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jha 2026, 28(4): 57-69 |
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Mirzaei H, Moradi N, Zahiri M. Identifying barriers to electronic prescription in Bandar Abbas pharmacies 2025. jha 2026; 28 (4) :57-69
URL: http://jha.iums.ac.ir/article-1-4725-en.html
URL: http://jha.iums.ac.ir/article-1-4725-en.html
1- Department of Health Services Management, Islamic Azad University, Marvdasht Branch, Marvdasht, Iran
2- Department of Health Services Management, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran. ,nasrin.moradi.2009@gmail.com
3- School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
2- Department of Health Services Management, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran. ,
3- School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Table 1. Themes and categories identified for challenges in electronic prescribing implementation
Another challenge identified during the interviews was related to technological, which can be considered one of the most fundamental challenges. The implementation of electronic prescribing requires robust technological infrastructure, including high-speed internet, effective systems, and the capacity to operate multiple applications simultaneously. A major technological challenge is the proliferation of insurance applications without adherence to internationally recognized standards. Each insurance organization has developed its own software, forcing healthcare providers to use multiple applications throughout the day. This software fragmentation results in wasted staff time. Consistent with the findings, Najafi Sarband et al. [19] confirmed that integrating these systems could improve efficiency and reduce the time required to deliver healthcare services. Milani et al., [26] in a study evaluating pharmacists' prescription practices in Brazil, identified infrastructure and technological gaps as the most significant challenges. Similarly, Borhani et al. [18] reported that technological and infrastructure challenges were among the main barriers. Alharati et al. [27] also highlighted technical problems as a key challenge in the implementation of electronic prescribing. In some peripheral urban areas and regions with underdeveloped infrastructure, private pharmacies face greater difficulties in establishing communication with telecommunications companies, as they are not part of the governmental system. In contrast, public sector pharmacies, due to national requirements for establishing pharmacies in healthcare centers and hospitals, benefit from intersectoral coordination, which ensures that telecommunications companies provide the minimum required infrastructure.
Security was another identified challenge. Although mentioned less frequently, security remains critical because electronic prescribing, aligned with the family physician program, allows simultaneous access to patient information; robust security policies are essential. To address this issue, utilizing high-speed internet and domestic antivirus solutions could help reduce the risk of unauthorized access to patient data. This finding aligns with the results of Moghadam Montazeri et al. [28] and Jogi et al. [29] who highlighted system security as a key challenge in electronic prescribing.
Financial constraints were another challenge identified in this study. Participants reported budgetary limitations for purchasing new and updated systems as a significant barrier. In line with this, Jebraeily et al. [30] found that financial challenges are among the most significant obstacles to the implementation of e-prescribing in Iran. It is recommended that the government provide low-interest loans to support the upgrading of private pharmacy equipment. Additionally, insurance organizations could offer higher technical fees for electronic prescriptions than for paper prescriptions (e.g., 5–10% higher) to financially support pharmacies in upgrading their systems and facilitating the successful implementation of the program.
It is essential to recognize the interconnection of these challenges. For example, financial constraints directly affect technological challenges, such as the inability to purchase new hardware. In contrast, legal challenges, including the lack of standardized guidelines, can lead to security issues in data exchange among insurance organizations. Ultimately, all of these challenges impact the quality and delivery of services to the end stakeholders.
Limitations
One of the main limitations of this study is its qualitative nature, which limits the generalizability of the results. As this study was conducted in a specific context in Iran, generalizing the findings to other regions requires consideration of local data and contextual conditions. In addition, this study focused solely on the perspective of private pharmacy staff, and other stakeholders (such as physicians, patients, and health system managers) were not included, which also affects the generalization of the results.
Conclusion
The implementation of the electronic prescribing system, although it is satisfactory to pharmacy staff and beneficial in improving medication delivery processes, faces several challenges. The most significant of these challenges include a lack of technological development, budget constraints, insufficient regulations, and security concerns.
