Abstract
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.
Keywords: electronic prescribing, physicians' perspectives, opportunities, challenges, efficiency improvement
Background and Significance
Health care digitalization is a widespread developmental process in countries, aimed at enhancing the quality of patient care through standardized health care services. 1 A crucial stage in this health transformation program involves the adoption of an electronic prescribing (e-prescribing) system within health care services. 2 Drug prescription is a vital process in every country, and the implementation of e-prescribing plays a pivotal role in enabling more effective and efficient prescriptions by physicians. 3 4 5 For many years, handwritten prescriptions have been the preferred method of communication for physicians prescribing medications and pharmacists dispensing them. 6 7 Gradually, e-prescribing is replacing paper-based methods. The electronic transmission of prescriptions facilitates the clinical workflow, leading to improved efficiency and effectiveness in prescribing. 8 9
E-prescribing refers to the utilization of information and communication technology to share patient information through a network designed for the collective use of health care service providers. It allows for recording, storing, and authorized access to this information, enabling its transfer to pharmacies within an electronic environment. 2 10 Thus, e-prescribing entails utilizing computerized devices to document, alter, examine, and produce or send drug prescriptions, which enables a seamless two-way transfer between the point of care (hospital or office) and pharmacies. 11 12
Prescription errors contribute significantly to medication errors and pose a substantial risk to patient safety. 13 14 15 Therefore, the prescription process remains a primary concern for public health policies, as prescribing errors have been linked to a notable portion of recorded deaths in populations. 16
The implementation of an e-prescribing system can effectively address numerous issues associated with the traditional paper prescribing process. By enhancing the accuracy of medication registration and reducing medication errors, e-prescribing can contribute to lower the rising costs of health care services and significantly improve the quality of treatment. 17 18 19 20 Moreover, this system offers various benefits, including increased patient safety, improved medication compliance, better communication between physicians and pharmacists, and faster prescription refill processing compared to paper prescriptions. 5 21 22 23 24 25 26 27 28 Additionally, the use of e-prescribing is associated with a reduction in prescribing errors and adverse drug reactions as well as improved drug treatment outcomes, overall health care performance, accuracy, efficiency, and quality of health care and public health. Furthermore, it serves as a secure tool for electronic access to up-to-date formulation information and patients' medication history at the point of care, while also reducing the burden of additional paperwork. 5
Successful implementation and adoption of the e-prescribing system require essential steps, including comprehensive training of stakeholders, particularly prescribers, and the development of appropriate infrastructure. 9 E-prescribing, a critical component of the health information technology infrastructure, holds the potential to enhance the safety, quality, efficiency, and cost-effectiveness of patient care. 5 29 30 31 32 33 34 However, this system may sometimes contain ambiguous or incomplete information that does not align with the data received from the pharmacy. Such discrepancies can impede accurate and efficient processing and distribution at receiving pharmacies. 35 Prescribing stands as one of the primary and vital duties of physicians present a significant potential to enhance their working process. 36 Therefore, it becomes imperative to address their needs and clinical priorities in the development of a national e-prescribing system. 1 E-prescribing equips physicians with a robust tool to manage patients' medications safely and efficiently. By utilizing the system to produce legible and complete prescriptions, physicians can potentially reduce medication errors and enhance the efficiency and effectiveness of both pharmacies and them, thus diminishing the need for pharmacists to explain medications to patients. 21 22 37 38 39
The use of e-prescribing has become widespread in Iran since its implementation was mandated by the Ministry of Health and Medical Education on December 22, 2021. 40 Currently, e-prescribing is utilized in the majority of offices and health care centers. 41 42 Given that physicians are among the primary users of the e-prescribing system, evaluating its efficiency and effectiveness from their perspective plays a crucial role in the acceptance, utilization, and ultimately, the success of e-prescribing implementation. 32 Raeesi et al 43 evaluated the efficiency and effectiveness of the e-prescribing system in a private hospital affiliated with the Social Security Organization (SSO) in Sistan and Baluchistan Province in Iran. Because of the difference in the e-prescribing system used in Social Security hospitals with the system used in public hospitals that utilize two Iran Health Insurance Organization and the Social Security Organization (SSO) e-prescribing systems, 17 it is crucial to conduct a similar study in public hospitals. With this in mind, the purpose of this study was to assess physicians' viewpoints regarding the efficiency, effectiveness, opportunities, and challenges associated with e-prescribing in five teaching hospitals affiliated with Zahedan University of Medical Sciences.
Methods
Study Design, Study Population, and Setting
This descriptive analytics cross-sectional study was conducted between February 10 and June 25, 2023, to assess the efficiency and effectiveness of e-prescribing among physicians. Due to the mandatory use of e-prescribing, the study population comprised all physicians ( N = 250) working in five teaching hospitals affiliated with Zahedan University of Medical Sciences, specifically Ali-Ibne-Abitaleb, Khatam-Ol-Anbia, Alzahra, Baharan, and Bu Ali hospitals. Due to the finite population size of this study, all the doctors of the five studied hospitals who agreed to participate in the study were included. Therefore, the study samples consisted of 195 doctors who were selected through the census method.
