Volume 27, Issue 3 (11-2024)
jha 2024, 27(3): 103-117 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Najafi Sarband S, Amanzadeh M, Naimi R, Mohammad Shahi J, Mahdavi A. Benefits and challenges of electronic pharmaceutical prescriptions. jha 2024; 27 (3) :103-117
URL: http://jha.iums.ac.ir/article-1-4559-en.html
URL: http://jha.iums.ac.ir/article-1-4559-en.html
1- Department of Health Information Management, Faculty of Paramedical Sciences, Ardabil University of Medical Sciences, Ardabil, Iran.
2- Department of Infectious Disease, School Medicine, Ardabil University of Medical Sciences, Ardabil, Iran. ,a.mahdavi@arums.ac.ir
2- Department of Infectious Disease, School Medicine, Ardabil University of Medical Sciences, Ardabil, Iran. ,
Full-Text [PDF 958 kb]
(33 Downloads)
| Abstract (HTML) (68 Views)
Table 1. Demographic characteristics of the participants in the study
Table 2. Advantages of the electronic prescribing system from the perspective of the participants
Table 3. Challenges of the electronic prescribing system from the perspective of the participants
Full-Text: (8 Views)
Introduction
One of the most important functions in any health system is the drug prescription [1]. Physicians have long used paper prescriptions as a common method for decision-making for the diagnosis and treatment [2]. However, prescribing is one of the potential sources of errors that can compromise patient safety [3, 4]. Since paper prescription is linked to numerous risks, the likelihood of errors occurring is increased [5]. Considering the problems of paper prescriptions including the lack of management and support for drug interactions and side effects, the issuance of the wrong prescription to the patient, and the loss of patient and prescriber data, the implementation of electronic prescription has been proposed [6, 7].
The World Health Organization (WHO( defines e-prescribing as the process of providing and transmitting treatment instructions, such as medication, lab, and radiology orders, using computer software rather than papers [7]. This technology can be connected to an electronic health record system or utilized independently [8]. An electronic prescribing system presents an opportunity for process improvement. E-prescribing provides support for clinical decision-making in the field of medication management and reduces medical expenses [9]. This system has advantages such as prevention of counterfeiting in prescriptions [10], increased patient safety [10-13], improved quality of prescriptions [4, 14], and provision of quality care and reduction of human errors [4, 10, 11, 15], along with support for clinical decision-making [4, 11, 12, 14]. With the e-prescribing system, physicians have access to patient medication records, clinical decision support systems, and previous prescriptions, which can help improve prescribing and prevent prescription errors [16]. However, improper use of this system can lead to the emergence of a new type of errors that may threaten public health [17].
In a study, the findings show that, despite the benefits, the implementation and use of this system are costly due to the need for training to ensure the proper functioning of the electronic prescribing software[18]. In another study, the attitudes of physicians towards electronic prescriptions were evaluated, and the results showed that the main barriers to implementation included the lack of adequate infrastructure, the necessity of holding awareness sessions, and the need for training programs for the use of electronic prescriptions [19]. Previous studies have mainly considered the view of a stakeholder group (such as physicians or insurance companies), while it is necessary to pay attention to the views of the four main groups (physicians, technical officials of pharmacies, patients and
insurers) for a more comprehensive understanding of the challenges, and benefits of this system. Therefore, the study was conducted with the aim of analyzing the advantages and challenges of the electronic pharmaceutical prescription system from the perspective of these four groups in teaching hospitals affiliated with Ardabil University of Medical Sciences to provide solutions to improve the prescribing process and enhance the quality of pharmaceutical services.
Methods
This qualitative research was conducted in 2023-2024. The required data were collected through semi-structured interviews and analyzed using qualitative content analysis based on the Graneheim and Lundman approach. The data collection tool consisted of semi-structured questions, the face and content validity of which were confirmed by the research team, faculty members of the health information management department, and four experts in the field of electronic prescription. The interview guide was designed based on the specific objectives of the study and a review of the related literature. Some questions were common to all users, while others were tailored to each group. To ensure the validity of the instrument, three initial interviews were conducted on a trial basis and the extracted data were evaluated in accordance with the objectives of the study.
For participant selection, purposeful sampling with maximum variation was employed. The inclusion criteria included having experience using the electronic prescription system, availability, willingness to participate, and sufficient time for the interview. Patients were selected from three teaching hospitals: Imam Khomeini, Alawi, and Dr. Fatemi. The interviews continued until theoretical saturation, ultimately involving 11 physicians, 11 pharmacy technical managers, 24 patients, and four health insurance experts. Due to the diversity of experiences and varying levels of awareness among patients, a larger number of participants from this group were interviewed to achieve theoretical saturation.
