Indonesian Journal of Global Health Research

Volume 6 Number 6, December 2024

e-ISSN 2715-1972; p-ISSN 2714-9749
http://jurnal.globalhealthsciencegroup.com/index.php/IJGHR

EVALUATION OF THE IMPLEMENTATION OF THE HOSPITAL

MANAGEMENT INFORMATION SYSTEM USING THE HOT-FIT METHOD

Tania Evita Salsabila*, Shela Julia Veronica

Manajemen Rumah Sakit, Universitas Pelita Harapan, Jalan M.H. Thamrin Boulevard No.1100, Tangerang,
Banten 15811, Indonesia
*[email protected] [email protected]

ABSTRACT
Implementing a hospital management information system (SIMRS) is very important to integrate all
information generated in the service process. SIMRS can encourage increased efficiency and effectiveness of
services in hospitals along with the smooth flow of information between service providers and patients. In the
long term, the projected use of SIMRS can save costs and avoid repetitive administrative activities. The aim
of this research is to determine the level of SIMRS utilization at RSU Hermina Tangerang and to determine
the factors that influence SIMRS utilization. The type of research used in this research is quantitative with a
cross-sectional research design using a survey approach. The research population is all employees who use
SIMRS who have a username. Data collection was carried out using a questionnaire. Data analysis using SEM
PLS. Based on the research results, it shows that SIMRS at RSU Hermina Tanggerang is not running
optimally, it is evident that there are still many obstacles occurring in the field.

Keywords: evaluation; hot fit; pls sem; simrs

First Received Revised Accepted

28 June 2024 02 July 2024 09 July 2024
Final Proof Received Published
10 July 2024 01 December 2024
How to cite (in APA style)
Salsabila, T. E., & Veronica, S. J. (2024). Evaluation of the Implementation of the Hospital Management
Information System Using the Hot-Fit Method. Indonesian Journal of Global Health Research, 6(6), 3505-
3516. Retrieved from https://jurnal.globalhealthsciencegroup.com/index.php/IJGHR/article/view/3795.

INTRODUCTION
The rapid advancement of technology in the field of information has given birth to changes in
the order of life in society, nation and state. In this regard, the role and function of data and
information services carried out by hospitals as one of the data and information management
work units are required to be able to make various adjustments and changes. Information
systems can be used for data and information service activities in a more productive,
transparent, orderly, fast, easy, accurate, integrated, safe and efficient manner, especially
helping to facilitate and facilitate policy formation in improving the health service system.1
The implementation of the hospital management information system (SIMRS) is very
important to integrate all the information generated in the service process. SIMRS can
encourage increased efficiency and effectiveness of services in hospitals along with the
smooth flow of information between service providers and patients. Deep In the long term,
the use of SIMRS is projected to save costs and avoid repetition of administrative activities.
The importance of information systems in hospitals is strengthened by the enactment of Law
Number 44 of 2009 in article 52 paragraph 1 stating that every hospital is obliged to record
and reporting of all hospital administration activities in the form of a hospital management
information system (SIMRS). Since 2011, this regulation has been followed by Government
Regulations and Regulations of the Minister of Health which regulate the minimum
requirements for the management of SIMRS and the requirement for SIMRS to be integrated

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with Health Information Systems at the regional and central levels. Regulations related to the
implementation of applicable information systems include Minister of Health Regulation No.
1171 of 2011 concerning Hospital Information Systems, Minister of Health Regulation No. 82
of 2013 concerning Hospital Management Information Systems, Minister of Health
Regulation No. 92 of 2014 concerning the Implementation of Data Communication in
Integrated Health Information Systems, and Government Regulation No. 46 of 2014
concerning Health Information Systems. All hospitals must adjust to these regulations no later
than two years after they are promulgated, so it is necessary to manage the information system
to be able to comply with the applicable regulations.

The SIMRS implementation process requires a process that involves technical and non-
technical factors. Many hospitals have made considerable investments to implement
information systems, but some have experienced difficulties or failures in the adoption of
SIMRS. Failure to adopt information systems results in inefficient use of resources and
decreased motivation to implement the system. It is important to understand that mistakes in
managing, applying information technology and information systems can lead to the failure of
information technology and business processes themselves2. Errors in the application of
technology can be seen from inhibiting factors, including human factors. A study conducted at
a Saudi Arabia Hospital with 158 respondents found that the biggest inhibiting factor was
human beings with an average of 3.73, the second was finance at 3.50, the next inhibiting
factor was legal and regulatory factors, organizational factors, technical factors and
professional factors, these factors had an average of between 3.32-3.00.