To improve system performance, it is recommended to allocate sufficient and timely budgets, recruit specialized personnel (including prescription-review staff), establish the necessary infrastructure to upgrade existing systems in pharmacies, separate internal pharmacy internet networks to increase security and speed, and update related laws and guidelines to address the challenges of electronic prescribing systematically. Implementing these measures can sustainably strengthen the electronic prescribing system and increase its productivity.
Declarations
Ethical considerations: This article is based on a Master's thesis from Islamic Azad University, Marvdasht Branch, and was approved with the ethical approval code IR.IAU.M.REC.1403.509. In addition, informed consent forms were completed by the interviewees, and their identities have been kept confidential.
Funding: This study was conducted as part of a Master's thesis at Islamic Azad University, Marvdasht Branch, and was supported by the university. The funding body had no role in the data collection, analysis of data, or preparation of this manuscript.
Conflict of interest: None.
Authors’ contribution: MZ: Supervision; HM: Conceptualisation, study design, methodology, data collection, data analysis, software, data management, writing-original draft, final approval; NM: Supervision, study design, methodology, data management, writing-original draft, final approval.
Consent for Publication: Not applicable.
Data availability: The data and codes used in this study are available from the corresponding author upon request.
AI declaration: No artificial intelligence was used in the preparation of this article.
Acknowledgements: This article is derived from a Master’s thesis at Islamic Azad University, Marvdasht Branch, entitled “Investigation of Barriers to Electronic Prescribing in Pharmacies of Bandar Abbas" with the ethical approval code IR.IAU.M.REC.1403.509.
Full-Text: (8 Views)
Introduction
E-prescription is one of the key applications of health information technology [1]. It refers to the use of information and communication technologies to share patient information through a network designed for shared use among healthcare service providers [2]. The use of e-prescribing as an important strategic policy for improving healthcare delivery was first proposed in Europe [3]. The world's first electronic prescription for medication was implemented in Sweden in 1983. Subsequently, several European countries, including Denmark, Sweden, Norway, Finland, and Iceland, became pioneers in this field [4].
In Iran, the Social Security Organization initiated e-prescribing and the simultaneous elimination of paper prescription booklets for the first time in 2015 through a pilot program in Yazd Province [5]. Following this, nationwide implementation of the electronic prescribing project officially began in February 2019 and expanded to 235 cities across Iran by November 2019. Since 2020, this program has been prioritized by both the Ministry of Health and the Iran Health Insurance Organization [6].
In practice, e-prescribing systems are computer-based platforms that enable the direct electronic entry of medication orders. Their use can reduce medication errors by more than 50%. This process allows physicians, physician assistants, pharmacists, and nurses to use digital prescription software to electronically transmit new prescriptions or refill authorizations to local or mail-order pharmacies [7]. The processing of e-prescriptions is gradually becoming an integral part of pharmacy workflow [8]. To enhance patient safety, prescriptions are electronically transmitted to pharmacies through secure information exchange [9]. The electronic transmission and receipt of prescriptions have also streamlined clinical workflows [10]. E-prescribing also improves prescription retrieval speed using tracking codes, displays recorded medication orders, facilitates pharmacist-prescriber interaction, ensures accurate prescription review by pharmacists, detects potential drug interactions, provides access to patients’ medication histories, generates medication labels, shows pharmacy stock levels, determines insurance coverage limits, allows documentation of returned medications, and supports the exchange of information with insurance systems [11]. Additional benefits include enhanced data accessibility and cost savings [12], secure and efficient information exchange between prescribers and distributors [13], lower initial hardware and software costs [14], optimized expenditures, decreased prescribing errors [15], enhanced patient safety and quality of care [16], and reduced patient care costs [17].
