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The implementation of Electronic Medical Records (EMR) has become an important element in improving healthcare service quality, efficiency, and patient safety in hospitals. However, the benefits of EMR depend not only on system availability but also on the quality of the information provided and how actively the system is used by healthcare professionals. This study aims to analyze the influence of electronic medical record content and perceived ease of use on the net benefits of EMR, with actual system use acting as an intervening variable. The research applied a quantitative approach with a cross-sectional design conducted at RSM Hospital. The population consisted of all general practitioners and specialist doctors working at the hospital, totaling 51 respondents, and the study used a total sampling technique. Data were collected through structured questionnaires measured using a Likert scale and analyzed using the Structural Equation Modeling–Partial Least Squares (SEM-PLS) method. The results show that EMR content and perceived ease of use significantly influence the net benefits of EMR. Both variables also significantly affect the actual use of the system, while actual use significantly influences the benefits obtained. Furthermore, actual use mediates the relationship between EMR content, ease of use, and net benefits, indicating that better information quality and usability can encourage greater system utilization and maximize the advantages of EMR implementation.

Abortion is one of the pregnancy complications that still contributes to maternal morbidity and mortality, especially in the early trimester of pregnancy. Various maternal factors play a role in the occurrence of abortion, one of which is parity which reflects a mother's reproductive history. This study aims to analyze the relationship between parity and the incidence of abortion at Bumi Panua Pohuwato Hospital. The study used a quantitative approach with observational analytical design and cross-sectional design. The study population was all pregnant women who received obstetrics services at Bumi Panua Pohuwato Hospital during the study period. Samples were taken using a total sampling technique, so that all pregnant women who met the inclusion criteria were included in the study. The independent variable is parity, while the dependent variable is the incidence of abortion. Data were obtained from medical records and analyzed univariately to describe the characteristics of respondents, and bivariously using Chi-square test or Fisher Exact Test in accordance with the fulfillment of statistical requirements. The results showed that most of the respondents were in active reproductive age and first to second trimester pregnancy, with considerable parity variations. Bivariate analysis showed that parity did not have a statistically significant relationship with abortion incidence. The conclusion of this study shows that the incidence of abortion is not influenced by parity alone, but is likely influenced by the interaction of various other maternal factors. Therefore, abortion risk screening in antenatal services needs to be carried out comprehensively by considering various pregnancy risk factors.

The healthcare sector is increasingly confronted with a VUCA environment (Volatility, Uncertainty, Complexity, and Ambiguity), requiring hospitals to adopt adaptive, resilient, and innovative strategies. This study aims to systematically review the evidence on smart hospital strategies in responding to uncertainty, particularly in improving service quality, operational efficiency, and patient satisfaction. A systematic literature review was conducted using major academic databases, including Scopus-indexed sources, Google Scholar, and Semantic Scholar, covering publications from 2020 to 2026. Articles were selected based on predefined inclusion criteria focusing on hospital management strategies in dynamic and uncertain environments. A total of 10–15 relevant studies were included and analyzed using thematic synthesis. The findings indicate that key strategies in addressing VUCA challenges include digital transformation (e.g., electronic medical records and telemedicine), adaptive and transformational leadership, agile management approaches, and patient-centered care. Digital technologies significantly improve efficiency and decision-making processes, while agile and adaptive leadership enhances organizational responsiveness and resilience. However, several studies highlight that technological advancement alone is insufficient without integrating humanistic values such as empathy, communication, and trust. In conclusion, the most effective hospital strategies in a VUCA world are those that integrate technological innovation with human-centered care. Hospitals must develop flexible, data-driven, and patient-oriented systems to ensure sustainability and competitiveness in uncertain environments. Future research should focus on longitudinal and experimental designs to strengthen causal evidence and explore the integration of digital systems with humanistic healthcare values.

