Appl Clin Inform 2024; 15(03): 428-436
DOI: 10.1055/s-0044-1786872
Research Article

Physicians' Perspectives with the E-prescribing System in Five Teaching Hospitals

Jahanpour Alipour
1   Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
Abolfazl Payandeh
2   Genetics of Non-Communicable Disease Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
Aida Hashemi
3   Department of Health Information Technology, School of Paramedical, Zahedan University of Medical Sciences, Zahedan, Iran
Ali Aliabadi
3   Department of Health Information Technology, School of Paramedical, Zahedan University of Medical Sciences, Zahedan, Iran
4   Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
› Author Affiliations
Funding None.


Objectives Despite the evidence suggesting the potential of electronic prescribing (e-prescribing), this system also faces challenges that can lead to inefficiency and even failure. This study aimed to evaluate physicians' perspectives on the efficiency, effectiveness, opportunities, and challenges associated with the e-prescribing system.

Methods In 2023, a descriptive analytics cross-sectional study was carried out. Due to the finite population size, all the physicians from five studied hospitals who agreed to participate in the study were included through the census method (n = 195). Data collection was conducted using a validated questionnaire. Data were analyzed using descriptive (mean, standard deviation, and frequency) and analytical (Pearson's correlation coefficient, two-sample t-test, one-way analysis of variance (ANOVA), and linear multiple regression model) statistics.

Results The mean scores of efficiency and effectiveness were 47.47 ± 14.46 and 36.09 ± 10.67 out of 95 and 65, respectively. Removing the illegibility of the prescriptions (n = 22) was the most frequent opportunity and internet connectivity problem (n = 37) was the most frequent challenge associated with the e-prescribing system. There was a strong positive significant correlation between efficiency and effectiveness (r = 0.850, p< 0.01). Moreover, age was found to have a significant negative correlation with efficiency (B =  −7.261, p = 0.004) and effectiveness (B = − 5.784, p = 0.002).

Conclusion Physicians believe that e-prescribing enhances the efficiency and effectiveness of their work. There are many opportunity and challenges to the use of e-prescription. Assessing the needs of physicians, actively participating and training them in the stages of design and implementation, and conducting regular evaluations of the e-prescribing system are crucial to overcome the challenges. Our finding offers insightful information about how doctors see the e-prescribing system at teaching hospitals and provide a basis for managers and policy makers at the local and national levels to support the implementation of this system and plan for improvement of its shortcomings.

Protection of Human and Animal Subjects

The present study was reviewed and approved by Ethics Committee of Zahedan University of Medical Sciences (ethical code: IR.ZAUMS.REC.1401.379). All participants provided written informed consent for this study.

