Challenges of Implementing Electronic Prescribing in a Low-Income Country: A Qualitative Study
-
Hakimeh Mostafavi
,
Amirhossein Takian
,
Sahar Mostafavi
,
Ahad Bakhtiari
,
Efat Mohamadi
,
Fateme Yaftian
,
Alireza Olyaeemanesh
Abstract
Background: Electronic prescribing (E-prescribing) is a novel digital tool that can provide a complete patient profile and further helps to avoid prescription errors. In this study, we aimed to evaluate the present state of E-prescribing in Iran, identify its process, and diagnose its software flaws.
Methods: Semi-structured interviews with several user groups, health system executives, and patients were conducted for this qualitative study (concluded in 2022) and MAXQDA 11 software was used for coding and data management.
Results: According to our interviews, E-prescribing process’s challenges include: a lack of appropriate culture, support for service providers, and physician cooperation; poor management; frequent system interruptions; extra workload imposed on pharmacies; and a failure to adapt systems for underprivileged areas. Moreover, the software themselves have a number of flaws, notably, inconsistent and missing medical codes, their inability to keep up with an increase in the workload, difficulty in connecting some older systems with the latest ones, and a lack of user-friendly interface.
Conclusion: Despite E-prescribing system’s continual improvements, its further effective implementation in our country requires an ongoing interaction with all manners of stakeholders, enlisting their opinions, and resolving its problems as quickly as feasible.
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2. Stroetmann KA, Artmann J, Stroetmann VN, Protti D, Dumortier J, Giest S, et al. European countries on their journey towards national eHealth infrastructures. Luxembourg: Office for official publications of the european communities. 2011.
3. Whitehouse D, Giest S, Dumortier J, Artmann JH, Heywood J. Country Brief: England. European Commission England: DG Information Society and Media, ICT for Health Unit. 2010.
4. Peikari HR, Rezazadeh M. Investigating the Relationship between Electronic Prescription System and Reduction of Pharmacists’ Errors Using UTAUT Model. Health Research Journal. 2021;6(2):139-46. https://doi.org/10.52547/hrjbaq.6.2.139.
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6. Kajbjer K, Nordberg R, Klein GO. Electronic Health Records in Sweden: From Administrative Management to Clinical Decision Support. History of Nordic Computing 3; 2011. p. 74-82.
7. Shawahna R, Rahman NU, Ahmad M, Debray M, Yliperttula M, Decleves X. Electronic prescribing reduces prescribing error in public hospitals. J Clin Nurs. 2011;20(21-22):3233-45. [PubMed ID:21627699]. https://doi.org/10.1111/j.1365-2702.2011.03714.x.
8. Adlan OMA, Alzubaidi AJ. Electronic prescribing Design (E-prescribing). IOSR Journal of Engineering (IOSRJEN). 2015;5(02):24-7.
9. Sands DZ. E-Prescribing: What Is It? Why Should I Do It? What’s in the Future? American College of Physicians. 2008;5(1):15-7.
10. Roumeliotis N, Sniderman J, Adams-Webber T, Addo N, Anand V, Rochon P, et al. Effect of Electronic Prescribing Strategies on Medication Error and Harm in Hospital: a Systematic Review and Meta-analysis. J Gen Intern Med. 2019;34(10):2210-23. [PubMed ID:31396810]. [PubMed Central ID:PMC6816608]. https://doi. org/10.1007/s11606-019-05236-8.
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12. Ahmadi M, Samadbeik M, Sadoughi F. Modeling of outpatient prescribing process in iran: a gateway toward electronic prescribing system. Iranian journal of pharmaceutical research: IJPR. 2014;13(2):725.
13. Esdar M, Husers J, Weiss JP, Rauch J, Hubner U. Diffusion dynamics of electronic health records: A longitudinal observational study comparing data from hospitals in Germany and the United States. Int J Med Inform. 2019;131:103952. [PubMed ID:31557699]. https://doi.org/10.1016/j.ijmedinf.2019.103952.