The interviews were recorded after informed consent and with prior notice, and each interview lasted an average of 30 to 40 minutes. The text of the interviews was implemented word for word and analyzed using MAXQDA 2020 software. Finally, the collected data were analyzed in-depth and systematically to comprehensively identify and categorize the advantages and challenges of the electronic prescription system from the perspectives of the four participant groups.
Results
In this study, 11 physicians, 11 pharmacy technical managers, 24 patients, and four insurance experts participated. The demographic characteristics of the participants are presented in Table 1. Among the participants, the majority were male. In the patient group, the majority of participants were women with a high school diploma or lower levels of education.
One of the most important functions in any health system is the drug prescription [1]. Physicians have long used paper prescriptions as a common method for decision-making for the diagnosis and treatment [2]. However, prescribing is one of the potential sources of errors that can compromise patient safety [3, 4]. Since paper prescription is linked to numerous risks, the likelihood of errors occurring is increased [5]. Considering the problems of paper prescriptions including the lack of management and support for drug interactions and side effects, the issuance of the wrong prescription to the patient, and the loss of patient and prescriber data, the implementation of electronic prescription has been proposed [6, 7].
The World Health Organization (WHO( defines e-prescribing as the process of providing and transmitting treatment instructions, such as medication, lab, and radiology orders, using computer software rather than papers [7]. This technology can be connected to an electronic health record system or utilized independently [8]. An electronic prescribing system presents an opportunity for process improvement. E-prescribing provides support for clinical decision-making in the field of medication management and reduces medical expenses [9]. This system has advantages such as prevention of counterfeiting in prescriptions [10], increased patient safety [10-13], improved quality of prescriptions [4, 14], and provision of quality care and reduction of human errors [4, 10, 11, 15], along with support for clinical decision-making [4, 11, 12, 14]. With the e-prescribing system, physicians have access to patient medication records, clinical decision support systems, and previous prescriptions, which can help improve prescribing and prevent prescription errors [16]. However, improper use of this system can lead to the emergence of a new type of errors that may threaten public health [17].
In a study, the findings show that, despite the benefits, the implementation and use of this system are costly due to the need for training to ensure the proper functioning of the electronic prescribing software[18]. In another study, the attitudes of physicians towards electronic prescriptions were evaluated, and the results showed that the main barriers to implementation included the lack of adequate infrastructure, the necessity of holding awareness sessions, and the need for training programs for the use of electronic prescriptions [19]. Previous studies have mainly considered the view of a stakeholder group (such as physicians or insurance companies), while it is necessary to pay attention to the views of the four main groups (physicians, technical officials of pharmacies, patients and
insurers) for a more comprehensive understanding of the challenges, and benefits of this system. Therefore, the study was conducted with the aim of analyzing the advantages and challenges of the electronic pharmaceutical prescription system from the perspective of these four groups in teaching hospitals affiliated with Ardabil University of Medical Sciences to provide solutions to improve the prescribing process and enhance the quality of pharmaceutical services.
Methods
This qualitative research was conducted in 2023-2024. The required data were collected through semi-structured interviews and analyzed using qualitative content analysis based on the Graneheim and Lundman approach. The data collection tool consisted of semi-structured questions, the face and content validity of which were confirmed by the research team, faculty members of the health information management department, and four experts in the field of electronic prescription. The interview guide was designed based on the specific objectives of the study and a review of the related literature. Some questions were common to all users, while others were tailored to each group. To ensure the validity of the instrument, three initial interviews were conducted on a trial basis and the extracted data were evaluated in accordance with the objectives of the study.
For participant selection, purposeful sampling with maximum variation was employed. The inclusion criteria included having experience using the electronic prescription system, availability, willingness to participate, and sufficient time for the interview. Patients were selected from three teaching hospitals: Imam Khomeini, Alawi, and Dr. Fatemi. The interviews continued until theoretical saturation, ultimately involving 11 physicians, 11 pharmacy technical managers, 24 patients, and four health insurance experts. Due to the diversity of experiences and varying levels of awareness among patients, a larger number of participants from this group were interviewed to achieve theoretical saturation.
The interviews were recorded after informed consent and with prior notice, and each interview lasted an average of 30 to 40 minutes. The text of the interviews was implemented word for word and analyzed using MAXQDA 2020 software. Finally, the collected data were analyzed in-depth and systematically to comprehensively identify and categorize the advantages and challenges of the electronic prescription system from the perspectives of the four participant groups.
Results
In this study, 11 physicians, 11 pharmacy technical managers, 24 patients, and four insurance experts participated. The demographic characteristics of the participants are presented in Table 1. Among the participants, the majority were male. In the patient group, the majority of participants were women with a high school diploma or lower levels of education.
