INTRODUCTION:

Indonesia has encountered various challenges such as uneven access to health services and the imbalance ratio of health facilities and health workers to the total population of Indonesia. Thus, the Indonesian government has continuously worked on improving the quality of health services¹. Regulation of the Indonesian Minister of Health No. 21 of 2020 regarding the Ministry of Health Strategic Plan for 2020-2024 has urged the reformation of the health system, including the integration of information systems, research, and development of healthcare².

Through the Ministry of Health, the government has provided serious support in developing eHealth^3,4.

For many years, the Indonesian Ministry of Health has developed several health service applications. Unfortunately, the Indonesian community's health data is being scattered around various systems^3,4. More than 400 healthcare applications are developed by the central and regional governments. Thus, health policies were not entirely based on comprehensive data, and healthcare services are less efficient^3,4.

The Indonesian Ministry of Health has formulated this strategic plan in the 2024 Health Digital Transformation Strategy, which is based on the spirit of creating a healthy Indonesia collaboratively with the entire ecosystem of health industry players through the Indonesia Health Services (IHS; Satu Sehat) platform, an integrated health information system in Indonesia^5,6. IHS is a digital health ecosystem platform that provides data connectivity, analysis, and services to support and integrate various health applications in Indonesia⁶.

Despite the great idea of the IHS platform, its successful implementation is strongly affected by the health workers’ perceptions. Perception is related to attitude and behavior towards a policy and would affect people’s compliance in implementing the policy⁷. The success of digitizing health development and health services quality is primarily determined by the presence of sustainable programs and enable the preparation of health workers.

This paper aims to address the perception of pharmacists as part of the health worker community about the implementation of IHS. As one of the targeted IHS users, pharmacists’ perception is important to ensure the successful holistic implementation of IHS.

METHODS:

Research Design:

This study used a phenomenological qualitative design, and semi-structured interviews to evaluate pharmacists' perceptions of implementing IHS, which was then carried out through Focus Group Discussion (FGD). This research method has been approved by the Research Ethics Committee of the Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia.

Research Team:

The interview and discussion were led by two certified clinical pharmacists with more than five years experience in healthcare sector and supported by one undergraduate pharmacy student who assisted in running the FGD activities and data collection. The two coders have taken a course on utilizing the Nvivo application.

Location and Time of Research:

The FGD was conducted online via Zoom Meeting platform in March 2023. The duration of the FGD was approximately 2 hours. The online FGD was carried out to minimize the absence of participants.

Sampling:

To participate in this study, the participants must be under 60 years old with at least six months of experience in providing online drug services. Eight pharmacists participated. This number is the ideal size for a FGD, and data saturation can be expected. The participant who was not active in FGD was excluded from this study. A purposive sampling method was conducted to recruit participants according to predetermined inclusion criteria through telephone and invitation email. No compensation was given to the participants for their time.

Data Collection:

A brief presentation material on the objectives of the FGD and the definition of IHS as well as its implementation plan was given to the participants prior to the FGD. The participants were also handed a written informed consent containing a description of the research objectives and the confidentiality of participants before the discussion began. There were several guide topics addressed to ensure the consistency of the FGD, including the definition of IHS, pharmacist's views on implementing IHS, readiness in implementing IHS, workplace readiness in implementing IHS, and sources of information on IHS (if any). During FGD, audio-visual recording was carried out, and the critical points of the answers given by the participants were also recorded manually.

Analysis:

The recording results were transcribed verbatim. To ensure anonymity, the transcription was cleared from any personal identifier. The transcripts were then qualitatively read in detail to obtain the codes. Afterward, similar codes were processed to identify the key theme. Nvivo version 12 was used to help with the analysis process.

Data Validation:

The transcripts produced from the recordings were crosschecked with the participants to ensure credibility. If any discrepancy was found, the recording process was repeated until all participants confirmed.

RESULTS:

This qualitative research involved eight pharmacists as FGD participants according to the inclusion criteria. No invited participant was excluded during the discussion. All participants agreed upon the transcripts, and no repeat interview was taken. The distribution of the characteristics of the participants was demonstrated in Table 1.