14. Ham C. The management of the NHS in England. 2012;344. 15. Hyppönen H, Hämäläinen P, Reponen J. E-health and e-welfare of Finland-Check point 2015. 2015. Available from: https://www. julkari.fi/bitstream/handle/10024/129709/URN_ISBN_978-952- 302-563-9.pdf.
16. Kierkegaard P. eHealth in Denmark: a case study. J Med Syst. 2013;37(6):9991. [PubMed ID:24166019]. https://doi.org/10.1007/ s10916-013-9991-y.
17. Glenngård AH. The Swedish health care system. International Profiles of Health Care Systems The Commonwealth Fund. 2020:181-9.
18. Holmgren AJ, Botelho A, Brandt AM. A History of Prescription Drug Monitoring Programs in the United States: Political Appeal and Public Health Efficacy. Am J Public Health. 2020;110(8):1191-7. [PubMed ID:32552023]. [PubMed Central ID:PMC7349461]. https://doi.org/10.2105/AJPH.2020.305696.
19. Wood A, Denholm R, Hollings S, Cooper J, Ip S, Walker V, et al. Linked electronic health records for research on a nationwide cohort of more than 54 million people in England: data resource. BMJ. 2021;373:n826. [PubMed ID:33827854]. [PubMed Central ID:PMC8413899]. https://doi.org/10.1136/bmj.n826.
20. Manesh A. Identifying and explaining the current status of electronic prescription in basic health insurance organizations and the Ministry of Health and Medical Education and identifying obstacles and solutions, and requirements for implementation. Ministry Health Med Edu. 2021
21. Samadbeik M, Ahmadi M. Electronic prescription system: concepts and standards. Health Inf Manage. 2013;6(2):312-24.
22. Sayyadi-Tooranloo H, Mirghafouri H, Namjo M, Saghafi S. Assessing the efficient factors on implementing electronic extinctionin pharmacies of Yazd, Iran. Health Information Management. 2019;16(4):154-60.
23. Barber N, Cornford T, Klecun E. Qualitative evaluation of an electronic prescribing and administration system. Qual Saf Health Care. 2007;16(4):271-8. [PubMed ID:17693675]. [PubMed Central ID:PMC2464937]. https://doi.org/10.1136/qshc.2006.019505.
24. Tenny S, Brannan G, Brannan J, Sharts-Hopko N. Qualitative study. 2017. View Article. 2004.
25. Creswell JW, Clark VLP. Principles of qualitative research: Designing a qualitative study. Office of Qualitative & Mixed Methods Research, University of Nebraska, Lincoln. 2004.
26. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105-12. [PubMed ID:14769454]. https://doi.org/10.1016/j.nedt.2003.10.001.
27. Lincoln YS, Guba EG. Judging the quality of case study reports. International Journal of Qualitative Studies in Education. 1990;3(1):53-9. https://doi.org/10.1080/0951839900030105.
28. Sweidan M, Williamson M, Reeve JF, Harvey K, O’Neill JA, Schattner P, et al. Identification of features of electronic prescribing systems to support quality and safety in primary care using a modified Delphi process. BMC Med Inform Decis Mak. 2010;10:21. [PubMed ID:20398294]. [PubMed Central ID:PMC2881675].
https://doi.org/10.1186/1472-6947-10-21.
29. Schiff G, Mirica MM, Dhavle AA, Galanter WL, Lambert B, Wright A. A Prescription For Enhancing Electronic Prescribing Safety. Health Aff (Millwood). 2018;37(11):1877-83. [PubMed ID:30395495]. https://doi.org/10.1377/hlthaff.2018.0725.
30. Qureshi NA, Alnami MI, Dossari DSA. Analysis of Reported E-prescribing Medication Administration Errors at King Saud Medical City, Riyadh: A Cross-Sectional, Retrospective Study. J Pharmaceutical Res Int. 2020:34-45. https://doi.org/10.9734/ jpri/2020/v32i1030491.