Table 1. Demographic characteristics of the participants in the study
| Participants | Gender | Frequency |
| Full-time faculty physicians | Female | 2 |
| Male | 5 | |
| Non full-time faculty physicians | Female | 1 |
| Male | 3 | |
| Pharmacy technicians (licensed by the university) | Female | 5 |
| Male | 6 | |
| Patients (Undergraduate and Diploma) | Female | 14 |
| Male | 2 | |
| Patients (Bachelor and above) | Female | 5 |
| Male | 3 | |
| Experts of insurance organizations | Male | 4 |
Benefits of electronic prescribing
The advantages of electronic prescribing are outlined in Table 2, categorized by the four participant groups in the study. One of the physicians explicitly stated: "The electronic prescribing process facilitates prescription writing, reduces medication errors, and resolves the issue of illegibility compared to paper prescriptions." Supporting this point, one of the pharmacy managers remarked: "Electronic prescribing has simplified the process and resolved the issue of illegibility. Previously, pharmacy receptionists could easily read prescriptions from nearby clinics and familiar physicians; however, other pharmacies might struggle to decipher the messy handwriting of the same physician, and sometimes this illegibility would require patients to return to the clinic to ensure they correctly understood the spelling of medication names and instructions for use. These issues associated with handwritten prescriptions have been completely resolved with electronic prescriptions." One of the patients also mentioned: "in the paper prescriptions, we often encountered problems. For example, when we went to the pharmacy, the physician's prescription might not have been fully stamped or there might not be a physician's signature at all. Sometimes, the seal would fall on the name of the drug, causing the name of the drug to become unreadable. In addition, the physician's handwriting was so illegible in many cases that we had to go back to the office to fix the problem.” One insurance expert also pointed out the enhanced security and protective measures of the electronic prescribing system: "The presence of intelligent two-step protection, during access to the electronic prescription system has increased security."
According to an insurance expert, "electronic prescribing prevents duplicate prescriptions and medications. This issue has become one of the greatest advantages of electronic prescribing, meaning that as long as the defined treatment period for medications has not ended, issuing a new prescription for the same patient is not possible." One of the prominent goals of electronic prescribing is to prevent duplicate prescriptions. According to one pharmacy technical manager: "This system helps prevent unnecessary duplicate prescriptions. For example, if a medication was prescribed a few days ago by a physician and there is still time left before the medication is finished, the system alerts the same physician or another healthcare provider about the non-consumption of all medications and does not allow them to prescribe the same drug." An insurance expert pointed out an important feature in the prescribing system referred to as "effective date,": "The presence of the 'effective date' item in the system allows a physicians or healthcare provider to issue a diagnostic test order for a patient, for instance, two months in advance. In this case, the patient can visit the laboratory after two months; if they go before that date, the tests will not be visible in the system."
Challenges of electronic prescribing
The main challenges of electronic prescription are presented in Table 3, categorized by the four groups of participants. The results indicated that one of the main challenges to electronic prescription is the slow speed of the Internet and the system, which is caused by the lack of essential communication infrastructures. According to one of the physicians, "the intermittent disconnection and slow Internet are very problematic. The slow Internet speed causes delays for patients and sometimes leads to complaints. Naturally, if a patient's condition is urgent, there can be no delay or waiting for treatment actions, and a fundamental solution must be considered for that." Additionally, despite the importance of preventing drug interactions and reporting drug allergies, many of the platforms used in electronic prescription systems still lack this module, requiring physicians to exercise the same care and attention as they did during paper prescriptions. The inability to support clinical decision-making, the inefficient design of prescription systems, and the multiple prescription systems were other challenges mentioned, acknowledged by all groups except for patients.
According to most interviewees, one of the fundamental challenges of the electronic prescription system is the multitude of applications that do not adhere to internationally accepted standards. Each insurer has developed software based on its preferences, and physicians have to work with several types of software throughout the day. One physician mentioned, "Government software lacks facilities and capabilities to support decision-making, to the extent that there are no alerts regarding drug interactions and allergies. Just like with paper prescriptions, physicians must exercise due diligence in this matter."
The advantages of electronic prescribing are outlined in Table 2, categorized by the four participant groups in the study. One of the physicians explicitly stated: "The electronic prescribing process facilitates prescription writing, reduces medication errors, and resolves the issue of illegibility compared to paper prescriptions." Supporting this point, one of the pharmacy managers remarked: "Electronic prescribing has simplified the process and resolved the issue of illegibility. Previously, pharmacy receptionists could easily read prescriptions from nearby clinics and familiar physicians; however, other pharmacies might struggle to decipher the messy handwriting of the same physician, and sometimes this illegibility would require patients to return to the clinic to ensure they correctly understood the spelling of medication names and instructions for use. These issues associated with handwritten prescriptions have been completely resolved with electronic prescriptions." One of the patients also mentioned: "in the paper prescriptions, we often encountered problems. For example, when we went to the pharmacy, the physician's prescription might not have been fully stamped or there might not be a physician's signature at all. Sometimes, the seal would fall on the name of the drug, causing the name of the drug to become unreadable. In addition, the physician's handwriting was so illegible in many cases that we had to go back to the office to fix the problem.” One insurance expert also pointed out the enhanced security and protective measures of the electronic prescribing system: "The presence of intelligent two-step protection, during access to the electronic prescription system has increased security."