Tuberculosis (TB) remains a significant health issue in Indonesia, with the number of cases not showing a decline. Pediatric pulmonary tuberculosis is one of the leading causes of morbidity and mortality. In 2018, the number of TB cases in Aceh reached 41,595, with Aceh Utara having the highest number at 4,819 cases, followed by Bireuen with 3,636 cases, while Sabang recorded the lowest at 272 cases. The primary risk factor for pulmonary tuberculosis in children is a history of contact with adult TB patients, as children's immune systems are still weak, allowing the bacteria to enter their bodies easily. This study aims to examine the history of TB contact in children at the Pediatric Clinic of Cut Meutia General Hospital. The research used a descriptive observational design, with 105 respondents, and data was collected from medical records. The results showed that the majority of respondents were toddlers (47.6%), most were male (54.3%), and 58.1% had good nutritional status. A significant percentage of respondents (77.1%) had a history of contact with TB patients, and 83.8% did not receive BCG vaccination. These findings highlight that contact with TB patients is a key factor in the transmission to children.

Type 2 Diabetes Mellitus is a chronic disease with an increasing prevalence and requires long-term therapy, resulting in a significant economic burden on healthcare systems. This study aimed to analyze the cost-effectiveness of antidiabetic drug use among Type 2 Diabetes Mellitus patients in the inpatient unit of Dr. R. Hardjanto Hospital, Balikpapan. This research employed an observational analytic design with a cross-sectional approach and retrospective data collection from medical records and administrative data for the period January–December 2023. A total of 54 patients who met the inclusion criteria were included as study samples. Therapeutic effectiveness was assessed based on the achievement of random blood glucose levels ≤200 mg/dL, while the analysis focused on direct medical costs. Cost-effectiveness was evaluated using the Average Cost-Effectiveness Ratio (ACER) and Incremental Cost-Effectiveness Ratio (ICER). The results showed that Metformin–Apidra therapy achieved higher clinical effectiveness (92%) with an average cost of IDR 3,636,721 and an ACER value of IDR 39,529. Meanwhile, Glimepiride–Sansulin therapy demonstrated 81% effectiveness with a lower average cost of IDR 2,519,259 and an ACER value of IDR 31,101. The ICER value of IDR 10,158 indicates the additional cost required to achieve a 1% increase in effectiveness. In conclusion, Metformin–Apidra therapy is more clinically effective, whereas Glimepiride–Sansulin therapy is more cost-effective economically.

Stroke is one of the non-communicable diseases that is the leading cause of disability and death in the world. Clinical factors such as hypertension, diabetes mellitus, body mass index (BMI), and unhealthy lifestyle are known to contribute to the incidence of stroke. Oe-Cusse Referral Hospital serves as the main referral center in the treatment of stroke cases, but data on contributing clinical factors and medical treatment and rehabilitation strategies are still limited. This study aims to analyze the clinical factors that contribute to the incidence of stroke and describe medical treatment and rehabilitation strategies in stroke patients at Oe-Cusse Referral Hospital.This study is a quantitative study with a cross-sectional observational design. The research sample amounted to 50 stroke patients who were treated in the January-November 2025 period, selected using purposive sampling techniques. Data were collected through medical records and questionnaires related to medical treatment and rehabilitation. Data analysis was carried out using the SPSS program, including descriptive analysis and logistic regression to see the relationship between clinical factors (hypertension, diabetes mellitus, lifestyle, BMI, and other factors) and stroke incidence. The results of the descriptive analysis showed that the average age of stroke patients was 56.2 ± 9.8 years, with an age range of 39–78 years. The average BMI of the patient was 27.5 ± 3.1 kg/m² which indicates a tendency to be overweight. The average systolic blood pressure of the patient was 150 ± 18 mmHg, indicating the predominance of hypertension in stroke patients. The average length of rehabilitation lasted 6.3 ± 1.8 weeks. Logistic regression analysis showed a significant relationship between clinical factors, especially hypertension, BMI, and diabetes mellitus, and stroke incidence. Clinical factors such as hypertension, high BMI, and diabetes mellitus contribute significantly to the incidence of stroke at Oe-Cusse Referral Hospital.