Table 1. Characteristics of Participants

Participant Number	Gender	Pharmacy Digitalization Experience (Year)	Pharmacy Work Experience (year)	Age (year)	IHS Knowledge (%)
1	Male	1-2	≥5	30-34	80
2	Female	>2	≥5	30-34	80
3	Female	1-2	<5	20-24	80
4	Male	1-2	≥5	25-29	90
5	Female	1-2	<5	20-24	70
6	Female	1-2	<5	25-29	100
7	Female	<1	≥5	35-39	100
8	Female	<1	≥5	25-29	100

Table 2. Themes, codes and quotes acquired from the qualitative analysis

Themes	Codes	Quotes
Advantages or Benefits	Support rational therapy	Pharmacist 2: "/.../ So, with the implementation of an integrated health system, it becomes easier for pharmacists as they are assisted with an integrated patient medical record system. This allows us to better monitor and address issues such as drug duplication, medication errors, and other prevalent issues. We can collectively work to mitigate these problems and also have access to the patient's medication usage history and medical records, which enables us to find more suitable therapies for the patients. This is incredibly helpful for healthcare professionals at present."
	Know the patient's drug history	Pharmacist 3: "Well, I envision IHS as a website platform containing a kind of big data, ma'am. So, when we enter a patient's ID number (NIK) or their name, their complete medical history will appear, starting from their previous consultations, prescribed medications, diagnoses, past therapies, and so on. This way, when the patient returns, we already know what needs to be done and can provide optimal care, you know? It's like having all the patient's data accessible in one place on the website."
	Know the patient's medical history	Pharmacist 4: "Yes, that's true. But looking at the IHS system, it requires some extra effort, particularly when it comes to inputting patient data and diagnoses. However, overall, it's a positive development because, with such a system, we can determine the best therapy for the patient."
	Integrated patient medical records	Pharmacist 3: "I think it leans more towards the positive side. I even believe that with the implementation of IHS, things will become much easier and more convenient, not only for pharmacists but for all healthcare professionals. The reason is that we can access the patient's medical records. Currently, when a patient transfers from one hospital (Hospital A) to another (Hospital B), sometimes we have to dig up information about the medications they were prescribed, their medical history, and other relevant details. As you mentioned earlier, it's like putting together puzzle pieces. So, the IHS system can potentially optimize our patient care services. Thank you, ma'am."
	Integrated system	Pharmacist 5: "If we're unwilling to start, we won't make any progress, and we'll be left behind in time. From what Dr. Lusy explained, the IHS system seems ready to go because the application mapping itself looks quite promising. In the future, there will be further development of the application, and having everything integrated into one app will eliminate the need to search for other applications. Having IHS is sufficient as all the data will be consolidated within it."
	Data usage efficiency	Pharmacist 3: "Well, I envision IHS as a website platform containing a kind of big data, ma'am. So, when we enter a patient's ID number (NIK) or their name, their complete medical history will appear, starting from their previous consultations, prescribed medications, diagnoses, past therapies, and so on. This way, when the patient returns, we already know what needs to be done and can provide optimal care, you know? It's like having all the patient's data accessible in one place on the website."
	Facilitate patient monitoring by health workers	Pharmacist 2: "From my perspective, ma'am, the existence of IHS is an extraordinary development, especially in the healthcare field, as you explained earlier. There are currently many challenges for pharmacists, especially new ones who may not fully understand what needs to be reported and monitored. With IHS, where all health applications can be integrated into one platform, it becomes very convenient and helpful for healthcare professionals to monitor and manage everything."
	Time efficiency	Pharmacist 6: "From my perspective, I agree, ma'am, because, as my friends mentioned earlier, it's more efficient to have several applications combined into one. It would not only save time but also eliminate the need to switch between multiple applications. It's time-saving and more convenient since we won't have to move from one application to another."
	Patient document storage efficiency	Pharmacist 6: "/.../ and secondly, if the data is stored on the phone, it also saves storage space, ma'am."
	To avoid falling behind	Pharmacist 1: "Because if, for example, we don't keep up with the times, pharmacists will still be left behind, like that, ma'am."
Expectations	Patient data entry efficiency	Pharmacist 2: "Excuse me, ma'am. In my workplace, we haven't fully adopted IHS yet; there has only been some awareness-raising about it. As for the preparation for IHS, perhaps we can take cues from the recent 'Peduli Lindungi' application, which was updated and transformed into the IHS app. In this new app, we can already see a list of medicines and other features. So, the main effort we need to make is likely related to modeling, the underlying structure, drug naming, codes, and maybe some additional aspects. Aligning all these factors with IHS could be challenging because different institutions might have unique applications. Finding a way to synchronize the product master data across all institutions, similar to the approach used in IHS, could be a hurdle that needs to be addressed."