Evaluation of an information system is a real effort to find out the actual condition of an
information system implementation With this evaluation, the achievements of the
implementation of an information system can be known and further actions can be planned to
improve the performance of its implementation. The end user is one of the indicators to assess
the extent to which the information system can provide convenience and provide benefits to
the SIRMS user7.One of the theoretical frameworks used for the evaluation of information
systems in the field of health services is the HOT-Fit Model, which looks at the entire system
by placing important components in the information system, namely humans, organizations
and technology) and the suitability of relationships as determining factors for the successful
implementation of an information system. Where in evaluating the hospital management
information system by measuring assessments based on the respondent's attitude towards a
condition.

METHOD
The type of research used in this study is quantitative with a cross sectional research design
using a survey approach to determine the influence between independent variables (system
quality, information quality, service quality, top management support, project management,
vendor support, it capabilities of staff, system use and user satisfaction) on the dependent
variables of net benefit. The sampling technique in this study uses the purposive sampling
method with the hope that the quality or characteristics of the respondents can be represented.
The instrument used is a structured list of interview questions for the management group and
operators. The data sample collection point is cross sectional (one data collection per
respondent)8. The type of question used in the questionnaire is a closed ended question, which
is measured using five points on the likert scale ranging from 1 (strongly disagree) to 5
(strongly agree). The validity and reliability test of the questionnaire was carried out to ensure
that the research instruments used were valid and reliable. Data processing using SEM PLS
analysis with SmartPLS Software Version 3.0. Partial Least Squares is a powerful analysis

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method and is often called soft modellin. Because it eliminates the assumption that the data
must be normally distributed and there is no multicoloniality between exogenous variables
(independent variables), as well as allowing testing with a small sample. PLS is used to
explain the existence or absence of relationships between latent variables (predictions), and
also to confirm theories.
System use

Satisfaction
used

Top
management
support

Project
management

Vendor support Net Benefit

IT capabilities
of staff

System quality

Information
quality

Service quality

Figure 1. Research Concept Framework

Some of the research hypotheses developed in the research on factors that affect the use of
SIMRS include:
H1 : The Effect of System Quality on Net Benefit
H2 : There is an effect of information qualit on net benefit
H3 : There is an effect of service quality on net benefit
H4 : There is an influence of Top Management Support on Net Benefit
H5 : There is an influence of project management on net benefit
H6 : There is an influence of vendor support on net benefit
H7 : There is an effect of IT Capabilitie of Staff on Net Benefit
H8 : There is an effect of system use on net benefit
H9 There is an effect of user satisfaction on net benefit

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RESULTS
Table 1.
Characteristics of Respondents
Characteristic f %
Gender
Law Law 18 20,93
Woman 68 79,07
S2 Education
3 3,35
D4/S1 27 31,4
D3 46 53,5
High School/Equivalent 10 11,6
Registration Work Unit/RM
15 17,5
Nurses/Midwives 39 45,3
From the toad 15 17,5
Payment 10 11,6
Support 5 5,8
Doctor 2 2,3
Working Period
<1 year 0 0,0
1-5 years 25 29,1
6-10 years 17 19,8
>10 years 44 51,1
Age
<25 years 6 6,97
25-35 years old 38 44,19
36-45 years old 21 24,42
>45 years 19 22,09
Length of SIMRS
<1 year 3 3,49
1-5 years 70 81,4
6-10 years 12 13,95
>10 years 1 1,16
Table 1. showed that 79.07% of SIMRS users were women with different levels of education
with the highest percentage being D3 as much as 53.5%, high school as much as 11.6%, and
S1 as much as 31.4%. Judging from the work unit, SIMRS has been installed in almost all
service units in the hospital, the forefront is registration, then entering polyclinics such as
general polyclinics, obstetric polyclinics, pediatric polyclinics, ophthalmic polyclinics, skin
polyclinics, internal polyclinics, surgical polyclinics, etc. Laboratory, radiology,
physiotherapy, nutrition, pharmacy and emergency room as well as hospitalization.The length
of time respondents have used SIMRS as many as 81.4% of respondents have used SIMRS
for 1-5 years, showing that with the long use of SIMRS, respondents already know and
understand enough how to use SIMRS. The age of respondents who used SIMRS was
44.19% of respondents aged 26-35 years and as many as 24.42% were aged 36-45 years. This
shows that the age of respondents who use SIMRS is classified as productive who are able to
adapt to technology quickly and are used to using technology, especially in terms of
communication. This certainly makes it easier to use the SIMRS application properly.