Despite its advantages, the adoption of e-prescribing faces several challenges. For example, Borhani et al. [18] classified the challenges into organizational challenges and systemic challenges. Other studies by Najafi Sarband et al. [19] examined the advantages and challenges of electronic prescribing from the perspectives of physicians, pharmacy technical managers, patients, and insurance experts in teaching hospitals in Ardabil. They indicated that the implementation of e-prescribing systems has both strengths and weaknesses. Key challenges included insufficient internet speed, incomplete infrastructure, and the deployment of proprietary platforms by each insurance organization without compliance with data exchange standards. Conversely, identified benefits included reduced in medication and prescription errors, improved patient care management, better management of current and past medication records with access to comprehensive medication histories, secure electronic transmission of prescription information among stakeholders, elimination of paper-based prescription, and enhanced oversight of activities by the Ministry of Health and other regulatory authorities. Additionally, Alavi et al. [20] quantitatively assessed the perspectives of pharmacists in Gilan Mohaghegh et al. [11] examined factors affecting e-prescribing from the viewpoints of selected pharmacists and pharmacy technicians.
In Iran, few studies have yet examined the challenges of implementing electronic prescribing from the perspective of personnel working in private pharmacies, including pharmacy technical managers, pharmacy directors, and pharmacy technicians. Given that private pharmacies are required to implement and comply with the guidelines of the Ministry of Health, investigating their unique experiences regarding e-prescribing implementation is important. Accordingly, this study aimed to identify the barriers to electronic prescribing implementation in private pharmacies in Bandar Abbas.
Methods
This study was conducted using a qualitative content analysis in community private pharmacies in Bandar Abbas, Hormozgan Province, Iran. The study population consisted of 328 individuals, including pharmacists, pharmacy technicians, pharmacy managers, and other pharmacy staff working in private pharmacies. Participants were selected using purposive sampling until data saturation was reached. Twenty-five participants were included in the study according to inclusion and exclusion criteria.
Inclusion criteria were as follows: ppharmacists and pharmacy technicians with more than three years of work experience in a pharmacy, having experience working with an e-prescribing system, personnel currently employed in private pharmacies, a minimum educational level of a bachelor’s degree, and completion of relevant training courses (for pharmacy technicians). Exclusion criteria were also as follows: lack of willingness to participate, interviewing with at least two participants from the same pharmacy, and insufficient literacy or proficiency in information technology.
Data were collected through semi-structured interviews. The researchers introduced themselves to the participants through phone calls. During the call, the research objectives and interview conditions, including interview duration, purpose, and confidentiality of information were fully explained. Participants who agreed to participate completed a written informed consent form. Interview times were then scheduled by phone. Participants were informed of their right to terminate the interview at any time. Initially, participants answered demographic questions, including their age, gender, work experience, and educational level. The interviews then commenced with several general questions ("Please describe any challenges of e-prescribing system"). Follow-up questions were asked based on the participants' responses. Each interview lasted between 60 and 80 minutes. Prior to starting, participants' permission was obtained to audio-record the conversations, and each interview was assigned a unique code.
Data were analyzed using qualitative content analysis. Data collection and analysis were conducted simultaneously, following the approach proposed by Graneheim and Lundman [21]. The steps included: transcribing interviews and reviewing them repeatedly to gain a comprehensive understanding, identifying meaning units and condensing them, summarizing, categorizing and coding the condensed units a, organizing subcategories and selecting appropriate category titles to represent grouped data. Immediately after each interview, recordings were transcribed verbatim on the same day after repeated listening and then converted into written text. Meaning units were identified as sentences or paragraphs derived from interviews. Coding was performed independently by two authors (HM & NM) using MAXQDA 2020 software. The coding process used the participants' exact words or similar expressions representing the phenomenon. Subsequently, the initial categorization of codes was conducted. Conceptually similar codes were grouped into categories. Categories and their corresponding codes were regularly compared and reviewed against the data. After independent coding by the researchers, disagreements were discussed with the third author until consensus was reached among the team members. Then, similar and related subcategories were merged and main categories were developed by combining similar subcategories.
To ensure rigor, the study employed the four criteria proposed by Lincoln and Guba, including credibility, dependability, transferability, and confirmability [22]. A specialized team, comprising a faculty member in health services management and a physician, was involved in reviewing the findings. In addition to semi-structured interviews, field notes were taken to enhance data credibility. The preliminary findings, along with initial codes and categorizations, were shared with a subsample of participants for member checking. To ensure dependability, an external expert in e-prescribing and qualitative methods (not part of the research team) was consulted. For confirmability, all research activities were documented, and a detailed audit trail of the study process was prepared.