Publication History

Received: 14 December 2023

Accepted: 24 March 2024

Article published online:
29 May 2024

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  • References

  • 1 Wrzosek N, Zimmermann A, Balwicki Ł. A survey of patients' opinions and preferences on the use of e-prescriptions in Poland. Int J Environ Res Public Health 2021; 18 (18) 9769
  • 2 Bulut S, Yıldız A, Kaya S. Evaluation of transition to electronic prescriptions in Turkey: perspective of family physicians. Int J Health Policy Manag 2019; 8 (01) 40-48
  • 3 Samadbeik M, Ahmadi M. Electronic prescription system: concepts and standards. Health Inf Manag 2013; 10 (02) 1-13 [In Persian]
  • 4 Samadbeik M, Ahmadi M, Hosseini Asanjan SM. A theoretical approach to electronic prescription system: lesson learned from literature review. Iran Red Crescent Med J 2013; 15 (10) e8436
  • 5 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. Iran J Pharm Res 2019; 18 (04) 2204-2215
  • 6 Riaz MK, Hashmi FK, Bukhari NI, Riaz M, Hussain K. Occurrence of medication errors and comparison of manual and computerized prescription systems in public sector hospitals in Lahore, Pakistan. PLoS ONE 2014; 9 (08) e106080
  • 7 Bousoik E, Alhusadi N, Alzawi H, Ramadhan R, Albarassi R. Assessment of completeness of handwritten prescriptions in eastern Libya. Libyan Int Med Univ J 2023; 08 (01) 026-30
  • 8 Palappallil DS, Pinheiro C. Perceptions of prescribers towards electronic prescription: a pre-implementation evaluation. J Young Pharm 2018; 10 (03) 313-317
  • 9 Zaffar V, Anwar Y, Ilyas S, Sajid E, Sherazi BA. Knowledge and attitude of health care professionals towards electronic prescribing system in a public sector hospital of Lahore, Pakistan. J Pak Med Assoc 2020; 70 (02) 376-380
  • 10 Wrzosek N, Zimmermann A, Balwicki Ł. Doctors' perceptions of e-prescribing upon its mandatory adoption in Poland, using the Unified Theory of Acceptance and Use of Technology Method. Healthcare (Basel) 2020; 8 (04) 563
  • 11 Samadbeik M, Ahmadi M, Sadoughi F, Garavand A. A comparative review of electronic prescription systems: lessons learned from developed countries. J Res Pharm Pract 2017; 6 (01) 3-11
  • 12 Hincapie AL, Alamer A, Sears J, Warholak TL, Goins S, Weinstein SD. A quantitative and qualitative analysis of electronic prescribing incidents reported by community pharmacists. Appl Clin Inform 2019; 10 (03) 387-394
  • 13 Ryan C, Ross S, Davey P. et al. Prevalence and causes of prescribing errors: the PRescribing Outcomes for Trainee Doctors Engaged in Clinical Training (PROTECT) study. PLoS ONE 2014; 9 (01) e79802
  • 14 Howlett MM, Breatnach CV, Brereton E, Cleary BJ. Direct observational study of interfaced smart-pumps in pediatric intensive care. Appl Clin Inform 2020; 11 (04) 659-670
  • 15 Lyell D, Magrabi F, Coiera E. Reduced verification of medication alerts increases prescribing errors. Appl Clin Inform 2019; 10 (01) 66-76
  • 16 Gagnon MP, Nsangou ÉR, Payne-Gagnon J, Grenier S, Sicotte C. Barriers and facilitators to implementing electronic prescription: a systematic review of user groups' perceptions. J Am Med Inform Assoc 2014; 21 (03) 535-541
  • 17 Alipour J, Sharifian R, Dehghan Haghighi J, Hashemzehi M, Karimi A. Patients' perceptions, experiences, and satisfaction with e-prescribing system: a cross-sectional study. Int J Med Inform 2024; 181: 105282
  • 18 Howlett MM, Butler E, Lavelle KM, Cleary BJ, Breatnach CV. The impact of technology on prescribing errors in pediatric intensive care: a before and after study. Appl Clin Inform 2020; 11 (02) 323-335
  • 19 Stenner SP, Chakravarthy R, Johnson KB. et al. ePrescribing: reducing costs through in-class therapeutic interchange. Appl Clin Inform 2016; 7 (04) 1168-1181
  • 20 Hayavi-Haghighi MH, Davoodi S, Teshnizi SH, Jookar R. Usability evaluation of electronic prescribing systems from physicians' perspective: a case study from southern Iran. Inform Med Unlocked 2024; 45: 101460
  • 21 El-Dahiyat F, Kayyali R, Bidgood P. Physicians' perception of generic and electronic prescribing: a descriptive study from Jordan. J Pharm Policy Pract 2014; 7 (01) 7
  • 22 Grossman JM, Cross DA, Boukus ER, Cohen GR. Transmitting and processing electronic prescriptions: experiences of physician practices and pharmacies. J Am Med Inform Assoc 2012; 19 (03) 353-359
  • 23 Thomas CP, Kim M, McDonald A. et al. Prescribers' expectations and barriers to electronic prescribing of controlled substances. J Am Med Inform Assoc 2012; 19 (03) 375-381
