjoyment, credibility, and channel engagement affect channel loyalty. Meanwhile, the informativeness factor does not affect channel loyalty. This paper will also discuss the theoretical and practical implications of the study.

Survey-based data describing readiness to adopt an electronic pregnancy registration-monitoring system amongst health workers.

Electronic Health (eHealth) systems show a growing trend in developing countries to enhance their respective healthcare services. However, there is a lack of empirical study regarding readiness during preparation for eHealth implementation in Primary Health Care (PHC) units, specifically for antenatal care health workers who serve not only for personal care but also community services. The survey-based data applied in this research describes the assessment of the pre-implementation of the Electronic Pregnancy Registration and Monitoring System amongst health workers who involved in ANC services in primary health care (PHC) units of South Tangerang district, an urban area of Banten Province, Indonesia. Primary data was collected from 210 ANC health workers who work in 6 PHCs of the district. The data consists of socio-demographic factors of respondents such as age, education, years of experience etc., and captures individual responses to measure their readiness for eHealth adoption. The availability of this data will provide valuable information for researchers, healthcare organisations and government as the policy makers to prepare strategies with regard to readiness for eHealth adoption amongst health workers in PHCs.

Data modeling positive security behavior implementation among smart device users in Indonesia: A partial least squares structural equation modeling approach (PLS-SEM).

The article presents raw inferential statistical data related to understanding the positive security behaviors of smart device users in Indonesia, which was used to determine whether the studied variables were direct or mediating factors. The factors explored include government efforts, technology provider support, privacy concerns, trust, perceived behavioral control, attitudes, and subjective norms. The theory of planned behavior was adopted to develop the proposed model for implementing positive security behaviors. Structured questionnaires were distributed via an online survey to consumers currently using a smartphone or using a smartphone and some other smart device. Furthermore, the respondents were from 19 provinces in Indonesia. The quantitative research method was used to analyze the data. Reliability and validity were confirmed. Structural equation modeling (SEM) using the Smart PLS software version 3 was used to present data. SEM path analysis identified estimates of the relationships of the primary constructs in the data. The outcomes obtained from this dataset demonstrate a direct influence between government efforts, privacy, and perceived behavioral control and performing positive security behaviors. Other variables had positive and significant influences on implementing positive security behaviors, indicating their roles as mediation variables. This data is useful for reference and consideration in the improvement of smart device users' security behaviors. This data can also provide valuable insights to countries with characteristics that are similar to those of Indonesia.

Designing a health referral mobile application for high-mobility end users in Indonesia.

OBJECTIVE: The purpose of this study was to design a suitable mobile application for high mobility medical staff to support the health referral system of Indonesian universal health coverage. METHODS: Design science research (DSR) approach were conducted with two iterations. The first iteration was conducted by designing a high-fidelity mockup and evaluating the design using the System Usability Scale (SUS) framework to evaluate the overall usability of the system (n = 48). The second iteration was conducted by designing a running prototype and evaluating the design using the Post-Study System Usability Questionnaire (PSSUQ) framework to evaluate the system's usefulness, information quality, and interface quality (n = 31). For designing the user interface, the eight golden rules guided the process. RESULTS: The results found that the design for the first iteration was good and the second iteration's design was satisfactory to the respondents. The information quality aspects underwent several changes such as the implementation of local language as the users deemed it to be important to help them easily understand and use the system and eventually support their mobility at the health facility.

Data to model the effect of awareness on the success of IT Governance implementation: A partial least squares structural equation modeling approach (PLS-SEM).

This article presents raw inferential statistical data that determine the influence of awareness on the successful implementation of IT Governance. Data were collected from respondents in all regions of Indonesia. Quantitative research methods are used to analyze data. The structured questionnaire was distributed to respondents in all regions of Indonesia who understood the field of IT Governance whose reliability and validity were confirmed. Structural equation modeling (SEM) using Smart PLS software, version 3, is used to present data. SEM path analysis shows an estimate of the relationship of the main constructs in the data. The results obtained from this dataset show a positive relationship between Risk Management, IT Resources, Budget, Stakeholder Involvement, Policy, Business Strategy, Organization, Commitment, Competence, Communication to awareness and consciousness also has a significant influence on the success of IT Governance implementation. However, politics has proven to have a negative and insignificant influence on the awareness and success of implementing IT Governance.

Narrative Review for Exploring Barriers to Readiness of Electronic Health Record Implementation in Primary Health Care.