Results
Sixty percent of participants were female, and 40% were male. The majority of participants, approximately 68% were aged 26–35 years. Regarding educational level, 24% held a Doctor of Pharmacy degree, 16% had a master's degree and 60% had a bachelor's degree. Seventy-two percent of participants had less than five years of work experience, while 28% had more than five years of experience.
The data analysis identified five main challenges including legal challenges (with two main themes: intra-sectoral regulations and inter-sectoral regulations), security challenges (two main themes: patient data security and insurance system security), technological challenges (two main themes: existing equipment and need for new equipment), financial challenges, and stakeholder-related challenges (three main themes: patient, pharmacy, and insurance companies). These challenges were further divided into 34 subcategories. Among the identified challenges, stakeholder-related and legal challenges, each accounting for 29.4% of subcategories, were identified as the most prominent (Table 1).
Discussion
Stakeholder-related and legal challenges were identified as the most significant challenges. In the context of electronic prescribing, multiple challenges related to stakeholder involvement exist, involving patients, physicians, pharmacists, and pharmacies. These challenges include low patient awareness of online prescriptions and the exclusion of certain medications from insurance companies' coverage lists. Furthermore, to enhance public awareness of the electronic prescribing process, national awareness campaigns could be launched in collaboration with the Ministry of Health, insurance organizations, and national media. Consistent with our findings, Borhani et al. [18] also highlighted challenges related to training and informing stakeholders.
Participants indicated that although electronic prescribing was designed to control medication prescriptions, its incomplete implementation may indirectly contribute to increased sales of non-prescribed medications. The elimination of paper prescriptions reduces onsite supervision, while time pressures and system-related issues may lead to rapid drug dispensing or verbal recommendations by physicians. Additionally, pharmacies may exploit the system's free-entry feature to sell medications without a prescription. Patients seeking to avoid lengthy processes and system downtimes may increasingly turn to pharmacies, thereby increasing the consumption of over-the-counter (OTC) medications. Collectively, these factors may result in higher volumes of non-prescribed medication sales.
Legal challenges were identified as a significant barrier to the implementation of electronic prescribing. The most significant issues included unclear operational guidelines, the absence of support manuals for problem-solving, inconsistent guidelines across insurance organizations, and non-uniform drug coding among insurers.
The findings, consistent with those of Boraghi et al. [23], Harim et al. [24], and Haghshenas et al. [25], highlight the absence of unified regulations and comprehensive executive guidelines as significant challenges. Given the presence of multiple insurers in Iran, it seems necessary to consider upstream documents and regulations, such as the Seventh Development Plan, to develop a national strategic guideline for e-prescribing involving all stakeholders (the Ministry of Health, insurance organizations, the Medical Council, and the Pharmacists' related Association). This approach could facilitate the development of unified and mandatory regulations. To achieve this, meetings should be held with various insurance organizations to identify their specific needs. Based on these shared requirements, standardized regulations should be developed, and all insurers should be obliged to comply with them.
E-prescription is one of the key applications of health information technology [1]. It refers to the use of information and communication technologies to share patient information through a network designed for shared use among healthcare service providers [2]. The use of e-prescribing as an important strategic policy for improving healthcare delivery was first proposed in Europe [3]. The world's first electronic prescription for medication was implemented in Sweden in 1983. Subsequently, several European countries, including Denmark, Sweden, Norway, Finland, and Iceland, became pioneers in this field [4].
In Iran, the Social Security Organization initiated e-prescribing and the simultaneous elimination of paper prescription booklets for the first time in 2015 through a pilot program in Yazd Province [5]. Following this, nationwide implementation of the electronic prescribing project officially began in February 2019 and expanded to 235 cities across Iran by November 2019. Since 2020, this program has been prioritized by both the Ministry of Health and the Iran Health Insurance Organization [6].