This study was reviewed and approved by the Ethics Committee of the Deputy of Research and Technology of Zahedan University of Medical Sciences (IR.ZAUMS.REC.1401.379). Before completing the questionnaire, the participants took informed consent orally and in writing. The original approval document is available from: https://ethics.research.ac.ir/ProposalCertificateEn.php?id=308568&Print=true&NoPrintHeader=true&NoPrintFooter=true&NoPrintPageBorder=true&LetterPrint=true
Data Collection Tool
The data collection tool used in this study was a validated questionnaire developed by Raeesi et al. 43 We reevaluated the validity and reliability of the questionnaire. Content validity assessment was checked employing Content Validity Index (CVI) and Content Validity Ratio (CVR) indices for each question separately using 10 experts, including 5 experts in health information management and 5 experts in medical informatics, all of whom held PhD degrees. Since all the estimations are above 70% for CVI, and above 0.62 for CVR based on Lawshe's criteria, 44 the content validity was confirmed. For reliability or internal consistency, we asked 20 eligible cases to fill in the questionnaire, precisely. Then, Cronbach's alpha index was computed at 96.5% based on the answers. Since the estimated index was higher than the critical value of 70%, 45 the reliability was also confirmed.
The questionnaire was divided into five main parts. The first part included five demographic questions covering age, sex, work experience, level of computer skills (beginner, intermediate, advanced), and the average hours of computer use per work shift. The second and third parts of the questionnaire focus on the evaluation of the efficiency ( n = 19 questions) and effectiveness ( n = 13 questions) of the e-prescribing system. Within the efficiency section, questions were further divided into time-related ( n = 7 questions), cost-related ( n = 5 questions), and other aspects of efficiency ( n = 7 questions). On the other hand, the effectiveness section encompassed questions related to patient safety ( n = 6 questions) and other items concerning effectiveness ( n = 7 questions). A five-point Likert scale was utilized to measure physicians' opinions for each question, ranging from 1 to 5 (1: strongly disagree, 2: disagree, 3: undecided, 4: agree, and 5: strongly agree). Finally, the fourth and fifth parts of the questionnaire comprised two open-ended questions that asked for physicians' perspectives about the challenges and opportunities they perceived in using the e-prescribing system.
Statistical Analysis
The questionnaire was distributed manually among the participants and collected 2 weeks later. The collected data were analyzed using SPSS 22 software, employing both descriptive (mean, standard deviation, and frequency percentage) and analytical (Pearson's correlation, t -test, one-way ANOVA, and linear multiple regression model) statistics. To assess each variable, a criterion based on the percentage of the total score obtained in each dimension was used. If a dimension obtained less than 20% of the total score, it was considered very low, 21 to 40% as low, 41 to 60% as average, 61 to 80% as high, and 81 to 100% as very high. This categorization helped in evaluating different dimensions and understanding their significance in the study.
The normality of the data was assessed using the Shapiro–Wilk normality test, quantile–quantile plot, and skewness index simultaneously. Pearson's correlation test was used to examine the associations between the main variables, including time efficiency, cost efficiency, other efficiency, total efficiency, patient-safety effectiveness, other effectiveness, and total effectiveness. The independent samples t -test was administered to determine the relationship between qualitative two-group variables and the main variables. A linear multiple regression model was utilized to estimate the relationship between the dependent variables (effectiveness total and efficiency total) and the independent variables (sex, grouped age, grouped work experience, average hours of system use). The one-way ANOVA test was applied to compare the mean values of the main variables across groups. The significance level was set at 0.05.
Thematic analysis was applied for data analysis of two open-ended questions related to opportunities and challenges of the e-prescribing system. The initial concepts provided by physicians were extracted, then the concepts were coded and categorized and the emerging categories were reduced to achieve the final themes.
Results
Out of a total of 250 distributed questionnaires, 197 were returned, resulting in a response rate of 78.8%. Two questionnaires were excluded from the analysis due to incompleteness.
Slightly over half of the participants were women (54.9%). Furthermore, the majority of them were under 40 years old (79.5%) with a mean age of 34.25 ± 8.502. Additionally, most participants had less than 5 years of work experience (52.3%) with a mean of 7.18 ± 7.103 years. The mean hours spent working with the e-prescribing system were less than five per day (82.1%), and the majority had an intermediate level of computer skills (66.2%; Table 1 ).