Background: Three-monthly injectable contraception is one of the most commonly used hormonal contraceptive methods due to its effectiveness, practicality, and high acceptance among women of reproductive age. However, its use is frequently associated with menstrual changes, particularly amenorrhea, which may affect user satisfaction and continuity of contraceptive use. Objective: This study aimed to analyze the relationship between the use of 3-monthly injectable contraception and the incidence of amenorrhea among women of reproductive age. Methods: This study employed a quantitative approach with an analytical observational design using a cross-sectional method. The study was conducted at a primary healthcare facility providing family planning services. A purposive sampling technique was applied to select respondents who met the inclusion criteria. Data were collected using a structured questionnaire and supported by a review of medical records. The Chi-square test was used to analyze the relationship between contraceptive use and the incidence of amenorrhea, with a significance level set at p < 0.05. Results: The results showed that more than half of the respondents experienced amenorrhea. Amenorrhea was more frequently observed among women who had used 3-monthly injectable contraception for more than one year. Statistical analysis revealed a significant relationship between the duration of 3-monthly injectable contraceptive use and the incidence of amenorrhea (p < 0.05). Conclusion: There is a significant relationship between the use of 3-monthly injectable contraception and the occurrence of amenorrhea. These findings emphasize the importance of providing comprehensive counseling regarding potential menstrual changes to improve contraceptive acceptance and continuity.

The implementation of the Health Workload Analysis (ABK Kes) method reveals both strengths and weaknesses, particularly regarding the suboptimal execution of core tasks such as filing and distributing medical records. This study aims to compare the workload of health human resources (SDMK) between primary and advanced healthcare facilities—specifically Banyudono 1 Public Health Center and Indriati Boyolali Hospital—both of which have implemented hybrid medical record systems. Using primary data collected through interviews and observations and analyzed via the ABK Kes method, the results indicate a need for 10 additional staff members in the Casemix Unit at Indriati Boyolali Hospital and 2 additional medical record practitioners at Banyudono 1 Public Health Center. The Available Working Time (WKT) at the Public Health Center was set at 75,000 based on the Minister of PAN-RB Regulation No. 1 of 2020, whereas the Hospital used real-time calculations. While the Public Health Center aligns its policies with Ministry of Health Regulation No. 19 of 2020, the Hospital adjusts its staffing needs based on the ABK Kes results. Given that this method focuses primarily on quantity, future research and development (R&D) should integrate Lean Thinking for process analysis, ABK Kes for capacity, Queueing Theory for dynamic analysis, and NASA-TLX for psychological evaluation to provide a more holistic assessment of staffing needs.

The availability of human resources (HR) in hospitals is a key factor in ensuring quality healthcare services. A type C general hospital in Medan faces challenges in terms of limited health personnel in several service units. The Workload Indicators of Staffing Need (WISN) method by WHO is applied to calculate staffing requirements based on actual workload. This study aimed to analyze the workload and HR needs of a type C general hospital in Medan using the WISN method. A quantitative descriptive study with a WISN approach. Data were obtained from hospital management reports including patient visits, bed occupancy rate (BOR), and staff distribution across main units. Analysis was carried out by calculating available working time, workload standards, allowance standards, and HR needs per unit. The analysis indicated shortages of personnel in several units: inpatient nurses (−20), anesthetists (−2), pharmacists (−1), laboratory analysts (−5), radiographers (−5), and medical records staff (−6). Some units had surplus staff, such as maternity (+8). The type C general hospital in Medan continues to face HR shortages in critical service units. Workload-based HR planning using the WISN method is crucial to support effective recruitment and staff redistribution.