In practice, e-prescribing systems are computer-based platforms that enable the direct electronic entry of medication orders. Their use can reduce medication errors by more than 50%. This process allows physicians, physician assistants, pharmacists, and nurses to use digital prescription software to electronically transmit new prescriptions or refill authorizations to local or mail-order pharmacies [7]. The processing of e-prescriptions is gradually becoming an integral part of pharmacy workflow [8]. To enhance patient safety, prescriptions are electronically transmitted to pharmacies through secure information exchange [9]. The electronic transmission and receipt of prescriptions have also streamlined clinical workflows [10]. E-prescribing also improves prescription retrieval speed using tracking codes, displays recorded medication orders, facilitates pharmacist-prescriber interaction, ensures accurate prescription review by pharmacists, detects potential drug interactions, provides access to patients’ medication histories, generates medication labels, shows pharmacy stock levels, determines insurance coverage limits, allows documentation of returned medications, and supports the exchange of information with insurance systems [11]. Additional benefits include enhanced data accessibility and cost savings [12], secure and efficient information exchange between prescribers and distributors [13], lower initial hardware and software costs [14], optimized expenditures, decreased prescribing errors [15], enhanced patient safety and quality of care [16], and reduced patient care costs [17].
Despite its advantages, the adoption of e-prescribing faces several challenges. For example, Borhani et al. [18] classified the challenges into organizational challenges and systemic challenges. Other studies by Najafi Sarband et al. [19] examined the advantages and challenges of electronic prescribing from the perspectives of physicians, pharmacy technical managers, patients, and insurance experts in teaching hospitals in Ardabil. They indicated that the implementation of e-prescribing systems has both strengths and weaknesses. Key challenges included insufficient internet speed, incomplete infrastructure, and the deployment of proprietary platforms by each insurance organization without compliance with data exchange standards. Conversely, identified benefits included reduced in medication and prescription errors, improved patient care management, better management of current and past medication records with access to comprehensive medication histories, secure electronic transmission of prescription information among stakeholders, elimination of paper-based prescription, and enhanced oversight of activities by the Ministry of Health and other regulatory authorities. Additionally, Alavi et al. [20] quantitatively assessed the perspectives of pharmacists in Gilan Mohaghegh et al. [11] examined factors affecting e-prescribing from the viewpoints of selected pharmacists and pharmacy technicians.
In Iran, few studies have yet examined the challenges of implementing electronic prescribing from the perspective of personnel working in private pharmacies, including pharmacy technical managers, pharmacy directors, and pharmacy technicians. Given that private pharmacies are required to implement and comply with the guidelines of the Ministry of Health, investigating their unique experiences regarding e-prescribing implementation is important. Accordingly, this study aimed to identify the barriers to electronic prescribing implementation in private pharmacies in Bandar Abbas.
Methods
This study was conducted using a qualitative content analysis in community private pharmacies in Bandar Abbas, Hormozgan Province, Iran. The study population consisted of 328 individuals, including pharmacists, pharmacy technicians, pharmacy managers, and other pharmacy staff working in private pharmacies. Participants were selected using purposive sampling until data saturation was reached. Twenty-five participants were included in the study according to inclusion and exclusion criteria.
Inclusion criteria were as follows: ppharmacists and pharmacy technicians with more than three years of work experience in a pharmacy, having experience working with an e-prescribing system, personnel currently employed in private pharmacies, a minimum educational level of a bachelor’s degree, and completion of relevant training courses (for pharmacy technicians). Exclusion criteria were also as follows: lack of willingness to participate, interviewing with at least two participants from the same pharmacy, and insufficient literacy or proficiency in information technology.
Data were collected through semi-structured interviews. The researchers introduced themselves to the participants through phone calls. During the call, the research objectives and interview conditions, including interview duration, purpose, and confidentiality of information were fully explained. Participants who agreed to participate completed a written informed consent form. Interview times were then scheduled by phone. Participants were informed of their right to terminate the interview at any time. Initially, participants answered demographic questions, including their age, gender, work experience, and educational level. The interviews then commenced with several general questions ("Please describe any challenges of e-prescribing system"). Follow-up questions were asked based on the participants' responses. Each interview lasted between 60 and 80 minutes. Prior to starting, participants' permission was obtained to audio-record the conversations, and each interview was assigned a unique code.
