The implementation of Electronic Medical Records (EMR) at the Ancol Field Hospital (Rumkitlap Ancol) continues to face resistance from healthcare workers, a factor that could hinder the system's success. This study aims to analyze the influence of digital literacy and system quality on EMR user resistance, both directly and with transformational leadership acting as a moderating variable. A quantitative approach with a causal-explanatory design was employed. The study population consisted of 124 healthcare and administrative staff, with a sample of 95 respondents selected via simple random sampling. Data were collected using a 1–4 Likert scale questionnaire and analyzed using Partial Least Squares-Structural Equation Modeling (PLS-SEM) via SmartPLS 4. The results indicate that digital literacy, system quality, and transformational leadership simultaneously exert a significant influence on EMR user resistance, accounting for 43.6% of the variance (Adjusted R² = 0.436). Individually, digital literacy had a significant negative effect on resistance (β = -0.491; p = 0.000), as did system quality (β = -0.432; p = 0.000). Transformational leadership was not found to moderate the influence of either digital literacy (t = 0.893 < 1.96) or system quality (t = 1.005 < 1.96) on resistance. These findings underscore that reducing EMR resistance requires enhancing healthcare workers' digital literacy, improving system quality to ensure responsiveness and reliability, and strengthening transformational leadership as a direct approach, rather than relying solely on the moderating role of leadership.