Table 1. Participants demographic characteristics.
| Variable | Subcategories | N | Percentage (%) |
|---|---|---|---|
| Sex | Female | 107 | 54.9 |
| Male | 88 | 45.1 | |
| Age (years) | <40 | 155 | 79.5 |
| ≥40 | 40 | 20.5 | |
| Work experience (years) | <5 | 102 | 52.3 |
| ≥5 | 93 | 47.7 | |
| Average working hours with the computer (hours) | <5 | 160 | 82.1 |
| ≥5 | 35 | 17.9 | |
| Computer skill level | Elementary | 21 | 10.8 |
| Intermediate | 129 | 66.2 | |
| Advanced | 45 | 23.1 |
The patient safety dimension received the highest percentage of the obtained score, while the time efficiency dimension obtained the lowest percentage. Furthermore, the results indicated that the overall efficiency of e-prescribing and its subdimensions is less than 50% from the physicians' perspective ( Table 2 ).
Table 2. Estimation of the mean of evaluated dimensions of the questionnaire.
| Dimensions | Subdimensions | Mean ± S.D. (Min–Max) |
Median | Percentage of total score | Situation |
|---|---|---|---|---|---|
| Efficiency | Time | 15.84 ± 5.56 (7–35) | 15 | 45 | Average a |
| Cost | 14.35 ± 4.24 (5–25) | 15 | 57 | Average | |
| Other | 17.27 ± 5.81 (7–35) | 17 | 49 | Average | |
| Total | 47.47 ± 14.46 (19–95) | 47 | 49 | Average | |
| Effectiveness | Patient-safety | 18.14 ± 5.56 (6–30) | 18 | 60 | Average |
| Other | 17.95 ± 6.14 (7–35) | 18 | 51 | Average | |
| Total | 36.09 ± 10.67 (13–65) | 36 | 55 | Average |
Abbreviation: S.D., standard deviation.
Average means that in the relevant dimension, the average was between 40 and 60% of the total score and considered a fairly satisfactory level.
Table 3 reveals several significant correlations among the variables. Strong positive correlations were found between time efficiency and other efficiency (r = 0.881, p < 0.01), as well as total efficiency (r = 0.933, p < 0.01). Additionally, there was a strong positive correlation between cost efficiency and total efficiency (r = 0.860, p < 0.01). Moreover, a significant strong positive correlation was observed between total efficiency and other effectiveness, and total effectiveness (r = 0.968, p < 0.01). Likewise, a strong positive correlation was found between total effectiveness and patient safety effectiveness (r = 0.908, p < 0.01) and other effectiveness (r = 0.921, p < 0.01).
Table 3. Pearson's correlation coefficients between main evaluated dimensions.
| Dimensions | 1 | 2 | 3 | 4 | 5 | 6 | 7 | ||
|---|---|---|---|---|---|---|---|---|---|
| 1 | Efficiency | Time | 1 | ||||||
| 2 | Cost | 0.665 a | 1 | ||||||
| 3 | Other | 0.881 a | 0.776 a | 1 | |||||
| 4 | Total | 0.933 a | 0.860 a | 0.968 a | 1 | ||||
| 5 | Effectiveness | Patient-safety | 0.614 a | 0.731 a | 0.706 a | 0.734 a | 1 | ||
| 6 | Other | 0.763 a | 0.737 a | 0.836 a | 0.845 a | 0.734 a | 1 | ||
| 7 | Total | 0.745 a | 0.783 a | 0.832 a | 0.850 a | 0.908 a | 0.921 a | 1 | |
Correlation is significant at the 0.01 level (two-tailed).
Furthermore, the analysis revealed significant but moderate correlations among all the other variables.
There was a significant association between age and the main variables ( p < 0.05). One-way ANOVA showed no significant association between the physicians' level of computer skills and the main dimensions ( p < 0.05; Table 4 ).
Table 4. Correlations between main dimensions and demographic variables.