Background: Hypertension remains a major public health problem, particularly in primary health care settings. The coexistence of diabetes mellitus may contribute to increased hypertension severity; however, evidence from primary care data in Indonesia remains limited. Objective: This study aimed to examine the association between diabetes mellitus and hypertension severity among patients attending a primary health care center in Indonesia. Methods: A cross-sectional study was conducted using secondary data obtained from medical records at a primary health care center in 2025. A total of 84 patients with hypertension were included using total sampling. Hypertension severity was classified into stage 1 and stage 2. Bivariate analysis was performed using the Chi-square test or Fisher’s exact test as appropriate, with statistical significance set at p < 0.05. Data were analyzed using SPSS version 26. Results: Of the 84 participants, 33.3% had diabetes mellitus. Stage 2 hypertension was more prevalent than stage 1 hypertension. Diabetes mellitus was significantly associated with hypertension severity (p = 0.029), with a higher proportion of patients with diabetes mellitus presenting with stage 2 hypertension. Conclusion: Diabetes mellitus was significantly associated with greater hypertension severity in a primary health care setting. These findings highlight the importance of integrated management of diabetes mellitus in patients with hypertension at the prizary care level.

Background: Hypertension remains a major public health problem, particularly in primary health care settings. The coexistence of diabetes mellitus may contribute to increased hypertension severity; however, evidence from primary care data in Indonesia remains limited. Objective: This study aimed to examine the association between diabetes mellitus and hypertension severity among patients attending a primary health care center in Indonesia. Methods: A cross-sectional study was conducted using secondary data obtained from medical records at a primary health care center in 2025. A total of 84 patients with hypertension were included using total sampling. Hypertension severity was classified into stage 1 and stage 2. Bivariate analysis was performed using the Chi-square test or Fisher’s exact test as appropriate, with statistical significance set at p < 0.05. Data were analyzed using SPSS version 26. Results: Of the 84 participants, 33.3% had diabetes mellitus. Stage 2 hypertension was more prevalent than stage 1 hypertension. Diabetes mellitus was significantly associated with hypertension severity (p = 0.029), with a higher proportion of patients with diabetes mellitus presenting with stage 2 hypertension. Conclusion: Diabetes mellitus was significantly associated with greater hypertension severity in a primary health care setting. These findings highlight the importance of integrated management.

Umbilical cord infection is one of the leading causes of neonatal mortality in Indonesia. Appropriate umbilical cord care is essential to accelerate separation and prevent infection. In the working area of UPT Puskesmas Alai, variations in cord care practices and delayed separation cases were still found. This study aimed to analyze the effect of umbilical cord care using sterile gauze method on cord separation duration at UPT Puskesmas Alai. The study employed quasi-experimental design with one-group pre-test post-test approach on 32 respondents selected through purposive sampling. Pretest data were obtained from medical records, while posttest data through direct observation. Analysis used Wilcoxon Signed Rank Test (α=0.05). Results showed mean cord separation time in pretest group was 9.2 days (SD=1.08) and posttest group 6.0 days (SD=0.84). Wilcoxon test showed Z=-4.94 with p-value=0.000, indicating significant difference. Umbilical cord care using sterile gauze method effectively accelerates separation time compared to conventional methods. Healthcare workers are recommended to implement this method as standard care.

Chronic kidney disease (CKD) is a global health problem with continuously increasing prevalence and mortality. This condition is characterized by a progressive and irreversible decline in kidney function, which is clinically assessed using the estimated glomerular filtration rate (eGFR) as one of the main parameters for staging and monitoring disease progression. Red blood cell distribution width (RDW) is a hematological parameter that reflects the degree of variation in erythrocyte size. In patients with CKD, elevated RDW levels are often associated with oxidative stress and chronic inflammation, which may accelerate kidney damage and increase mortality risk. To analyze the correlation between RDW and eGFR values in patients with chronic kidney disease at ODSK Hospital, North Sulawesi Province. This study used an analytical observational design with a cross‑sectional approach. It was conducted retrospectively using secondary data from the medical records of CKD patients at ODSK Hospital, North Sulawesi Province, from February 2024 to August 2025. This study used a total sampling method with 189 CKD patients who met the inclusion and exclusion criteria.  Based on Spearman-rank correlation analysis, the p‑value obtained was 0.129 (>0.05). There was no significant relationship between RDW and eGFR values in CKD patients at ODSK Hospital, North Sulawesi.Province.

