Using an Electronic Immunization Registry (Aplikasi Sehat IndonesiaKu) in Indonesia: Cross-Sectional Study

Background: Electronic immunization registries (EIRs) are being increasingly used in low- and middle-income countries. In 2022, Indonesia's Ministry of Health introduced its first EIR, named Aplikasi Sehat IndonesiaKu (ASIK), as part of a comprehensive nationwide immunization program. This marked a conversion from traditional paper-based immunization reports to digital routine records encompassing a network of 10,000 primary health centers (puskesmas). Objective: This paper provides an overview of the use of ASIK as the first EIR in Indonesia. It describes the coverage of the nationwide immunization program (Bulan Imunisasi Anak Nasional) using ASIK data and assesses the implementation challenges associated with the adoption of the EIR in the context of Indonesia. Methods: Data were collected from primary care health workers' submitted reports using ASIK. The data were reported in real time, analyzed, and presented using a structured dashboard. Data on ASIK use were collected from theASIK website. A quantitative assessment was conducted through a cross-sectional survey between September 2022 and October 2022. A set of questionnaires was used to collectfeedback fromASIK users. Results: A total of 93.5% (9708/10,382) of public health centers, 93.5% (6478/6928) of subdistricts, and 97.5% (501/514) of districts and cities in 34 provinces reported immunization data using ASIK. With >21 million data points recorded, the national coveragefor immunization campaigns for measles-rubella; oral polio vaccine; inactivated polio vaccine; and diphtheria, pertussis, tetanus, hepatitis B, and Haemophilusinfluenzae typeB vaccinewere 50.1% (18,301,057/36,497,694), 36.2% (938,623/2,595,240), 30.7% (1,276,668/4,158,289), and 40.2% (1,371,104/3,407,900), respectively. The quantitative survey showed that, generally, users had a good understanding of ASIK as the EIR (650/809, 80.3%), 61.7% (489/793) of the users expressed that the user interface and user experience were overall good but could still be improved, 54% (422/781) of users expressed that the ASIK variable fit their needs yet could be improved further, and 59.1% (463/784) of users observed sporadic system interference. Challenges faced during the implementation of ASIK included a heavy workload burden for health workers, inadequate access to the internet at some places, system integration and readiness, and dual reporting using the paper-based format. Conclusions:The EIR is beneficial and helpful for monitoring vaccination coverage. Implementation and adoption of ASIK as Indonesia's first EIR still faces challenges related to human resources and digital infrastructure as the country transitions from paper-based reports to electronic or digital immunization reports. Continuous improvement, collaboration, and monitoring efforts are crucialto encourage the use of the EIR in Indonesia.