The Frozen Hybrid: A Lewin-Based Analysis of Stalled EMR Transformation in an Indonesian Regional Hospital
Keywords
change management digital transformation electronic medical records frozen hybrid health information management Lewin’s change model organizational barriersAbstract
Background: Indonesia’s mandated transition to electronic medical records (EMR) under Ministry of Health Regulation No. 24/2022 has resulted in widespread hybrid systems, where hospitals operate neither fully paper-based nor fully electronic, limiting expected efficiency gains. Existing studies largely emphasize technical evaluation frameworks, with limited attention to organizational change dynamics. Objective: This study examines organizational barriers and enablers in EMR implementation using Lewin’s 3-Stage Change Model and conceptualizes the ‘frozen hybrid’ as an organizational phenomenon. Methods: A qualitative descriptive study was conducted at RSUD Balaraja, a regional public hospital in Indonesia. Nine purposively selected informants participated in in-depth interviews, complemented by observation and document review. Data were analyzed thematically using a deductive–inductive approach aligned with Lewin’s stages. Analytical rigor was ensured through triangulation, inter-coder agreement (87%), and member checking. Results: The organization achieved partial Unfreeze through regulatory pressure and leadership investment but remained stalled in the Change stage. Three key themes emerged: (1) uneven adoption across units, with outpatient services largely digitalized while inpatient units maintained dual workflows; (2) persistent technical and human barriers, including network instability, system integration failures, workflow misalignment, and increased documentation burden; and (3) absence of sustained change management, reflected in limited training and declining leadership engagement. Partial Refreeze occurred only in selected functions, while hybrid practices became institutionalized in inpatient care. Conclusion: The findings introduce the ‘frozen hybrid’ as a stabilized state of incomplete digital transformation driven by organizational inertia. Achieving full digital integration requires sustained change management, leadership continuity, infrastructure strengthening, workflow redesign, and elimination of dual documentation practices
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