Data were analyzed using qualitative content analysis. Data collection and analysis were conducted simultaneously, following the approach proposed by Graneheim and Lundman [21]. The steps included: transcribing interviews and reviewing them repeatedly to gain a comprehensive understanding, identifying meaning units and condensing them, summarizing, categorizing and coding the condensed units a, organizing subcategories and selecting appropriate category titles to represent grouped data. Immediately after each interview, recordings were transcribed verbatim on the same day after repeated listening and then converted into written text. Meaning units were identified as sentences or paragraphs derived from interviews. Coding was performed independently by two authors (HM & NM) using MAXQDA 2020 software. The coding process used the participants' exact words or similar expressions representing the phenomenon. Subsequently, the initial categorization of codes was conducted. Conceptually similar codes were grouped into categories. Categories and their corresponding codes were regularly compared and reviewed against the data. After independent coding by the researchers, disagreements were discussed with the third author until consensus was reached among the team members. Then, similar and related subcategories were merged and main categories were developed by combining similar subcategories.
To ensure rigor, the study employed the four criteria proposed by Lincoln and Guba, including credibility, dependability, transferability, and confirmability [22]. A specialized team, comprising a faculty member in health services management and a physician, was involved in reviewing the findings. In addition to semi-structured interviews, field notes were taken to enhance data credibility. The preliminary findings, along with initial codes and categorizations, were shared with a subsample of participants for member checking. To ensure dependability, an external expert in e-prescribing and qualitative methods (not part of the research team) was consulted. For confirmability, all research activities were documented, and a detailed audit trail of the study process was prepared.
Results
Sixty percent of participants were female, and 40% were male. The majority of participants, approximately 68% were aged 26–35 years. Regarding educational level, 24% held a Doctor of Pharmacy degree, 16% had a master's degree and 60% had a bachelor's degree. Seventy-two percent of participants had less than five years of work experience, while 28% had more than five years of experience.
The data analysis identified five main challenges including legal challenges (with two main themes: intra-sectoral regulations and inter-sectoral regulations), security challenges (two main themes: patient data security and insurance system security), technological challenges (two main themes: existing equipment and need for new equipment), financial challenges, and stakeholder-related challenges (three main themes: patient, pharmacy, and insurance companies). These challenges were further divided into 34 subcategories. Among the identified challenges, stakeholder-related and legal challenges, each accounting for 29.4% of subcategories, were identified as the most prominent (Table 1).
Discussion
Stakeholder-related and legal challenges were identified as the most significant challenges. In the context of electronic prescribing, multiple challenges related to stakeholder involvement exist, involving patients, physicians, pharmacists, and pharmacies. These challenges include low patient awareness of online prescriptions and the exclusion of certain medications from insurance companies' coverage lists. Furthermore, to enhance public awareness of the electronic prescribing process, national awareness campaigns could be launched in collaboration with the Ministry of Health, insurance organizations, and national media. Consistent with our findings, Borhani et al. [18] also highlighted challenges related to training and informing stakeholders.
Participants indicated that although electronic prescribing was designed to control medication prescriptions, its incomplete implementation may indirectly contribute to increased sales of non-prescribed medications. The elimination of paper prescriptions reduces onsite supervision, while time pressures and system-related issues may lead to rapid drug dispensing or verbal recommendations by physicians. Additionally, pharmacies may exploit the system's free-entry feature to sell medications without a prescription. Patients seeking to avoid lengthy processes and system downtimes may increasingly turn to pharmacies, thereby increasing the consumption of over-the-counter (OTC) medications. Collectively, these factors may result in higher volumes of non-prescribed medication sales.
