Socio-Technical Evaluation of an EHR–PHR Interoperability Model for Tuberculosis Care Using SEIPS 3.0: A Pre-Deployment Mixed-Methods Study in Indonesia

Taufiq Sitompul; Harco Leslie Hendric Spits Warnars; Maria Susan Anggreainy; Yohannes Kurniawan

doi:10.48161/qaj.v6n4a2627

Authors

Taufiq Sitompul Computer Science Department, BINUS Graduate Program, Bina Nusantara University, Jakarta 11530, Indonesia. https://orcid.org/0000-0001-6147-2659
Harco Leslie Hendric Spits Warnars Computer Science Department, BINUS Graduate Program, Bina Nusantara University, Jakarta 11530, Indonesia. https://orcid.org/0000-0002-5942-417X
Maria Susan Anggreainy Computer Science Department, BINUS Graduate Program, Bina Nusantara University, Jakarta 11530, Indonesia.
Yohannes Kurniawan Computer Science Department, BINUS Graduate Program, Bina Nusantara University, Jakarta 11530, Indonesia. https://orcid.org/0000-0001-8876-3472

DOI:

https://doi.org/10.48161/qaj.v6n4a2627

Keywords:

Tuberculosis, Interoperability, FHIR, PHR, SEIPS, Socio-technical evaluation.

Abstract

Technical exchange standards alone do not guarantee successful health information interoperability; adoption depends on work-system, governance, and organizational factors as well as data-exchange capability, yet socio-technical evaluations remain scarce in low- and middle-income countries (LMICs). This pre-deployment study evaluates a seven-component electronic health record (EHR)–personal health record (PHR) interoperability model for tuberculosis (TB) care, implemented as a six-layer Fast Healthcare Interoperability Resources (FHIR) R4 architecture aligned with Indonesia’s national SATUSEHAT exchange, using the Systems Engineering Initiative for Patient Safety (SEIPS) 3.0 framework. A formative–summative mixed-methods design triangulated four evidence streams: a multi-stakeholder contextual inquiry with 93 participants across three regions (60 TB patients, 7 family caregivers, and 26 facility, district, vendor, and national-level professionals); sandbox technical verification; expert judgment; and user/stakeholder evaluation including System Usability Scale (SUS) assessment. A component was rated as strong, adequate, or needing reinforcement only where at least two streams converged. Four components were strong, two adequate, and one in need of reinforcement; all overall technical thresholds were met, but two components required organizational reinforcement. Verification showed 98.9% FHIR conformance (184/186 assertions; two failures reported), zero critical security findings, and zero offline data loss. Field evidence indicated organizational gaps: all 14 facility officers ran a facility EHR alongside the national SITB register across four EHR products with no automatic synchronization, while only 3 of 41 patients had ever been told how their data are used and 29 of 42 wanted a say in data sharing. Mean SUS was 71.8 (95% CI 66.5–77.1). All technical testing used synthetic data; clinical outcomes are projected. The findings identify work-system alignment and patient-facing data governance as priorities for subsequent implementation in LMIC disease programs.

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