31. Eltajoury W, M. Maatuk A, Denna I, K. Elberkawi E. Physicians’ Attitudes towards Electronic Prescribing Software: Perceived Benefits and Barriers. International Conference on Data Science, E-learning and Information Systems 2021. 2021. p. 47-53.
32. Baysari MT, Raban MZ. The safety of computerised prescribing in hospitals. Aust Prescr. 2019;42(4):136-8. [PubMed ID:31427845]. [PubMed Central ID:PMC6698235]. https://doi.org/10.18773/austprescr.2019.037.
33. Almutairi BA, Potts HWW, Al-Azmi SF. Physicians’ Perceptions of Electronic Prescribing with Electronic Medical Records in Kuwaiti Primary Healthcare Centres. Sultan Qaboos Univ Med J. 2018;18(4):e476-e82. [PubMed ID:30988966]. [PubMed Central ID:PMC6443264]. https://doi.org/10.18295/squmj.2018.18.04.008.
34. Hollingworth W, Devine EB, Hansen RN, Lawless NM, Comstock BA, Wilson-Norton JL, et al. The impact of e-prescribing on prescriber and staff time in ambulatory care clinics: a time motion study. J Am Med Inform Assoc. 2007;14(6):722-30. [PubMed ID:17712088]. [PubMed Central ID:PMC2213487]. https://doi.
org/10.1197/jamia.M2377.
35. Alshahrani F, Marriott JF, Cox AR. A qualitative study of prescribing errors among multi-professional prescribers within an eprescribing system. Int J Clin Pharm. 2021;43(4):884-92. [PubMed ID:33165835]. [PubMed Central ID:PMC8352824]. https://doi.org/10.1007/s11096-020-01192-0.
36. Artawan IP, Martini IAO. Hospital E-prescribing implementation in reducing medication error. International Journal of Business, Economics and Management. 2020;3(1):67-76.
37. Savari E, Ajami S. Electronic prescription and medication errors. Health Information Management. 2015;12(2):263-72.
2. Stroetmann KA, Artmann J, Stroetmann VN, Protti D, Dumortier J, Giest S, et al. European countries on their journey towards national eHealth infrastructures. Luxembourg: Office for official publications of the european communities. 2011.
3. Whitehouse D, Giest S, Dumortier J, Artmann JH, Heywood J. Country Brief: England. European Commission England: DG Information Society and Media, ICT for Health Unit. 2010.
4. Peikari HR, Rezazadeh M. Investigating the Relationship between Electronic Prescription System and Reduction of Pharmacists’ Errors Using UTAUT Model. Health Research Journal. 2021;6(2):139-46. https://doi.org/10.52547/hrjbaq.6.2.139.
5. Odukoya OK, Stone JA, Chui MA. Barriers and facilitators to recovering from e-prescribing errors in community pharmacies. J Am Pharm Assoc (2003). 2015;55(1):52-8. [PubMed ID:25539495]. [PubMed Central ID:PMC4312611]. https://doi.org/10.1331/JAPhA.2015.13239.
6. Kajbjer K, Nordberg R, Klein GO. Electronic Health Records in Sweden: From Administrative Management to Clinical Decision Support. History of Nordic Computing 3; 2011. p. 74-82.
7. Shawahna R, Rahman NU, Ahmad M, Debray M, Yliperttula M, Decleves X. Electronic prescribing reduces prescribing error in public hospitals. J Clin Nurs. 2011;20(21-22):3233-45. [PubMed ID:21627699]. https://doi.org/10.1111/j.1365-2702.2011.03714.x.
8. Adlan OMA, Alzubaidi AJ. Electronic prescribing Design (E-prescribing). IOSR Journal of Engineering (IOSRJEN). 2015;5(02):24-7.
9. Sands DZ. E-Prescribing: What Is It? Why Should I Do It? What’s in the Future? American College of Physicians. 2008;5(1):15-7.