Legal challenges were identified as a significant barrier to the implementation of electronic prescribing. The most significant issues included unclear operational guidelines, the absence of support manuals for problem-solving, inconsistent guidelines across insurance organizations, and non-uniform drug coding among insurers.
The findings, consistent with those of Boraghi et al. [23], Harim et al. [24], and Haghshenas et al. [25], highlight the absence of unified regulations and comprehensive executive guidelines as significant challenges. Given the presence of multiple insurers in Iran, it seems necessary to consider upstream documents and regulations, such as the Seventh Development Plan, to develop a national strategic guideline for e-prescribing involving all stakeholders (the Ministry of Health, insurance organizations, the Medical Council, and the Pharmacists' related Association). This approach could facilitate the development of unified and mandatory regulations. To achieve this, meetings should be held with various insurance organizations to identify their specific needs. Based on these shared requirements, standardized regulations should be developed, and all insurers should be obliged to comply with them.
Table 1. Themes and categories identified for challenges in electronic prescribing implementation
| Challenge | Main theme | Subcategories | Frequency (percentage) of subcategories |
| Legal | Intra-sectoral regulations | Lack of specialized knowledge among some staff for reviewing prescriptions and understanding insurance regulations; Differences in staff education levels; Ineffectiveness of training provided to some staff regarding insurance guidelines and e-prescribing; Lack of clarity in guidelines and operational manuals; Absence of support manuals for problem-solving | 10 (29.4) |
| Inter-sectoral regulations | Multiple and different guidelines across various insurance organizations, Non-uniform drug coding among different insurance companies; Poor inter-sectoral cooperation; Differences in drug coverage across insurers; Undefined codes for certain medications | ||
| Security | Patient data security | Access to complete patient medication and treatment history in the pharmacy; Low public trust in online systems | 4 (11.7) |
| Insurance system security | Visibility of all insurance performance records for patients; Resistance to adopting system guideline changes in some insurance organizations | ||
| Technology | Existing equipment | Lack of resources and facilities; Shortage of up-to-date computer systems and use of outdated systems; System and internet downtime and slow speed; Delayed connection to insurance systems; Multiple and fragmented insurance applications | 7 (20.5) |
| Need for new equipment | Insufficient budget for purchasing necessary equipment; Lack of budget for establishing high-speed and reliable internet | ||
| Financial | Financial needs | Insufficient budget for new system procurement; Financial burden of purchasing mobile devices for pharmacists to access prescriptions; Inadequate salaries relative to workload | 3 (8.8) |
| Stakeholders | Patient-related | Mismatch between patient profiles and insurance profiles; Limited patient awareness of online prescriptions | 10 (29.4) |
| Pharmacy-related | Non-uniform authentication and eligibility verification systems across different insurance providers; Selling medications outside prescriptions with the ability to register free sales; Multiple brand names of medications from different manufacturers | ||
| Insurance company-related | Non-uniform profiles among insurance companies; Some medications not covered by insurance companies; Delays or failures in sending confirmation messages to patients and pharmacists; Late payments from some insurance companies; Delayed responses from insurance companies |
Another challenge identified during the interviews was related to technological, which can be considered one of the most fundamental challenges. The implementation of electronic prescribing requires robust technological infrastructure, including high-speed internet, effective systems, and the capacity to operate multiple applications simultaneously. A major technological challenge is the proliferation of insurance applications without adherence to internationally recognized standards. Each insurance organization has developed its own software, forcing healthcare providers to use multiple applications throughout the day. This software fragmentation results in wasted staff time. Consistent with the findings, Najafi Sarband et al. [19] confirmed that integrating these systems could improve efficiency and reduce the time required to deliver healthcare services. Milani et al., [26] in a study evaluating pharmacists' prescription practices in Brazil, identified infrastructure and technological gaps as the most significant challenges. Similarly, Borhani et al. [18] reported that technological and infrastructure challenges were among the main barriers. Alharati et al. [27] also highlighted technical problems as a key challenge in the implementation of electronic prescribing. In some peripheral urban areas and regions with underdeveloped infrastructure, private pharmacies face greater difficulties in establishing communication with telecommunications companies, as they are not part of the governmental system. In contrast, public sector pharmacies, due to national requirements for establishing pharmacies in healthcare centers and hospitals, benefit from intersectoral coordination, which ensures that telecommunications companies provide the minimum required infrastructure.