	Server system strengthening	Pharmacist 5: "Since this system is digital, we must ensure that when the server is down, it doesn't affect everything and result in all users being unable to access it. Instead, it would be better to focus on improving and strengthening the server system first, ma'am."
	User-friendly system	Pharmacist 1: "Well, it's the government's responsibility to make the application as user-friendly and straightforward as possible for us. Also, when it comes to usage in all healthcare facilities, meaning when a healthcare facility is granted permission by the government, they will have to use the IHS system. However, the IHS system should be easy to use to facilitate both users and healthcare professionals; that’s the idea, ma'am."
Challenges	Inequality in technological development	Pharmacist 6: "As for me, I'm ready, ma'am, because I currently work in the Jakarta area, so it might be easier to raise awareness among patients in urban areas. However, there might be some challenges when it comes to my colleagues working in rural areas and others. There are various factors to consider, such as signal availability and other potential hindrances in the service process at that time."
	Unstable online network risk	Pharmacist 2: "Yes, ma'am, I want to add more. Apart from what Pharmacist 1 informed earlier, there is another aspect that the government needs to consider because IHS is an online platform that relies on internet connectivity. So, if there is a system error with IHS, it might lead to data issues and disruptions. It is essential to ensure the system remains stable and reliable. We don't want errors because they not only impact the public but also affect healthcare professionals, ma'am."
	Synchronization in data search	Pharmacist 6: "/.../ but perhaps, one of the challenges is when the application is in use, for example, if there are patients with similar names or incorrect ID numbers (NIK), and such issues would require further attention and follow-up, ma'am, that's how it is, ma'am."
	Technology illiterate	Pharmacist 1: "As for the user's perspective, ma'am, it might be that people from my generation would be more likely to use the application. However, for the older generation, like elderly individuals, it might be challenging for them to use the application, ma'am."
	Lack of use of technology in the workplace	Pharmacist 2: "Yes, ma'am, perhaps for regular pharmacies, it might be a bit lacking (in technology use) because manual data input processes limit us. So, there is a significant need for improvement to move towards IHS, ma'am, something like that."
Readiness	Awareness from leaders	Pharmacist 1: "Well, from my perspective and as a leader, I am very supportive of the government's IHS system, ma'am. The management is also aware of this IHS system."
	Knowledge of the IHS Platform	Pharmacist 1: "Yes, it's still vague, ma'am. The information is still partial."
	Information updates	Pharmacist 1: "Well, from my perspective, continuous promotion of IHS is essential because so far, perhaps only our generation is updated about it. However, those in the generations below or above us might be unaware of it, ma'am."
	The need for discussion with health facilities	Pharmacist 4: "As for my workplace, ma'am, we are already aware of IHS, and it's currently in the discussion phase regarding its implementation and how it will be carried out. So, it's still in the early stages of discussions, ma'am."
	Support from health facilities	Pharmacist 4: "From my perspective, ma'am, the management is highly supportive of this initiative, and gradually, we are moving towards the implementation of IHS.'"
	Organizing seminars/workshops	Pharmacist 4: "From my perspective, it would be beneficial to organize a dedicated seminar for IHS, focusing on implementing it, the practical aspects of entering data, and other relevant information. I have accessed the IHS application several times, but there are some features that I'm not familiar with and don't know how to use it properly."
	Providing manual books	Pharmacist 2: "So, perhaps a manual book is needed, which could be available on the IHS platform. This way, both the public and healthcare professionals can receive better understanding and training. It could be through direct training or the manual book, ma'am."
	Providing tutorial video	Pharmacist 5: "Ma'am, perhaps it would be helpful to create video tutorials or some other easy-to-follow resources for colleagues who cannot attend seminars or training sessions. This way, they can refer to the videos anytime to learn how to use the system effectively."
	Continuous promotions	Pharmacist 4: "For me, ma'am, as I mentioned earlier, whether we feel ready or not, we must be prepared. However, the promotion and awareness-raising should continue and be even more intense."
Source of Information	Light discussion with fellow pharmacists	Pharmacist 4: "It's more or less the same, ma'am, from using Instagram social media and having casual discussions with colleagues."
	Ministry of Health	Pharmacist 2: "It's more or less the same, ma'am. So, the information I received came directly from the Ministry of Health's sources, whether through social media /.../."
	Pharmacy social media	Pharmacist 2: "/.../ and there were also some pieces of information provided on pharmacy websites, for example, some on Instagram, where there was already some information related to IHS in the context of pharmacy."
	Messaging platforms via healthcare organization groups	Pharmacist 3: " I know it from a fellow pharmacist in the IAI (Indonesian Pharmacists Association) group."