10. Roumeliotis N, Sniderman J, Adams-Webber T, Addo N, Anand V, Rochon P, et al. Effect of Electronic Prescribing Strategies on Medication Error and Harm in Hospital: a Systematic Review and Meta-analysis. J Gen Intern Med. 2019;34(10):2210-23. [PubMed ID:31396810]. [PubMed Central ID:PMC6816608]. https://doi. org/10.1007/s11606-019-05236-8.
11. Odukoya OK, Chui MA. E-prescribing: a focused review and new approach to addressing safety in pharmacies and primary care. Res Social Adm Pharm. 2013;9(6):996-1003. [PubMed ID:23062769]. [PubMed Central ID:PMC3709012]. https://doi.org/10.1016/j. sapharm.2012.09.004.
12. Ahmadi M, Samadbeik M, Sadoughi F. Modeling of outpatient prescribing process in iran: a gateway toward electronic prescribing system. Iranian journal of pharmaceutical research: IJPR. 2014;13(2):725.
13. Esdar M, Husers J, Weiss JP, Rauch J, Hubner U. Diffusion dynamics of electronic health records: A longitudinal observational study comparing data from hospitals in Germany and the United States. Int J Med Inform. 2019;131:103952. [PubMed ID:31557699]. https://doi.org/10.1016/j.ijmedinf.2019.103952.
14. Ham C. The management of the NHS in England. 2012;344. 15. Hyppönen H, Hämäläinen P, Reponen J. E-health and e-welfare of Finland-Check point 2015. 2015. Available from: https://www. julkari.fi/bitstream/handle/10024/129709/URN_ISBN_978-952- 302-563-9.pdf.
16. Kierkegaard P. eHealth in Denmark: a case study. J Med Syst. 2013;37(6):9991. [PubMed ID:24166019]. https://doi.org/10.1007/ s10916-013-9991-y.
17. Glenngård AH. The Swedish health care system. International Profiles of Health Care Systems The Commonwealth Fund. 2020:181-9.
18. Holmgren AJ, Botelho A, Brandt AM. A History of Prescription Drug Monitoring Programs in the United States: Political Appeal and Public Health Efficacy. Am J Public Health. 2020;110(8):1191-7. [PubMed ID:32552023]. [PubMed Central ID:PMC7349461]. https://doi.org/10.2105/AJPH.2020.305696.
19. Wood A, Denholm R, Hollings S, Cooper J, Ip S, Walker V, et al. Linked electronic health records for research on a nationwide cohort of more than 54 million people in England: data resource. BMJ. 2021;373:n826. [PubMed ID:33827854]. [PubMed Central ID:PMC8413899]. https://doi.org/10.1136/bmj.n826.
20. Manesh A. Identifying and explaining the current status of electronic prescription in basic health insurance organizations and the Ministry of Health and Medical Education and identifying obstacles and solutions, and requirements for implementation. Ministry Health Med Edu. 2021
21. Samadbeik M, Ahmadi M. Electronic prescription system: concepts and standards. Health Inf Manage. 2013;6(2):312-24.
22. Sayyadi-Tooranloo H, Mirghafouri H, Namjo M, Saghafi S. Assessing the efficient factors on implementing electronic extinctionin pharmacies of Yazd, Iran. Health Information Management. 2019;16(4):154-60.
23. Barber N, Cornford T, Klecun E. Qualitative evaluation of an electronic prescribing and administration system. Qual Saf Health Care. 2007;16(4):271-8. [PubMed ID:17693675]. [PubMed Central ID:PMC2464937]. https://doi.org/10.1136/qshc.2006.019505.
24. Tenny S, Brannan G, Brannan J, Sharts-Hopko N. Qualitative study. 2017. View Article. 2004.
25. Creswell JW, Clark VLP. Principles of qualitative research: Designing a qualitative study. Office of Qualitative & Mixed Methods Research, University of Nebraska, Lincoln. 2004.
26. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105-12. [PubMed ID:14769454]. https://doi.org/10.1016/j.nedt.2003.10.001.
27. Lincoln YS, Guba EG. Judging the quality of case study reports. International Journal of Qualitative Studies in Education. 1990;3(1):53-9. https://doi.org/10.1080/0951839900030105.
28. Sweidan M, Williamson M, Reeve JF, Harvey K, O’Neill JA, Schattner P, et al. Identification of features of electronic prescribing systems to support quality and safety in primary care using a modified Delphi process. BMC Med Inform Decis Mak. 2010;10:21. [PubMed ID:20398294]. [PubMed Central ID:PMC2881675].
https://doi.org/10.1186/1472-6947-10-21.
29. Schiff G, Mirica MM, Dhavle AA, Galanter WL, Lambert B, Wright A. A Prescription For Enhancing Electronic Prescribing Safety. Health Aff (Millwood). 2018;37(11):1877-83. [PubMed ID:30395495]. https://doi.org/10.1377/hlthaff.2018.0725.
30. Qureshi NA, Alnami MI, Dossari DSA. Analysis of Reported E-prescribing Medication Administration Errors at King Saud Medical City, Riyadh: A Cross-Sectional, Retrospective Study. J Pharmaceutical Res Int. 2020:34-45. https://doi.org/10.9734/ jpri/2020/v32i1030491.
31. Eltajoury W, M. Maatuk A, Denna I, K. Elberkawi E. Physicians’ Attitudes towards Electronic Prescribing Software: Perceived Benefits and Barriers. International Conference on Data Science, E-learning and Information Systems 2021. 2021. p. 47-53.
32. Baysari MT, Raban MZ. The safety of computerised prescribing in hospitals. Aust Prescr. 2019;42(4):136-8. [PubMed ID:31427845]. [PubMed Central ID:PMC6698235]. https://doi.org/10.18773/austprescr.2019.037.
33. Almutairi BA, Potts HWW, Al-Azmi SF. Physicians’ Perceptions of Electronic Prescribing with Electronic Medical Records in Kuwaiti Primary Healthcare Centres. Sultan Qaboos Univ Med J. 2018;18(4):e476-e82. [PubMed ID:30988966]. [PubMed Central ID:PMC6443264]. https://doi.org/10.18295/squmj.2018.18.04.008.
34. Hollingworth W, Devine EB, Hansen RN, Lawless NM, Comstock BA, Wilson-Norton JL, et al. The impact of e-prescribing on prescriber and staff time in ambulatory care clinics: a time motion study. J Am Med Inform Assoc. 2007;14(6):722-30. [PubMed ID:17712088]. [PubMed Central ID:PMC2213487]. https://doi.
org/10.1197/jamia.M2377.
35. Alshahrani F, Marriott JF, Cox AR. A qualitative study of prescribing errors among multi-professional prescribers within an eprescribing system. Int J Clin Pharm. 2021;43(4):884-92. [PubMed ID:33165835]. [PubMed Central ID:PMC8352824]. https://doi.org/10.1007/s11096-020-01192-0.
36. Artawan IP, Martini IAO. Hospital E-prescribing implementation in reducing medication error. International Journal of Business, Economics and Management. 2020;3(1):67-76.
37. Savari E, Ajami S. Electronic prescription and medication errors. Health Information Management. 2015;12(2):263-72.
| Files | ||
| Issue | Vol 9 No 3 (2025) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/htaa.v9i3.19643 | |
| Keywords | ||
| E-Prescribing E-Prescription Prescriber Pharmacies Patients | ||
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How to Cite
1.
Mostafavi H, Takian A, Mostafavi S, Bakhtiari A, Mohamadi E, Yaftian F, Olyaeemanesh A. Challenges of Implementing Electronic Prescribing in a Low-Income Country: A Qualitative Study. Health Tech Ass Act. 2025;9(3).