Security was another identified challenge. Although mentioned less frequently, security remains critical because electronic prescribing, aligned with the family physician program, allows simultaneous access to patient information; robust security policies are essential. To address this issue, utilizing high-speed internet and domestic antivirus solutions could help reduce the risk of unauthorized access to patient data. This finding aligns with the results of Moghadam Montazeri et al. [28] and Jogi et al. [29] who highlighted system security as a key challenge in electronic prescribing.
Financial constraints were another challenge identified in this study. Participants reported budgetary limitations for purchasing new and updated systems as a significant barrier. In line with this, Jebraeily et al. [30] found that financial challenges are among the most significant obstacles to the implementation of e-prescribing in Iran. It is recommended that the government provide low-interest loans to support the upgrading of private pharmacy equipment. Additionally, insurance organizations could offer higher technical fees for electronic prescriptions than for paper prescriptions (e.g., 5–10% higher) to financially support pharmacies in upgrading their systems and facilitating the successful implementation of the program.
It is essential to recognize the interconnection of these challenges. For example, financial constraints directly affect technological challenges, such as the inability to purchase new hardware. In contrast, legal challenges, including the lack of standardized guidelines, can lead to security issues in data exchange among insurance organizations. Ultimately, all of these challenges impact the quality and delivery of services to the end stakeholders.
Limitations
One of the main limitations of this study is its qualitative nature, which limits the generalizability of the results. As this study was conducted in a specific context in Iran, generalizing the findings to other regions requires consideration of local data and contextual conditions. In addition, this study focused solely on the perspective of private pharmacy staff, and other stakeholders (such as physicians, patients, and health system managers) were not included, which also affects the generalization of the results.
Conclusion
The implementation of the electronic prescribing system, although it is satisfactory to pharmacy staff and beneficial in improving medication delivery processes, faces several challenges. The most significant of these challenges include a lack of technological development, budget constraints, insufficient regulations, and security concerns.
To improve system performance, it is recommended to allocate sufficient and timely budgets, recruit specialized personnel (including prescription-review staff), establish the necessary infrastructure to upgrade existing systems in pharmacies, separate internal pharmacy internet networks to increase security and speed, and update related laws and guidelines to address the challenges of electronic prescribing systematically. Implementing these measures can sustainably strengthen the electronic prescribing system and increase its productivity.
Declarations
Ethical considerations: This article is based on a Master's thesis from Islamic Azad University, Marvdasht Branch, and was approved with the ethical approval code IR.IAU.M.REC.1403.509. In addition, informed consent forms were completed by the interviewees, and their identities have been kept confidential.
Funding: This study was conducted as part of a Master's thesis at Islamic Azad University, Marvdasht Branch, and was supported by the university. The funding body had no role in the data collection, analysis of data, or preparation of this manuscript.
Conflict of interest: None.
Authors’ contribution: MZ: Supervision; HM: Conceptualisation, study design, methodology, data collection, data analysis, software, data management, writing-original draft, final approval; NM: Supervision, study design, methodology, data management, writing-original draft, final approval.
Consent for Publication: Not applicable.
Data availability: The data and codes used in this study are available from the corresponding author upon request.
AI declaration: No artificial intelligence was used in the preparation of this article.
Acknowledgements: This article is derived from a Master’s thesis at Islamic Azad University, Marvdasht Branch, entitled “Investigation of Barriers to Electronic Prescribing in Pharmacies of Bandar Abbas" with the ethical approval code IR.IAU.M.REC.1403.509.
Type of Study: Research |
Subject:
Health Information Management
Received: 2025/09/27 | Accepted: 2026/02/17 | Published: 2026/03/6
Received: 2025/09/27 | Accepted: 2026/02/17 | Published: 2026/03/6
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