Health Information Systems in Indonesia: Understanding and Addressing Complexity

Abstract

The article is addressing the problem posed by fragmented and poorly coordinated Health Information Systems (HIS) in developing countries within the framework of complexity. HISs that can provide quality data for monitoring, management and health services provision are important for countries, which requires a sensitive understanding of complexity and how they can be managed. Using a case from Indonesia, we discuss the challenges of integrating HIS using the concept of attractor for change from the field of Complex Adaptive Systems (CAS). The dashboard is positioned as such an attractor as a means to get different stakeholders to discuss and reach a consensus on how to integrate and share data without disturbing the underlying systems too much. A more generic model to manage complexity is proposed.As a general rule we say that the higher the complexity, and the more embedded in the social context the systems are, the less easy it is to handle complexity. In the following model, we analyse complexity along two dimensions: more or less contextsensitive, and more or less networked or interdependent of other systems. The context-sensitive vs context-free dichotomyComplexity is a function of the nature of interaction of the system with local business processes, their levels of formalization, or standardisation, and the rate of change of the different components. The stronger the interaction and lower the levels of formalisation, the more unique features the system will need to include, making it more context-sensitive. This links with the web model [1] presented earlier, where the social systems model represents the context-sensitive end of the continuum and the discrete entity model the context-free end.

Health information systems implementation: Weaving alliances in East African Community

“…Lack of coordination and HIS fragmentation poses as the major challenges facing HIS implementation in developing countries (Braa et al, 2017; Sæbø, Kossi, Titlestad, Tohouri, & Braa, 2011; Stansfield, Orobaton, Lubinski, Uggowitzer, & Mwanyika, 2008); and thus forming the vein of this study's problem. HIS fragmentation and lack of coordination often lead to overlapping and inefficient national systems which undermine the efforts towards providing better health services (Sæbø et al, 2011).…”

“…This study extends these arguments by positing itself towards establishing an understanding of the process of weaving alliances in a fragmented HIS setting. In particular, it aims at highlighting the efforts of individuals in tinkering, transforming, creating and maintaining alliance within the environment which they live and work, and the necessary shared ICT capabilities for aligning diverse stakeholders (Braa et al, 2017; Hanseth & Lyytinen, 2010; Lawrence et al, 2011). Such a holistic alliance perspective in the context of HIS requires an adaptation of the earlier Kale and Singh's model of alliance formation.…”

“…I use the term shared ICT capabilities to denote the possibility of a user or group of users to perform set of actions on an object or process such as database, mobile or text editor (Hanseth & Lyytinen, 2010). Braa et al (2017) in their study of adopting information systems in Indonesia describe how district dashboards were used as the means of getting different stakeholders to discuss and reach a consensus in integrating and sharing health data without disturbing the underlying systems too much. They argue that order could emerge around shared ICT capabilities such as dashboards through various feedback mechanisms, and incremental and evolutionary approaches allowing for learning among stakeholders.…”

“…However, HIS adoption and its widespread use in developing countries have received different outcomes. Several studies provide an account of HIS implementation being characterised as problematic, fragmented and unsustainable (Braa, Sahay, Lewis, & Senyoni, 2017; Heeks, 2002; Kimaro & Nhampossa, 2005; Sanner & Sæbø, 2014). The failure or lack of sustainable HIS implementations in developing countries has prompted researchers and practitioners to question why some information systems tend to have “longer legs” 1 than others; leading to their widespread adoption and eventual institutionalisation (P. Wang & Swanson, 2008).…”

Readiness Model in Adopting E-health: An Indonesian Experience

“…In case of Indonesia context, the Indonesian Health Ministry has established the official regulation toward the use of information technology in the health sector, Hospital Management Information Systems and Regional Health Information systems, through inter-agency cooperation hospitals, governments, universities, private companies, and providers of telecommunications services [12]. Furthermore, Indonesia with more than 265 million populations with GDP 4130 US Dollars had have in total number 2.776 hospitals, which are in detail 2.198 as general hospitals and 578 as special hospitals and is added 9.825 Community Health Centers [13].…”