Evaluation of Measurement Model (outer model) Evaluation of measurement models is

a type of
SEM that uses variance in the iteration process so that it does not require correlation between
indicators or their latent constructs in a structural model. This measurement model aims to
test the predictive relationship between constructs by looking at whether there is a

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relationship or influence between the constructs. The thing that needs to be done to calculate
the validity and reliability of the construct is to look at the validity of convergence, validity of
discrimination, and reliability of the construct. Convergent validity refers to the correlation
between the score of an item/indicator and its construction score. Individual indicators are
considered reliable if the correlation value is above 0.60 in accordance with the output
obtained from data processing using SmartPLS. To see if the value is >0.60 or not, it is
necessary to carry out a loading factor test as shown in figure 2 below

Figure 2. Loading Factor Results

Figure 2 shows that all loading factor values of each indicator for exogenous and endogenous
constructs have a result of >0.60, except for the SQ2, SQ3, SQ4 indicators which are
indicators for system quality constructs. Because the loading factor values are 0.398, 0.211,
0.257 (<0.60), the SQ2, SQ3, SQ4 indicators must be excluded from the model. Then on the
TMS3 indicator which is a top management support construction indicator with a loading
factor value of 0.233. Furthermore, on the PM2, VS1 and US1 indicators which are indicators
of project management, vendor support and user satisfaction construction with PM2 loading
factor values of 0.592, VS1 0.504 and US1 0.521, these indicators must be removed from the
model. Then after the indicator is issued, a recalculation is carried out with the PLS algorithm.
The results of the PLS calculation algorithm after issuing the QS2, QS3, QS4, TMS3, PM2,
VS1 and SU1 indicators.

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Figure 3. Loading Factor Results after Elimination

Figure 3 explains that after the seven indicators are issued, the results show that there are no
more indicators that have a loading factor value of <0.60. So that the indicator is declared
significant and has met the requirements for convergence validity.
Tabel 3.
Nilai Composite Reliability, Composite Reliability dan AVE
Variable Value Composite Cronbach alpha AVE Scores
Reliability
SQ 1,000 1,000 1,000
IQ 0,876 0,848 0,640
SEQ 0,830 0,731 0,555
TMS 0,767 0,649 0,527
PM 0,805 0,640 0,579
VS 0,804 0,668 0,587
IT 0,854 0,784 0,595
HIS 0,802 0,679 0,503
US 0,792 0,615 0,561
NB 0,832 0,733 0,533
Table 3 explains that the composite reliability and cronbach alpha values of each variable
are >0.60, thus explaining that the high reliability of the measuring tool means that all
constructs have good reliability. The AVE value is greater than 0.5, indicating that all of the
above indicators have met the convergence validity requirements.