This study identified the use of abbreviations in Medical Treatment Consent Forms (SPTK) at X Hospital Indonesia. A quantitative cross-sectional descriptive approach was applied to 76 SPTKs in September 2024, and questionnaires were administered to 30 patient-responsible physicians (DPJP). The results showed that 75% of SPTKs contained abbreviations, even though 97% of respondents understood the risk of miscommunication to patient safety. The state of the art includes accreditation standards that prohibit the use of abbreviations in informed consent, with global orthopedic studies reporting a decrease from 54% to 22% after educational interventions, as well as Indonesian regulations, namely Peraturan Mentri Kesehatan (Permenkes) Republik Indonesia No. 24/2022, which emphasizes that medical records must be complete. The novelty lies in the first empirical analysis in Indonesian hospitals to reveal the disparity between high physician knowledge and low documentation compliance, contributing to the development of evidence-based monitoring for patient safety. These findings support recommendations for daily review of SPTK, ongoing socialization, and integration of digital checklists to reduce medical errors.

Type 2 Diabetes Mellitus (T2DM) is a global health problem with continuously increasing prevalence, covering the majority of diabetes cases worldwide. Persistent hyperglycemia in T2DM progressively damages the kidneys. Early assessment of kidney function, especially through the examination of urea levels and estimated glomerular filtration rate (eGFR) values, is important to predict CKD prognosis and guide therapeutic intervention. To discover the profile of urea levels and eGFR values in Type 2 Diabetes Mellitus patients at ODSK Hospital, North Sulawesi Province. This study is a descriptive quantitative observational study with a cross-sectional design, conducted retrospectively using secondary data from the medical records of Type 2 Diabetes Mellitus patients at ODSK Hospital, North Sulawesi Province during the period February 2024–August 2025 who met the inclusion criteria. From a total sample of 658 Type 2 Diabetes Mellitus patients, the majority of patients had high urea levels (53.3%). Based on sex, the proportion of high urea levels in males (57.2%) was higher compared to females (50.5%). Meanwhile, the distribution of eGFR values showed that the G1 category was the most frequent (23.9%). However, the majority of other patients (75.1%) were already in categories G2 to G5, which indicates a decrease in kidney function. This decrease in kidney function was slightly more detected in male patients (76.1%) compared to female patients (74.4%). Type 2 Diabetes Mellitus patients at ODSK Hospital, North Sulawesi Province, have high urea levels and the majority have decreased eGFR values.

Chronic Kidney Disease (CKD) is a global health problem with a continuously increasing prevalence and mortality rate. Global data indicates that kidney disorders have affected more than 850 million people, with CKD being one of the leading causes of death. North Sulawesi is recorded as one of the provinces with the highest prevalence of CKD. Blood creatinine is used as the primary marker of kidney function, while hypertension is a comorbidity commonly found in CKD patients and can act as both a cause and a consequence of impaired kidney function. Several studies have reported varying results regarding the relationship between creatinine levels and blood pressure. Purpose to analyze the association between serum creatinine levels and blood pressure in chronic kidney disease patients with hypertension at ODSK Hospital, North Sulawesi Province. Methods the research design used an observational analytic cross-sectional design. This study used an observational analytic cross-sectional design. It was a retrospective study utilizing secondary data from medical records for the period of June 2022 to August 2025. Total sampling method was employed with a sample size of 65 patients who met the inclusion criteria. Based on the Spearman correlation test results, the significance values between creatinine and systolic pressure was 0.685, and between creatinine and diastolic pressure was 0.787 (p-value >0.05). There is no significant correlation between serum creatinine levels and blood pressure in chronic kidney disease patients with hypertension at ODSK Hospital, North Sulawesi Province.