OBJECTIVES: The aim of this study is to explore the enabling factors associated with readiness in Electronic Health Record (EHR) implementation and to identify the barriers related to readiness regarding the situation of primary health cares in developed and developing countries. METHODS: A narrative review of open-source literature was conducted using the ProQuest, ScienceDirect, MEDLINE, and PMC databases to identify the enabling factors and barriers to EHR readiness. The keywords applied were 'electronic health record', 'readiness', 'primary health care', and 'primary care'. RESULTS: Some barriers were found that may affect readiness, specifically individual barriers and organizational barriers. In developing countries, organizational barriers such as a lack of skilled manpower, insufficient senior management, and a lack of interaction among team members were the common barriers, while in developed countries individual barriers such as unfamiliarity with new systems and a lack of time to use computers were frequently found as barriers to readiness. CONCLUSIONS: This study summarized the enabling factors and barriers with regard to EHR readiness in developed and developing countries.

Health Referral Enterprise Architecture Design in Indonesia.

OBJECTIVES: In this study an enterprise architecture (EA) was developed for a health referral information system (HRIS) for individual healthcare in Indonesia with reference to the Open Group Architecture Framework (TOGAF) 9.1. The HRIS includes patient referrals for vertical and horizontal references (internal and external), specimen referrals, and health personnel referrals. METHODS: This research was a qualitative study that used the interview and observation method of the Primary Health Care Information System (SIMPUS) application developed by the Agency for Assessment and Application of Technology (BPPT). The interviews were conducted at South Tangerang City Government Health Office with five resource persons who were responsible for conducting health referral processes. RESULTS: The EA of the HRIS includes the principles of architecture, business, application, data, and technology architecture. Twelve principles, four referral processes, and three application reference modules and centralized applications comprise the architecture of the HRIS. The HRIS is a centralized integrated application that uses application program interface (API) to integrate with SIMPUS. CONCLUSIONS: The proposed architecture was developed in an integrated and comprehensive manner for the individual healthcare referral process, which can be implemented by regulators and healthcare facilities. This architecture can also help regulators and healthcare facilities to standardize and integrate health referral data and related processes.

Critical success factors for mobile health implementation in Indonesia.

PURPOSE: Mobile-based technology health services in Indonesia are experiencing significant growth. However, the implementation of m-health in Indonesia is at a stand-still because the numbers of users or medical personnel who use m-health applications are still low. Given this fact, this study aims to identify critical success factors (CSFs) in the implementation of a mobile health applications in Indonesia. This research covers the following four dimensions: system quality, information quality, service quality, and organizational. METHOD: This study uses a quantitative research approach with the entropy method to analyze system quality, information quality, and service quality, and it uses a qualitative approach for the organizational dimension. A total of 127 respondents completed the questionnaire (quantitative approach) and interviews were performed with three personnel from the Social Security Agency for Health (BPJS-K) (qualitative approach). RESULTS: The highest weights for each dimension were as follows: ease of access for the system quality dimension; adequate and relevant information for the information quality dimension; user service convenience for the service quality dimension; and top management support for the organizational dimension. CONCLUSIONS: Based on the results of this study, the regulator, health facilities management, and mobile health provider should ensure a long-term commitment to support the implementation of mobile health applications. In order to reach a wider market, all mobile health applications should be as user friendly as possible for the patients.

User acceptance factors of hospital information systems and related technologies: Systematic review.

This study reviews the literature on the most important acceptance factors associated with Hospital Information Systems (HIS) and related technologies based on user groups' perspectives (medical staff, hospital management, administrative personnel, patient, medical student, and IT staff), which can assist researchers and hospital management to develop suitable acceptance models to improve the quality of HIS. We conducted searches in online databases with large repositories of academic studies, written in English and fully accessible by the authors. The articles being reviewed are related to health information technology (HIT), clinical information systems (CIS), HIS, electronic medical records (EMR), telemedicine or telehealth, picture archiving and communication systems (PACS), radio frequency identification (RFID), and computerized physician order entry (CPOE), where the use of most of those applications and technologies is highly integrated. A predefined string was used to extract 1,005 articles, and the results were reviewed and checked. The results of this study found 15 user acceptance factors related to HIS and related technologies that were frequently identified by a minimum of five previous studies. These factors were related to individual, technological, and organizational factors. In addition, HIS and related technologies' user acceptance factors in each user group describe different results.