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Table 4.
Cross Loading Value All Indicators
SQ IQ SEQ TMS PM VS IT HIS US NB
SQ1 0,942 0,837 0,762 0,560 0,756 0,558 0,628 0,620 0,724 0,762
IQ1 0.926 0,910 0,850 0,691 0,782 0,791 0,665 0,732 0,882 0,850
IQ2 0.943 0,778 0,901 0,765 0,778 0,834 0,682 0,765 0,868 0,901
IQ3 0,734 0,739 0,683 0,522 0,741 0,640 0,671 0,737 0,697 0,683
IQ4 0,774 0,758 0,544 0,619 0,749 0,626 0,692 0,602 0,725 0,544
SEQ1 0,685 0.852 0,610 0,662 0,606 0,556 0,652 0,697 0,649 0,610
SEQ2 0,760 0.813 0,816 0,529 0,577 0,569 0,660 0,669 0,741 0,816
SEQ3 0,835 0,815 0,854 0,614 0,648 0,758 0,619 0,593 0,733 0,854
SEQ4 0,836 0,767 0,672 0,636 0,623 0,779 0,612 0,671 0,751 0,672
TMS1 0,827 0,758 0.941 0,610 0,574 0,713 0,565 0,614 0,710 0.941
TMS2 0,866 0,737 0.960 0,840 0,625 0,739 0,714 0,749 0,878 0.960
TMS4 0,818 0,771 0.908 0,705 0,528 0,585 0,715 0,830 0,815 0.908
PM1 0,664 0,615 0,726 0.801 0,731 0,657 0,636 0,656 0,681 0,726
PM3 0,768 0,665 0,701 0.970 0,763 0,670 0,716 0,682 0,783 0,701
PM4 0,548 0,527 0,477 0.851 0,730 0,501 0,684 0,702 0,579 0,477
VS1 0,749 0,660 0,614 0.928 0,750 0,504 0,684 0,715 0,756 0,614
VS2 0,745 0,616 0,535 0,651 0.784 0,625 0,495 0,620 0,735 0,535
VS3 0,585 0,514 0,428 0,428 0.821 0,935 0,591 0,451 0,565 0,428
VS4 0,711 0,784 0,479 0,482 0.882 0,669 0,670 0,522 0,603 0,479
IT1 0,680 0,786 0,539 0,591 0.914 0,651 0,670 0,560 0,675 0,539
IT2 0,731 0,761 0,674 0,619 0.878 0,741 0,720 0,646 0,721 0,674
IT3 0,683 0,584 0,683 0,667 0,630 0.915 0,818 0,676 0,733 0,683
IT4 0,835 0,717 0,835 0,724 0,778 0.933 0,857 0,679 0,821 0,835
SU1 0,635 0,545 0,635 0,591 0,537 0.919 0,565 0,668 0,651 0,635
SU2 0,683 0,568 0,683 0,567 0,512 0.759 0,492 0,716 0,501 0,683
SU3 0,761 0,703 0,761 0,634 0,696 0.934 0,660 0,769 0,748 0,761
SU4 0,451 0,526 0,326 0,461 0,532 0,449 0.754 0,681 0,583 0,784
US1 0,691 0,628 0,699 0,540 0,591 0,551 0.717 0,441 0,521 0,786
US2 0,518 0,552 0,465 0,537 0,436 0,270 0.764 0,700 0,636 0,761
US3 0,622 0,705 0,596 0,765 0,625 0,602 0.869 0,795 0,781 0,584
US4 0,617 0,669 0,623 0,541 0,698 0,700 0.850 0,548 0,808 0,717
NB1 0,713 0,690 0,638 0,650 0,707 0,674 0,656 0.765 0,720 0,752
NB2 0,596 0,563 0,613 0,701 0,472 0,574 0,640 0.886 0,743 0,756
NB3 0,734 0,796 0,758 0,586 0,654 0,731 0,731 0.839 0,756 0,749
NB4 0,370 0,422 0,474 0,508 0,267 0,416 0,639 0.769 0,593 0,710
Table 4 shows that the cross loading value of each indicator in the variable is >0.60. Thus,
as a result of convergent validity and discriminant validity, all variables and indicators in the
study have good validity

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Structural Model Evaluation (inner model)

Table 5.
Path Coefficient Value for Each Hypothetical Path
Variable Original Sample Standard T-statistic P-Values
sample Mean Deflected
SQ→NB 0,001 0,012 0,084 0,016 0,988
IQ→NB -0,019 -0,016 0,124 0,155 0,877
SEQ→NB 0,105 0,107 0,081 1,294 0,196
TMS→NB -0,028 -0,040 0,089 0,317 0,751
PM→NB 0,265 0,263 0,102 2,603 0,010
VS→NB -0,118 -0,085 0,079 1,487 0,138
IT→NB 0,012 0,015 0,089 0,129 0,897
SU→NB 0,614 0,604 0,087 7,002 0,000
US→NB 0,030 0,029 0,121 0,244 0,807

Hypothesis Testing
Table 6.
Hypothesis Test Results
Variable Hipotesis T-statistic T-table Result
SQ→NB H1 0,016 1,96 Rejected
IQ→NB H2 0,155 1,96 Rejected
SEQ→NB H3 1,294 1,96 Rejected
TMS→NB H4 0,317 1,96 Rejected
PM→NB H5 2,603 1,96 Accepted
VS→NB H6 1,487 1,96 Rejected
IT→NB H7 0,129 1,96 Rejected
SU→NB H8 7,002 1,96 Accepted
US→NB H9 0,244 1,96 Rejected