According to an insurance expert, "electronic prescribing prevents duplicate prescriptions and medications. This issue has become one of the greatest advantages of electronic prescribing, meaning that as long as the defined treatment period for medications has not ended, issuing a new prescription for the same patient is not possible." One of the prominent goals of electronic prescribing is to prevent duplicate prescriptions. According to one pharmacy technical manager: "This system helps prevent unnecessary duplicate prescriptions. For example, if a medication was prescribed a few days ago by a physician and there is still time left before the medication is finished, the system alerts the same physician or another healthcare provider about the non-consumption of all medications and does not allow them to prescribe the same drug." An insurance expert pointed out an important feature in the prescribing system referred to as "effective date,": "The presence of the 'effective date' item in the system allows a physicians or healthcare provider to issue a diagnostic test order for a patient, for instance, two months in advance. In this case, the patient can visit the laboratory after two months; if they go before that date, the tests will not be visible in the system."
Challenges of electronic prescribing
The main challenges of electronic prescription are presented in Table 3, categorized by the four groups of participants. The results indicated that one of the main challenges to electronic prescription is the slow speed of the Internet and the system, which is caused by the lack of essential communication infrastructures. According to one of the physicians, "the intermittent disconnection and slow Internet are very problematic. The slow Internet speed causes delays for patients and sometimes leads to complaints. Naturally, if a patient's condition is urgent, there can be no delay or waiting for treatment actions, and a fundamental solution must be considered for that." Additionally, despite the importance of preventing drug interactions and reporting drug allergies, many of the platforms used in electronic prescription systems still lack this module, requiring physicians to exercise the same care and attention as they did during paper prescriptions. The inability to support clinical decision-making, the inefficient design of prescription systems, and the multiple prescription systems were other challenges mentioned, acknowledged by all groups except for patients.
According to most interviewees, one of the fundamental challenges of the electronic prescription system is the multitude of applications that do not adhere to internationally accepted standards. Each insurer has developed software based on its preferences, and physicians have to work with several types of software throughout the day. One physician mentioned, "Government software lacks facilities and capabilities to support decision-making, to the extent that there are no alerts regarding drug interactions and allergies. Just like with paper prescriptions, physicians must exercise due diligence in this matter."
Table 2. Advantages of the electronic prescribing system from the perspective of the participants
| Advantages | Physicians | Technical managers of the pharmacy | Patients | Insurance organizations |
| Fixing the illegibility of prescriptions and reducing medication errors | a | a | a | a |
| No need for a health insurance booklet, visit with an ID card | a | a | a | a |
| The possibility of editing the prescription | a | a | - | a |
| Facilitating the prescription process and easy use of the system | - | a | - | a |
| Online monitoring and tracking of prescriptions prescribed by insurance organizations | - | - | - | a |
| Ability to access patient records | a | - | a | a |
| Security and confidentiality of information | a | a | a | a |
| Ability to store medications and frequent prescriptions | a | - | - | a |
| Facilitating reporting to monitor by relevant officials in the Ministry of Health and insurance companies | a | a | - | a |
| Marking specific patients by the system and the possibility of viewing their information | a | a | a | a |
| Warning for duplicate prescriptions | a | a | - | a |
| Determining the maximum amount of medications | a | a | a | a |
| The possibility of obtaining medicine in case of lack of medicine in several occasions | - | a | a | a |
| Calculating and updating drug prices systematically and daily |
| a | a | |||
| The possibility of obtaining medicine in case of drug shortage from several pharmacies at the same time, covering by insurance | a | a | a | |
| Extending the validity of the prescribed prescription up to two months | a | a | a | |
| Existence of an effective date | a | a | a |
Table 3. Challenges of the electronic prescribing system from the perspective of the participants
| Challenges | Physicians | Technical managers of the pharmacy | Patients | Insurance organizations |
| Interruption and slowness of the system and the Internet | a | a | a | a |
| Lack of warning for interactions and drug sensitivity | a | a | - | a |
| Problems related to the search for drugs | a | - | - | a |
| Inability to support clinical decisions | a | a | - | a |
| The possibility of medication errors due to registration by the secretary | - | - | a | - |
| Inefficient design of the systems | a | a | - | a |
| Multiple prescribing systems in the country | a | a | - | a |
Discussion
The study shows that the implementation of the electronic prescription system has strengths and capabilities, as well as weaknesses and challenges. Insufficient internet speed, lack of infrastructure, and failure to comply with data exchange standards by insurance systems are among the weaknesses. Its benefits include reducing medication errors, improving patient management, accessing drug records, removing paper works, and enabling better oversight by responsible entities. The system, which combines medicine process and information technology, has improved the quality of healthcare services and is useful for physicians, patients, health officials and insurance organizations.