| Characteristics | Subgroups | Time efficiency | Cost efficiency | Other efficiency | Total efficiency | Patient-safety | Other effectiveness | Total effectiveness | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Mean | p | Mean | p | Mean | p | Mean | p | Mean | p | Mean | p | Mean | p | ||
| Sex | Female | 15.99 ± 5.32 | 0.69 | 14.18 ± 4.16 | 0.55 | 17.30 ± 5.44 | 0.92 | 47.48 ± 13.92 | 0.99 | 17.84 ± 5.02 | 0.64 | 17.97 ± 5.80 | 0.96 | 36.07 ± 10.34 | 0.97 |
| Male | 15.67 ± 5.86 | 14.55 ± 4.34 | 17.22 ± 6.25 | 47.45 ± 15.17 | 18.19 ± 5.46 | 17.93 ± 6.56 | 36.12 ± 11.12 | ||||||||
| Age (years) | <40 | 16.31 ± 5.68 | 0.02 | 14.76 ± 4.17 | <0.001 | 17.88 ± 5.76 | <0.001 | 48.96 ± 14.45 | <0.001 | 18.56 ± 4.98 | <0.001 | 18.54 ± 6.15 | <0.001 | 37.28 ± 10.40 | <0.001 |
| ≥40 | 14.02 ± 4.70 | 12.77 ± 4.17 | 14.90 ± 5.44 | 41.70 ± 13.12 | 15.82 ± 5.58 | 15.67 ± 5.60 | 31.50 ± 10.57 | ||||||||
| Work experience (years) | <5 | 16.32 ± 5.75 | 0.21 | 14.95 ± 4.14 | 0.04 | 17.73 ± 5.79 | 0.24 | 49.00 ± 14.44 | 0.12 | 18.62 ± 5.17 | 0.08 | 18.55 ± 6.08 | 0.15 | 37.18 ± 10.49 | 0.14 |
| ≥5 | 15.32 ± 5.32 | 13.69 ± 4.27 | 16.76 ± 5.81 | 45.78 ± 14.37 | 17.31 ± 5.20 | 17.29 ± 6.17 | 34.90 ± 10.80 | ||||||||
| Working with the system (hours) | <5 | 15.83 ± 5.42 | 0.96 | 14.41 ± 4.22 | 0.65 | 17.48 ± 5.69 | 0.27 | 47.74 ± 14.27 | 0.58 | 18.12 ± 5.02 | 0.48 | 18.08 ± 6.15 | 0.54 | 36.38 ± 10.50 | 0.43 |
| ≥5 | 15.88 ± 6.23 | 14.05 ± 4.33 | 16.28 ± 6.29 | 46.22 ± 15.47 | 17.42 ± 6.05 | 17.37 ± 6.12 | 34.80 ± 11.49 | ||||||||
| Computer skill level | Elementary | 14.57 ± 5.59 | 0.40 | 13.33 ± 5.37 | 0.51 | 16.00 ± 5.77 | 0.30 | 43.90 ± 15.91 | 0.37 | 17.90 ± 5.04 | 0.99 | 17.04 ± 6.36 | 0.78 | 34.95 ± 10.80 | 0.86 |
| Intermediate | 16.19 ± 5.65 | 14.47 ± 4.11 | 17.72 ± 5.85 | 48.38 ± 14.41 | 18.04 ± 5.24 | 18.05 ± 6.12 | 36.31 ± 10.82 | ||||||||
| Advanced | 15.44 ± 5.28 | 14.48 ± 4.03 | 16.57 ± 5.67 | 46.51 ± 13.91 | 17.91 ± 5.32 | 18.08 ± 6.19 | 36.00 ± 10.39 | ||||||||
The linear multiple regression model showed a significant correlation between total efficiency and age (B = − 7.261, p = 0.004) as well as between total effectiveness and age (B = − 5.784, p = 0.002) after controlling for the effect of all other confounding variables.
According to physicians' perspectives, the most common opportunities were removing the illegibility of prescriptions ( n = 22), improving access to the patients' previous drug information ( n = 8), and time-saving ( n = 7). On the other hand, the physicians identified internet connectivity problems ( n = 37), absence of some medicines and special tests or paraclinical services ( n = 15), and loss of time for physicians ( n = 33) as the most frequent challenges associated with e-prescribing systems from their point of view ( Table 5 ).
Table 5. Initial and final themes of opportunities and challenges of electronic prescribing system extracted from physicians' perspectives.
| Opportunities | Challenges | ||
|---|---|---|---|
| Initial themes | Final themes | Initial themes | Final themes |
|
• Time-saving (
n
= 7)
• Paper-saving ( n = 5) • Speeding up prescription process ( n = 3) • Reducing the workload of physicians ( n = 1) |
Providing savings |
• Loss of time for physicians due to working with the system (
n
= 33)
• Increase patients' waiting time ( n = 3) • increase patients' costs ( n = 2) |
Loss of savings |
|
• Improving the accessibility of the patient's previous drug information (
n
= 8)
• Easy access to the e-prescribing system ( n = 4) • Correction of drug prescription writing ( n = 1) • Availability of all the details related to the drugs ( n = 1) • Better familiarity with different types of drugs ( n = 1) |
Facilitating prescribing process |
• Internet network problems (
n
= 37)
• Absence of some desired medicines and special tests or paraclinical services ( n = 15) • E-prescribing system problems ( n = 9) • Absence of electronic infrastructure ( n = 7) • The complexity and lack of user-friendliness of the system ( n = 3) • Lack of single e-prescribing system for all types of insurances ( n = 3) • Failure in functioning of the system ( n = 1) • System error during use regarding some insurances ( n = 1) • Failure to provide a one-time password on time ( n = 1) • Failure to register patients' drug codes due to system malfunctions ( n = 1) • Design problems of the e-prescribing system ( n = 1) |
Infrastructure, system (software), and internet network issues |
|
• