Evaluation Of Electronic Medical Record Downtime Management On Patient Service Efficiency At Hospital X

Abstract

Electronic medical record (EMR) implementation in hospitals is vulnerable to downtime, during which the system becomes inaccessible because of infrastructure disruption, network failure, software malfunction, or cyberattack, potentially delaying care and increasing patient-safety risks. Evidence concerning how downtime management affects service efficiency in Indonesian hospitals remains limited. This study evaluated EMR downtime management and its implications for patient service efficiency at Hospital X. A descriptive qualitative design was applied using semi-structured interviews with four informants directly involved in downtime management. Data were analyzed using the Miles and Huberman interactive model and validated through source triangulation with internal standard operating procedures and official downtime reports. Hospital X had a basic response mechanism consisting of conversion to manual documentation followed by data re-entry after system recovery, with responsibilities divided between electrical-facility maintenance and the hospital information-system unit. Official documentation for March-April 2026 recorded five downtime events totaling approximately 4 hours 28 minutes, caused by a firewall anomaly, Transmedik server anomalies, and a total power outage. Server anomalies occurred most frequently, while the firewall anomaly produced the longest single disruption. Downtime resulted in patient backlogs, slower clinical services, longer waiting for supporting examinations, and additional staff workload from retrospective data entry. Major constraints were delayed or unclear notifications, uncertain recovery estimates, and dependence on hierarchical approval, whereas existing standard operating procedures did not explicitly define escalation criteria or decision-making authority. Current management is operationally usable but remains predominantly manual. Hospital X therefore requires more structured communication triggers, explicit escalation authority, and consideration of digital backup mechanisms to strengthen service continuity, efficiency, and patient safety during EMR disruption.