Table 6 shows that there are three indicators accepted after hypothesis testing, Among them
are project management and system use

DISCUSSION
The Effect of System Quality Factors on Net Benefit
From the results of the research that has been carried out, it shows that hypothesis 1 (H1) is
rejected so that it can be proven that the system quality factor has no effect on net benefit.
This can also be seen from the results of the analysis conducted descriptively which shows
that the majority of respondents do not agree that SIMRS operates properly without both
technical and non-technical obstacles during working hours. Respondents felt that the internet
network was not so good, when the system was operating, it often took a long time to load,
affecting data entry not in real time. The ease of technology is something that affects the
frequency of system use. Ease of use is also influenced by ease of learning and usefulness is
influenced by ease of use. Meanwhile, convenience and usefulness will affect the acceptance
of the system by its users. The system received will provide satisfaction for its users. From
this research case, the quality of the system has not satisfied its users due to the system that
often errors during busy service hours and slow internet networks. Therefore, it is necessary
to improve and improve the quality of the system in order to provide optimal benefits for
users by further increasing the use of SIMRS in hospitals14.

The Influence of Information System Factors on Net Benefits

From the results of the research that has been carried out, it shows that hypothesis 2 (H2) is
rejected so that it can be proven that the information quality factor has no effect on net

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benefit. This can also be seen from the results of the analysis conducted descriptively which
shows that the majority of respondents stated that they did not agree with SIMRS producing
information that could be accounted for in its truth, respondents did not agree that SIMRS
produced was timely and accurate and very complete and relevant to the information needed.
A system that often fails is one of the obstacles to providing timely information, officers who
do not enter data and systems that sometimes do not match the input and output. The low
benefits felt by information system users show that information system users are not satisfied,
the quality of the information produced is not accurate and accountable. The information
generated from SIMRS technology has not been used for reporting or decision-making. Based
on the results of the data analysis that has been carried out by the researcher, there is no
influence between the quality of information on the benefits and satisfaction of use.

The Effect of Service Quality Factor on Net Benefit

From the results of the research that has been carried out, it shows that hypothesis 3 (H3) is
rejected so that it can be proven that the service quality factor has no effect on net benefit. The
results of the descriptive analysis on service quality showed that only 55.81% of respondents
stated that they did not agree that it was quickly repaired in the event of a system malfunction,
53.49% of respondents did not agree that SIMRS had user documentation, 50% of
respondents did not agree that SIMRS had heldesk support and 51.16% did not agree that
SIMRS had a helpdesk number that could be contacted in case of complaints or disturbances
in the system.This hypothesis shows that user dissatisfaction is caused by vendor services that
are not quick to respond when needed, the unavailability of a helpdesk, vendors have not
provided quality assurance and service for the use of SIMRS and have not been able to solve
problems that may arise in the use of SIMRS. To support the needs of a hospital, good
communication with the management is needed before the system is translated into a
programming language so that it will make it easier for users to meet their needs in using an
information system. Good communication will produce the information needed for the
analysis of hospital management needs so that the implementation of SIMRS can be
beneficial for all parties.

The influence of Top Management Support factors on Net Benefit

From the results of the research that has been carried out, it shows that hypothesis 4 (H4) is
rejected so that it can be proven that the top management support factor has no effect on net
benefit. Leadership support in the form of leadership commitment in SIMRS is still not
optimal. The leadership has not yet established policies and guidelines for the use of SIMRS.
SIMRS has not been a priority from the leadership and the follow-up of the evaluation that
has not been carried out.The top management support factor has a very significant effect on
the success of ERP implementation. Top management support has a significant effect on the
success of IT adoption, research was conducted on three subjects and significant results were
found three times. According to him, from this top management, it can be studied the profile
and vision and mission, employees and middle management of an agency, so that
strengthening in top management will affect the success of IT10 adoption.