The participants’ ages ranged from 20-39 years old, with the majority being women (75%), had digitalization experience in the pharmaceutical sector for 1-2 years (62.5%), and had work experience ≥5 years (62.5%). From this table, it could be seen that all participants have good knowledge about the IHS platform (range 70-100%). Meanwhile, the FGD, which lasted for approximately two hours, resulted in five themes and various codes, which are shown in Table 2. The elicited key themes were benefits, expectations, challenges, readiness, and sources of information.

DISCUSSION:

This study provides insight into the implementation of the IHS app based on pharmacist perception. Based on the discussion, the pharmacists’ perceptions were generally positive towards the enforcement of the IHS platform, while also recognizing some limitations and challenges. In developing the IHS platform, the Indonesian Ministry of Health adopted the Platform-as-a-Service (PAAS) infrastructure model to integrate patient medical record data from various healthcare facilities, including government hospitals, private hospitals, healthcare centers, clinics, laboratories, and pharmacies, into an IHS platform^2,6. Currently, PAAS cloud systems are used to serve a variety of applications, including high-performance calculations, web applications, storage services, and data analytics services^8,9. The information technology industry is undergoing a major change because cloud systems lower capital costs¹⁰. Cloud services based on PAAS will undoubtedly support storage effectiveness, eliminating the need for hardcopy documents and enabling more effective data usage.

Another significant advantage of implementing IHS is related to preventing medical errors. Specifically, data integration can simplify checking medical records and patient medication histories to avoid medical errors and, ultimately, support the rationality of patient therapy. Some studies reported the correlation between ineffective communication and the incidence of medication errors, both among health workers and between patients and health workers^11-13. One observational study showed that patients who had communication problems were three times more likely to have preventable unwanted side effects (odds ratio [OR] = 3.00; 95% confidence interval [CI] 1.43 – 6.27)¹³. Ineffective communication can be influenced by physical setting factors and communication media¹¹. A quantitative descriptive study showed that health workers such as doctors and nurses tend to use patient status more as a communication medium, compared to team-centered communication¹⁴. Aligned with those findings, previous studies have shown that limited access to patient-related information during decision-making is one of the primary causes of medical errors in healthcare^15,16. As a result, it is envisaged that the availability of IHS with an integrated recording system would be able to overcome communication problems caused by physical barriers and communication mediums, hence reducing the likelihood of medical errors.

In addition, cloud computing enables remote patient monitoring systems by health workers and may increase the comfort of patients who need home care, including elderly patients and patients with physical limitations. This patient monitoring function allows to present the overview of the patient's clinical condition as a whole, not fragmented, thereby, reducing unnecessary examinations and drug use, which may greatly support patient’ safety¹⁷. Meanwhile, one of the ultimate goals of integrating health data is forming big data, a massive volume of information that can be further analyzed to support personalized medicine¹⁸.

On the other hand, the participants expected that the IHS system would be user-friendly. This is in accordance with the previous findings about the importance of ease of use to support the successful implementation of an electronic health record recording system^19-21. Parallel to those, other studies also revealed that healthcare systems that are difficult for users to understand would complicate patient care processes^22,23. Complicated system would downgrade the speed of work^20,24. Meanwhile, user-friendly design could also increase data-entry efficiency²⁵. In fact, different healthcare facilities might also have different electronic health record interfaces, which could cause confusion for health workers who work in multiple instances. Thus, a standardized patient data input with a simple design is expected by the participants.