  • 24 Clauson KA, Alkhateeb FM, Lugo KD, Khanfar NM. E-prescribing: attitudes and perceptions of community pharmacists in Puerto Rico. Int J Electron Healthc 2011; 6 (01) 34-46
  • 25 Dehghan H, Eslami S, Ghasemi SH. et al. Development of a national roadmap for electronic prescribing implementation. Stud Health Technol Inform 2019; 260: 121-127
  • 26 Dhavle AA, Rupp MT. Towards creating the perfect electronic prescription. J Am Med Inform Assoc 2015; 22 (e1): e7-e12
  • 27 Hayavi-haghighi MH, Alipour J, Dehghani M. Nursing errors and Computerized Provider Order Entry (CPOE). Inform Med Unlocked 2021; 25: 100648
  • 28 Aluga D, Nnyanzi LA, King N, Okolie EA, Raby P. Effect of electronic prescribing compared to paper-based (handwritten) prescribing on primary medication adherence in an outpatient setting: a systematic review. Appl Clin Inform 2021; 12 (04) 845-855
  • 29 Dreischulte T, Donnan P, Grant A, Hapca A, McCowan C, Guthrie B. Safer prescribing—a trial of education, informatics, and financial incentives. N Engl J Med 2016; 374 (11) 1053-1064
  • 30 Porterfield A, Engelbert K, Coustasse A. Electronic prescribing: improving the efficiency and accuracy of prescribing in the ambulatory care setting. Perspect Health Inf Manag 2014; 11 (Spring): 1g
  • 31 Warholak TL, Rupp MT. Analysis of community chain pharmacists' interventions on electronic prescriptions. J Am Pharm Assoc (2003) 2009; 49 (01) 59-64
  • 32 Hailiye Teferi G, Wonde TE, Tadele MM. et al. Perception of physicians towards electronic prescription system and associated factors at resource limited setting 2021: cross sectional study. PLoS ONE 2022; 17 (03) e0262759
  • 33 Shimoga SV, Lu YZ. Does electronic prescribing of controlled substances deter controlled substance prescribing in emergency departments?. Heliyon 2023; 9 (04) e14981
  • 34 Daher A, Badran EF, Al-Lawama M. et al. Impact of computerized prescription on medication errors and workflow efficiency in neonatal intensive care units: a quasi-experimental three-phase study. Methods Inf Med 2020; 59 (04/05): 140-150
  • 35 Dhavle AA, Yang Y, Rupp MT, Singh H, Ward-Charlerie S, Ruiz J. Analysis of prescribers' notes in electronic prescriptions in ambulatory practice. JAMA Intern Med 2016; 176 (04) 463-470
  • 36 Clyne B, Bradley MC, Hughes C, Fahey T, Lapane KL. Electronic prescribing and other forms of technology to reduce inappropriate medication use and polypharmacy in older people: a review of current evidence. Clin Geriatr Med 2012; 28 (02) 301-322
  • 37 Motulsky A, Sicotte C, Gagnon MP. et al. Challenges to the implementation of a nationwide electronic prescribing network in primary care: a qualitative study of users' perceptions. J Am Med Inform Assoc 2015; 22 (04) 838-848
  • 38 Odukoya OK, Stone JA, Chui MA. E-prescribing errors in community pharmacies: exploring consequences and contributing factors. Int J Med Inform 2014; 83 (06) 427-437
  • 39 Williams J, Malden S, Heeney C. et al. Optimizing hospital electronic prescribing systems: a systematic scoping review. J Patient Saf 2022; 18 (02) e547-e562
  • 40 Bahmani F, Hashemi A, Noroozi M. New national legislation on electronic prescription in Iran: a severe breach of medical confidentiality. J Iran Med Council 2022; 5 (04) 735-737
  • 41 Alinejad A, Nourani A, Jebraeily M. Usability evaluation of the user interface in electronic prescribing systems of Iran Health Insurance Organization and Social Security Organization. J Health Admin 2022; 25 (02) 78-94
  • 42 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. Payavard Salamat. 2021; 14 (06) 557-568
  • 43 Raeesi A, Abbasi R, Khajouei R. Evaluating physicians' perspectives on the efficiency and effectiveness of the electronic prescribing system. Int J Technol Assess Health Care 2021; 37: e42
  • 44 Lawshe CH. A quantitative approach to content validity. Person Psychol 1975; 28 (04) 563-575
  • 45 Heale R, Twycross A. Validity and reliability in quantitative studies. Evid Based Nurs 2015; 18 (03) 66-67
  • 46 Lapane KL, Rosen RK, Dubé C. Perceptions of e-prescribing efficiencies and inefficiencies in ambulatory care. Int J Med Inform 2011; 80 (01) 39-46
  • 47 Lau G, Ho J, Lin S, Yeoh K, Wan T, Hodgkinson M. Patient and clinician perspectives of an integrated electronic medication prescribing and dispensing system: a qualitative study at a multisite Australian hospital network. HIM J 2019; 48 (01) 12-23
  • 48 Lau P, Tran MT, Kim RY, Alrefae AH, Ryu S, Teh JC. E-prescription: views and acceptance of general practitioners and pharmacists in Greater Sydney. Aust J Prim Health 2024; 30 (01) PY22240