According to the results, reducing drug errors is one of the main benefits of electronic prescribing, mainly due to increased readability. These findings are consistent with the results of studies by Albarrak et al.[ 4], Osmani et al. [20] and Lanham et al.[ 16] confirming the positive impact of electronic systems on reducing drug errors. In paper-based prescriptions, problems such as illegible handwriting, ambiguous terms, or errors in determining drug dosage may lead to errors, whereas electronic prescriptions minimize these challenges using clear standards. Access to patient records is another important benefit of electronic prescribing. This feature not only improves the quality of medical care and reduces drug errors but also allows for more accurate follow-up on the patient's treatment process. These results are consistent with the findings of Gagnon et al. [21] and Lanham et al.[16]. Other findings include the elimination of paper prescriptions and significant cost savings. This result is consistent with studies by Osmani et al. [20] and Lanham et al. [16], which show that replacing paper prescriptions with electronic ones improves productivity and accessibility in addition to reducing costs
One of the main identified challenges is the lack of technical infrastructure, including frequent power outages, systems outages, and lack of high-speed and sustainable internet access. This finding is consistent with the results of studies by Eltajoury et al. [19], ovarinen et al. [22], Tan et al. [23], Gagnon et al.[ 21], Samadbeik et al.[24], which highlights the negative impact of inadequate infrastructure on productivity and service quality. Another challenge is the multiple insurance software. This software dispersion waste time for physicians and pharmacies, as they must navigate multiple systems. This issue has been examined and confirmed in detail in a study conducted by Borhani et al.[25] at Mashhad University of Medical Sciences. They indicate that integrating insurance software can improve efficiency and reduce the time required to deliver healthcare.
The present study indicates that this system can lead to a transformation in the medical system, increasing effectiveness and efficiency, contingent upon the development of certain requirements, including: integration with databases of other health systems (primary care and hospital based information systems such as SIB and HIS system), access to patient information for family physicians and referral system, integration of prescription systems, strengthening of technical and network infrastructure, empowering users (especially physicians), connecting to clinical decision-making systems, and the utilizing artificial intelligence (such as voice command instead of manual typing). This finding aligns with the results of Vojdani et al. [26] and Jabraeili et al. [2]
According to the survey, stakeholders and users are satisfied with the system, but have made significant points regarding the need to improve its shortcomings. To improve the electronic prescription system, users are requesting the ability use it offline, ensuring that services can be provided without interruption during internet outages. Additionally, there is a need for a secure and fast communication infrastructure and the integration of insurance software with clear rules to minimize confusion between clients and treatment staff. Furthermore, it is necessary to increase the accuracy of physicians in recording drug codes and to strengthen clinical decision support systems (such as warnings for drug interactions and incorrect dosage). Moreover, public education through media and social networks, along with workshops for physicians and pharmacists, can help reduce resistance to change and minimize medical errors. Addressing these challenges will result in improved service quality, increased stakeholder satisfaction, and adoption of electronic prescriptions.
Limitations
The limitations of our study include the low educational level of most patients and the lack of cooperation of armed forces insurance experts, which should be carefully considered when interpreting the results and generalizing the findings.
Conclusion
Implementing an electronic prescription system is essential to improving the health system, but internet infrastructure challenges may disrupt its performance. To address these problems, it is necessary for the cooperation of medical university administrators, IT professionals and health stakeholders to design a user-friendly, flexible (with online/offline functionality) system that meets the needs of doctors, pharmacies, patients and insurance companies. Macro planning, resource allocation, and continuous monitoring of system performance along with receiving user feedback, will contribute to sustainable development and improve service quality.
Declerations
Ethical considerations: This research has been approved by the code of ethics IR.ARUMS.MEDICINE.REC.1402.040 at Ardabil University of Medical Sciences. Participation in this research was voluntary and the confidentiality of the information of the participants in this research was respected.
Funding: This research was done without financial support.
Conflict of interest: There is no conflict of interest in this research.
Authors’ contribution: Sara Najafi Sarband: Conceptualization, Study design, Data collection, Data analysis, Resources, writing-original draft, final approval; Abdullah Mahdavi: Conceptualization, study design, methodology, data analysis, writing-original draft, review and editing, Final approval; Masoud Amanzadeh: Software, data analysis, writing-review and editing, final approval; Roya Naimi: Conceptualization, study design, writing-original draft, final approval; Jafar Mohammad Shahi: Conceptualization, study design, final approval. The final editing of the article has been done by the authors and has been approved by all the authors of the article.