In implementing a new system, various challenges generally need to be anticipated. Cloud computing requires a stable internet connection to run smoothly²⁶. Based on data from the Indonesia Central Statistics Agency²⁷ in 2019, internet access inequality existed in various regions in Indonesia. The highest percentage of internet access availability was in the DKI Jakarta area. In contrast, outside Java and Bali, individual internet access availability was only about 50%, with the lowest internet access availability being 19.72% in Papua^27,28. Likewise, there are variations of internet bandwidth in various regions in Indonesia²⁹. Based on the studies done by Chirchir et al.³⁰ and Fraser et al.³¹, slow internet access in various low-income countries meant a barrier to electronic health record implementation. Thus, this issue certainly could contribute to the difficulty of the IHS implementation.

Another concern raised in the discussion was regarding technology illiteracy. Research has found that certain regions of Java Island, one of the most prominent islands in Indonesia, have a high rate of technology illiteracy²⁹. This issue is influenced by factors such as mobile phone ownership, computer ownership, and internet accessibility. This situation could potentially hinder the successful implementation of the IHS app.

The recent study highlighted the limited use of technology in the workplace. Despite being familiar with various technologies, many Indonesian healthcare professionals still rely on manual methods such as writing medical records and prescribing medications on paper due to the lack of digital or electronic resources³². This emphasizes the need for healthcare facilities to provide digital tools and encourage professionals to integrate patient data using these facilities. However, it's important to note that the data integration process in the IHS app will not be straightforward. A study in Africa identified several challenges in health data integration, including poor technology infrastructure, inadequate personal skills, lack of training for new users, insufficient funding and regulation, lack of input standardization, coordination issues, reliance on paper-based systems, lack of stakeholder participation, and inadequate supervisio³³. Considering these findings, it's crucial to address these issues before implementing the IHS system.

Most of the participants already had a good understanding of the IHS platform (Table 1). However, successful implementation of IHS requires thorough preparation. The respondents suggested the need to develop a strategic plan before implementing IHS, which can be achieved through focus group discussions (FGD) with stakeholders from various health facilities. The FGD was found to be useful in understanding how individuals perceive, justify, and comprehend managerial initiatives, as well as their levels of support³⁴. Furthermore, it is highly recommended to obtain information updates from reputable sources to enhance health workers’ preparedness. According to the participants, socialization about IHS implementation could be facilitated through seminars, workshops, providing manuals in books or videos, and continuous promotional activities to highlight the benefits of IHS. Additionally, social media, messaging platforms, or official websites of the Indonesian Ministry of Health and other health professional associations may be utilized to support the IHS implementation.

This project had some limitations, such as a small number of participants and the average age range of the participants, which was about 20-39 years old. Including older pharmacists, who may potentially be technologically illiterate, and more pharmacist representatives from other regions would have yielded more valuable insight. Nevertheless, the project's findings are interesting and can be used as valuable input for various stakeholders, including the government, health facilities, and professional organizations. This input can support the successful implementation of an integrated health system (IHS), which is expected to improve the rationality of therapy.

CONCLUSION:

Despite numerous challenges, pharmacists are embracing the implementation of the IHS application with a positive attitude. To successfully implement this system, the Indonesian government must thoroughly prepare and collaborate with stakeholders, health facility leaders, and health professional organizations to provide education, information, and address challenges. It is crucial to ensure stable internet connections and technological literacy to support the continuity of this integrated health system. Once these issues are addressed, the successful implementation of IHS is highly anticipated.

CONFLICT OF INTEREST:

The authors declared no conflict of interest.

ACKNOWLEDGMENTS:

The authors would like to thank all participants for their willingness to join the FGD, the Chief Executive Officer of Lifepack. id for the support of the FGD. The authors also want to thank the Atma Jaya Catholic University of Indonesia for providing an internal grant that made it possible to carry out this research.

ETHICAL PERMISSION:

This research has been approved by the Research Ethics Committee of the Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia (AJCUI), number 11/02/KEP-FKIKUAJ/2023.

DATA AVAILABILITY STATEMENT:

The corresponding author provides data accessibility, which was stored on Atma Jaya Catholic University server.

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Received on 15.07.2024 Revised on 30.11.2024

Accepted on 15.03.2025 Published on 01.12.2025

Available online from December 06, 2025

Research J. Pharmacy and Technology. 2025;18(12):5879-5885.

DOI: 10.52711/0974-360X.2025.00849

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.