Weight gain can be a concern for some women, with some considering a body conforming to specific beauty standards as an ideal or desired goal. The use of progesterone hormone injections, which affect the appetite control center in the hypothalamus, can increase appetite and potentially lead to weight gain. This research employs a descriptive-analytical method with a quantitative approach conducted at the Independent Midwife Practice in the working area of the Kragilan Serang Community Health Center, Banten, using secondary data from medical records. Data collection involved 96 respondents divided into 48 samples of 1-month injectable contraceptive (KB Suntik) users and 48 samples of 3-month injectable contraceptive users. The total research sample size is 96 respondents, with the majority falling in the 20–40 age group and the remainder aged >40 years. The results indicate that among the 48 respondents using the 1-month injectable contraceptive, the average weight gain is 0. 938 kg, while for the 3-month injectable contraceptive, the average weight gain is 4. 251 kg.

Diabetes Mellitus is a chronic disease that requires early detection to prevent serious complications. This study aims to implement the Artificial Neural Network (ANN) algorithm with the Backpropagation method to predict the risk of diabetes. The dataset used is the Pima Indians Diabetes Dataset, consisting of 768 medical records with 8 feature attributes. This study employs the Multi-Layer Perceptron method with an architecture of 8 input neurons, two hidden layers, and 1 output neuron. Model evaluation is conducted using a Confusion Matrix to measure accuracy levels. The test results show that the model is capable of predicting diabetes diagnosis with an accuracy rate of 76.62%. Based on these results, it can be concluded that the Backpropagation algorithm is effective as an alternative method for early detection of diabetes, although further development is needed to improve the model's sensitivity to positive cases.  

Informed consent constitutes a fundamental legal and ethical requirement in healthcare services, ensuring that every medical action is performed with the patient’s full awareness and voluntary approval. In Indonesia, the obligation to obtain informed consent is firmly regulated under the Health Law No. 17 of 2023, the Minister of Health Regulation on Medical Consent, and provisions on medical records. This paper examines the essential role of informed consent as a protective instrument for both patients and healthcare providers within the clinical and legal framework. Informed consent guarantees patients’ rights to information, autonomy, and decision-making, while providing legal safeguards for medical practitioners by documenting the process of explanation, acceptance, or refusal of medical treatment. Proper documentation within medical records ensures accountability, continuity of care, and serves as crucial evidence when medical disputes arise. Medical disputes often stem from dissatisfaction, communication gaps, or misunderstandings about risks inherent in medical procedures. Therefore, informed consent functions not merely as an administrative requirement but as a mechanism for preventing conflict, clarifying responsibilities, and distinguishing unavoidable medical risks from professional negligence. By strengthening the implementation of informed consent, healthcare providers can enhance transparency, improve service quality, and reduce the likelihood of medical litigation.  

Anemia in pregnant women is a health problem that contributes significantly to Low Birth Weight (BBLR), a serious issue in Indonesia with a prevalence exceeding 15% according to WHO, and is a major contributor to the high Neonatal Mortality Rate. This study aims to examine the relationship between anemia in pregnant women and the incidence of BBLR at the Sungai Durian Health Center, Sintang Regency. Using a case control analytical research design with secondary data from medical records in 2024, the sample used was 116 respondents, consisting of 58 pregnant women with BBLR babies as the case group and 58 pregnant women with normal birth weight babies (BBLN) as the control group, which were taken by total sampling technique. Data analysis was carried out using the Chi-Square test and the Odds Ratio (OR) with a significance level of 95%. The results of the study show that the incidence rate of BBLR at the Sungai Durian Health Center in 2024 is 25.8%, and the incidence of anemia in pregnant women is 46.6%. Statistical tests showed a significant relationship between anemia in pregnant women and the incidence of BBLR (p < 0.05). Pregnant women with anemia had a 21.758 times greater risk of giving birth to a BBLR baby compared to non-anemic mothers (OR=21.758; CI 95% = 1.45–7.08). The study concluded that there was a relationship between the nutritional status of pregnant women and the incidence of preeclampsia at the Sungai Durian Sintang Health Center.