Consent for publication: None
AI deceleration: None
Acknowledgments: This article is a part of the dissertation titled "Identifying and prioritizing the main challenges of electronic pharmaceutical prescribing in the teaching and therapeutic hospitals of Ardabil University of Medical Sciences" in the master's degree approved by Ardabil University of Medical Sciences in 1402 with the code is IR.ARUMS.MEDICINE.REC.1402.040.
The study shows that the implementation of the electronic prescription system has strengths and capabilities, as well as weaknesses and challenges. Insufficient internet speed, lack of infrastructure, and failure to comply with data exchange standards by insurance systems are among the weaknesses. Its benefits include reducing medication errors, improving patient management, accessing drug records, removing paper works, and enabling better oversight by responsible entities. The system, which combines medicine process and information technology, has improved the quality of healthcare services and is useful for physicians, patients, health officials and insurance organizations.
According to the results, reducing drug errors is one of the main benefits of electronic prescribing, mainly due to increased readability. These findings are consistent with the results of studies by Albarrak et al.[ 4], Osmani et al. [20] and Lanham et al.[ 16] confirming the positive impact of electronic systems on reducing drug errors. In paper-based prescriptions, problems such as illegible handwriting, ambiguous terms, or errors in determining drug dosage may lead to errors, whereas electronic prescriptions minimize these challenges using clear standards. Access to patient records is another important benefit of electronic prescribing. This feature not only improves the quality of medical care and reduces drug errors but also allows for more accurate follow-up on the patient's treatment process. These results are consistent with the findings of Gagnon et al. [21] and Lanham et al.[16]. Other findings include the elimination of paper prescriptions and significant cost savings. This result is consistent with studies by Osmani et al. [20] and Lanham et al. [16], which show that replacing paper prescriptions with electronic ones improves productivity and accessibility in addition to reducing costs
One of the main identified challenges is the lack of technical infrastructure, including frequent power outages, systems outages, and lack of high-speed and sustainable internet access. This finding is consistent with the results of studies by Eltajoury et al. [19], ovarinen et al. [22], Tan et al. [23], Gagnon et al.[ 21], Samadbeik et al.[24], which highlights the negative impact of inadequate infrastructure on productivity and service quality. Another challenge is the multiple insurance software. This software dispersion waste time for physicians and pharmacies, as they must navigate multiple systems. This issue has been examined and confirmed in detail in a study conducted by Borhani et al.[25] at Mashhad University of Medical Sciences. They indicate that integrating insurance software can improve efficiency and reduce the time required to deliver healthcare.
The present study indicates that this system can lead to a transformation in the medical system, increasing effectiveness and efficiency, contingent upon the development of certain requirements, including: integration with databases of other health systems (primary care and hospital based information systems such as SIB and HIS system), access to patient information for family physicians and referral system, integration of prescription systems, strengthening of technical and network infrastructure, empowering users (especially physicians), connecting to clinical decision-making systems, and the utilizing artificial intelligence (such as voice command instead of manual typing). This finding aligns with the results of Vojdani et al. [26] and Jabraeili et al. [2]
According to the survey, stakeholders and users are satisfied with the system, but have made significant points regarding the need to improve its shortcomings. To improve the electronic prescription system, users are requesting the ability use it offline, ensuring that services can be provided without interruption during internet outages. Additionally, there is a need for a secure and fast communication infrastructure and the integration of insurance software with clear rules to minimize confusion between clients and treatment staff. Furthermore, it is necessary to increase the accuracy of physicians in recording drug codes and to strengthen clinical decision support systems (such as warnings for drug interactions and incorrect dosage). Moreover, public education through media and social networks, along with workshops for physicians and pharmacists, can help reduce resistance to change and minimize medical errors. Addressing these challenges will result in improved service quality, increased stakeholder satisfaction, and adoption of electronic prescriptions.
Limitations
The limitations of our study include the low educational level of most patients and the lack of cooperation of armed forces insurance experts, which should be carefully considered when interpreting the results and generalizing the findings.
Conclusion
Implementing an electronic prescription system is essential to improving the health system, but internet infrastructure challenges may disrupt its performance. To address these problems, it is necessary for the cooperation of medical university administrators, IT professionals and health stakeholders to design a user-friendly, flexible (with online/offline functionality) system that meets the needs of doctors, pharmacies, patients and insurance companies. Macro planning, resource allocation, and continuous monitoring of system performance along with receiving user feedback, will contribute to sustainable development and improve service quality.
Declerations
Ethical considerations: This research has been approved by the code of ethics IR.ARUMS.MEDICINE.REC.1402.040 at Ardabil University of Medical Sciences. Participation in this research was voluntary and the confidentiality of the information of the participants in this research was respected.