The Effect of Project Management Factors on Net Benefit

From the results of the research that has been carried out, it shows that hypothesis 5 (H5) is
accepted so that it can be proven that the project management factor has an effect on the net
benefit. The results of the descriptive analysis on project management showed that 83.72% of
respondents agreed that the management supported the implementation of SIMRS, 73.26% of
employees accepted the process of changing the work culture from paper recording to the
SIMRS system, 56.98% of respondents agreed that the management provided infrastructure

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support to support the implementation of SIMRS, 52.33% of respondents agreed that the
implementation of SIMRS received financial support from management. Medical staff who
actively use SIMRS is one of the factors driving the adoption of information systems. Staff
cohesion, support between colleagues, regular use of SIMRS are the driving factors for the
use of SIMRS7.

The Effect of Vendor Support Factors on Net Benefit

From the results of the research that has been carried out, it shows that hypothesis 6 (H6) is
rejected so that it can be proven that the vendor support factor has an effect on net benefit.
The existence of a rejected hypothesis indicates that there is a problem with the quality of the
vendor. Based on the results of the study, many respondents complained about the existence
of SIMRS which often errors during busy working hours, then also the length of response
from the vendor to overcome the problem. In addition, the quality of information is also
considered inaccurate. Technical problems, unintegrated systems, equipment disruptions and
poor service quality are things that can cause reluctance to use SIMRS. 7 Service quality is
the user's perception of the services that have been provided by the service provider. Initially,
a measure of service quality was used to measure customer satisfaction which was defined as
a comparison between customer expectations and perceptions of the quality of customer
service provided.

The Effect of IT Capabilities of Staff Factor on Net Benefit

From the results of the research that has been carried out, it shows that hypothesis 7 (H7) is
rejected so that it can be proven that the IT capabilities of staff factor has no effect on net
benefit. The existing SIMRS has not been supported by expert staff in accordance with PMK
No. 82 of 2013 that the Hospital must have an information and technology unit/installation
and have staff with qualifications such as system analyst staff, programmer staff, hardware
staff and network maintanance staff. At present, the staff serving in SIMRS are 3 computer
graduates and 4 non-computer graduates. For this reason, it is necessary to accept contract
personnel who are in accordance with these qualifications as well as experience in the field of
information systems or utilize existing human resources either with education or training to
improve the quality of SIMRS human resources in hospitals.Based on the results of their
research, they are of the opinion that the existence of an IT team that has good competence
and performance to handle SIMRS technical problems, is available 24 hours/7 days a year and
has the ability to communicate well with users will affect the successful implementation of
SIMRS14.

Effect of System Use Factor on Net Benefit

From the results of the research that has been carried out, it shows that hypothesis 8 (H8) is
accepted so that it can be proven that the System use factor affects the net benefit. From
observations in the field, they feel that the use of SIMRS makes the process of searching for
information easier, SIMRS is very helpful for their daily work. Therefore, it is necessary to
increase the use of a quality system to achieve the net benefits desired by hospitals.

Effect of User Satisfaction Factor on Net Benefit

From the results of the research that has been carried out, it shows that hypothesis 9 (H9) is
rejected so that it can be proven that the user satisfaction factor has no effect on net benefit.
The results of the descriptive analysis on user satisfaction showed that 30.23% of respondents
did not agree that the facilities and features in SIMRS were in accordance with their needs,
30.93% overall SIMRS was in line with expectations in helping my daily tasks, 20.93% of

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users were satisfied with the appearance of the application and easy to use 45.35% of the
information generated by the system, accurate and could help in the decision-making process.
User satisfaction is the response and feedback that users generate after using the information
system. User attitude towards information systems is a subjective criterion regarding how
much users like the system used6. The level of satisfaction has a direct effect on the use of the
system. If SIMRS is satisfactory, the level of use will be more frequent. User satisfaction is a
factor that encourages the use of the system and affects the user's perception of the benefits
obtained

CONCLUSION
SIMRS at Hermina Tanggerang Hospital has not run optimally, it is evident that there are still
many obstacles that occur in the field, including: systems that often error during service
hours, information that is not complete and accurate, slow response in case of system damage,
leadership commitment that has not been maximized and policies and guidelines related to
SIMRS, vendors in the development of SIMRS are still lacking and the competence of IT
staff is not optimal and not in accordance with educational background or experience. The
variables that have an influence on net benefit are: project management and system use. The
variables that do not have an influence on net benefit are: system quality, information quality,
service quality, top management support, vendor support, IT capabilities support and user
satisfaction

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