Funding: This research was done without financial support.
Conflict of interest: There is no conflict of interest in this research.
Authors’ contribution: Sara Najafi Sarband: Conceptualization, Study design, Data collection, Data analysis, Resources, writing-original draft, final approval; Abdullah Mahdavi: Conceptualization, study design, methodology, data analysis, writing-original draft, review and editing, Final approval; Masoud Amanzadeh: Software, data analysis, writing-review and editing, final approval; Roya Naimi: Conceptualization, study design, writing-original draft, final approval; Jafar Mohammad Shahi: Conceptualization, study design, final approval. The final editing of the article has been done by the authors and has been approved by all the authors of the article.
Consent for publication: None
AI deceleration: None
Acknowledgments: This article is a part of the dissertation titled "Identifying and prioritizing the main challenges of electronic pharmaceutical prescribing in the teaching and therapeutic hospitals of Ardabil University of Medical Sciences" in the master's degree approved by Ardabil University of Medical Sciences in 1402 with the code is IR.ARUMS.MEDICINE.REC.1402.040.
Type of Study: Research |
Subject:
Health Information Management
Received: 2024/07/1 | Accepted: 2025/05/21 | Published: 2025/06/7
Received: 2024/07/1 | Accepted: 2025/05/21 | Published: 2025/06/7
پیوست [PDF 321 KB] (3 Download)
References
1. Bulut S, Yıldız A, Kaya S. Evaluation of transition to electronic prescriptions in Turkey: perspective of family physicians. International Journal of Health Policy and Management. 2018;8(1):40-48. doi: 10.15171/ijhpm.2018.89 [DOI:10.15171/ijhpm.2018.89]
2. Jebraeily M, Rashidi A, Mohitmafi T, Muossazadeh R. Evaluation of outpatient electronic prescription system capabilities from the perspective of physicians in specialized polyclinics of Urmia social security organization. Journal of Payavard Salamat. 2021;14(6):557-568. [In Persian]. Available form: http://payavard.tums.ac.ir/article-1-7062-en.html
3. Kauppinen H, Ahonen R, Timonen J. The impact of electronic prescriptions on medication safety in Finnish community pharmacies: a survey of pharmacists. International Journal of Medical Informatics. 2017;100:56-62. doi: 10.1016/j.ijmedinf.2017.01.014 [DOI:10.1016/j.ijmedinf.2017.01.014]
4. Albarrak AI, Al Rashidi EA, Fatani RK, Al Ageel SI, Mohammed R. Assessment of legibility and completeness of handwritten and electronic prescriptions. Saudi Pharmaceutical Journal. 2014;22(6):522-527. [DOI:10.1016/j.jsps.2014.02.013]
5. Kenawy AS, Kett V. The impact of electronic prescription on reducing medication errors in an egyptian outpatient clinic. International Journal of Medical Informatics. 2019;127:80-87. doi: 10.1016/j.ijmedinf.2019.04.005 [DOI:10.1016/j.ijmedinf.2019.04.005]
6. Samadbeik M, Ahmadi M, Asanjan SMH. A theoretical approach to electronic prescription system: lesson learned from literature review. Iranian Red Crescent Medical Journal. 2013;15(10):e8436. doi: 10.5812/ircmj.8436 [DOI:10.5812/ircmj.8436]
7. Almutairi BA, Potts HW, Al-Azmi SF. Physicians' perceptions of electronic prescribing with electronic medical records in Kuwaiti primary healthcare centres. Sultan Qaboos University Medical Journal. 2019;18(4):e476. doi: 10.18295/squmj.2018.18.04.008 [DOI:10.18295/squmj.2018.18.04.008]
8. Motulsky A, Lamothe L, Sicotte C. Impacts of second-generation electronic prescriptions on the medication management process in primary care: A systematic review. International Journal of Medical Informatics. 2013;82(6):473-91. doi: 10.1016/j.ijmedinf.2013.01.012 [DOI:10.1016/j.ijmedinf.2013.01.012]
9. Samadbeik M, Ahmadi M, Sadoughi F, Garavand A. Main elements of national model of electronic prescription system from physicians' point of view: a case study in a developing country. Iranian Journal of Pharmaceutical Research: IJPR. 2019;18(4):2204. doi: 10.22037/ijpr.2019.1100801
10. Amlashi SRA, Leyli EK, Sheikhtaheri A. Physicians' and pharmacists' viewpoint on ambulatory electronic prescription system.Journal of Health Administration 2022, 25(3):108-124. [In Persian]. doi: 10.22034/25.3.108
11. Hosseini H, Khajouie R, MiriAliabadi F. A study on physicians' attitude toward computerized physician order entry system. Payesh (Health Monitor)Journal. 2015;14(4):411-419. Available form: http://payeshjournal.ir/article-1-223-en.html
12. Zarour K, Fetni MO, Belagrouz S. Towards electronic prescription system in a developing country. Applied Medical Informatics, Technology Platform. 2021;43(1):56-67. Available from: https://ssrn.com/abstract=4804444
13. Ai A, Wong A, Amato M, Wright A. Communication failure: analysis of prescribers' use of an internal free-text field on electronic prescriptions. Journal of the American Medical Informatics Association. 2018;25(6):709-714. [DOI:10.1093/jamia/ocy003]
14. Palappallil DS, Pinheiro C. Perceptions of prescribers towards electronic prescription: a pre-implementation evaluation. Journal of Young Pharmacists. 2018;10(3):313-317. https://dx.doi.org/10.5530/jyp.2018.10.69 [DOI:10.5530/jyp.2018.10.69]
15. Hailiye Teferi G, Wonde TE, Tadele MM, Assaye BT, Hordofa ZR, Ahmed MH, et al. Perception of physicians towards electronic prescription system and associated factors at resource limited setting 2021: cross sectional study. PloS One. 2022;17(3):e0262759. [DOI:10.1371/journal.pone.0262759]
16. Lanham AE, Cochran GL, Klepser DG. Electronic prescriptions: opportunities and challenges for the patient and pharmacist. Advanced Health Care Technologies. 2016:1-11. doi: 10.2147/AHCT.S64477 [DOI:10.2147/AHCT.S64477]
17. Khammarnia M, Mehdipour Y, Ebrahimi S, Hakimi D, Sotodezadeh F. The impact of computerized physician order entry system on the quality of health services: the viewpoints of physicians and nurses. Journal of Health and Biomedical Informatics. 2016;3(3):166-173. [In Persian]. Available form: http://jhbmi.ir/article-1-164-en.html
18. Ayaz S, Naqvi A, Branch G, editors. The role of e-prescribing in health care. 2015 Internet Technologies and Applications (ITA); 2015: IEEE.315-319. doi: 10.1109/ITechA.2015.7317416 [DOI:10.1109/ITechA.2015.7317416]
19. Eltajoury M.W, M. Maatuk A, Denna I, K. Elberkawi E, editors. Physicians' attitudes towards electronic prescribing software: perceived benefits and barriers. International Conference on Data Science, E-learning and Information Systems 2021; 47-53. [DOI:10.1145/3460620.3460629]
20. Osmani F, Arab-Zozani M, Shahali Z, Lotfi F, editors. Evaluation of the effectiveness of electronic prescription in reducing medical and medical errors (systematic review study). Annales Pharmaceutiques Françaises; 2023, 81(3): 433-445. doi: 10.1016/j.pharma.2022.12.002 [DOI:10.1016/j.pharma.2022.12.002]
21. Gagnon M-P, Nsangou É-R, Payne-Gagnon J, Grenier S, Sicotte C. Barriers and facilitators to implementing electronic prescription: a systematic review of user groups' perceptions. Journal of the American Medical Informatics Association. 2014;21(3):535-541. doi: 10.1136/amiajnl-2013-002203 [DOI:10.1136/amiajnl-2013-002203]
22. Oravainen T, Airaksinen M, Hannula K, Kvarnström K. How physicians renew electronic prescriptions in primary care: Therapeutic decision or technical task? International Journal of Environmental Research and Public Health. 2021;18(20):10937. doi: 10.3390/ijerph182010937 [DOI:10.3390/ijerph182010937]
23. Tan T, Chan S, Ind M, Pace G, Bailey J, Reed K, et al. Benefits and challenges of electronic prescribing for general practitioners and pharmacists in regional Australia. Australian Journal of Rural Health. 2023;31(4):776-781. doi: 10.1111/ajr.12999 [DOI:10.1111/ajr.12999]
24. Samadbeik M, Ahmadi M, Sadoughi F. An Applied review model of electronic prescription system in developed countries. Journal of Clinical Research in Paramedical Sciences. 2016;5(2). e81456. Available form: https://brieflands.com/articles/jcrps-81456
25. Borhani Moghani N, Meraji M, Houshmand E, Fazaeli S, Vedjani M, Ebnehosseni Z. Explaining the challenges of implementation electronic prescription from practitioners' attitudes; A qualitative study. Health Information Management. 2023;20(4):182-189. [Inpersian]. [DOI:10.48305/him.2024.42028.1136]
26. Vejdani M, Varmaghani M, Meraji M, Jamali J, Hooshmand E, Vafaee-Najar A. Electronic prescription system requirements: a scoping review. BMC Medical Informatics and Decision Making. 2022;22(1):231. [In Persian]. [DOI:10.1186/s12911-022-01948-w]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
Site Keywords
Health, Administration, Scientific Article, Iran University of Medical Sciences,
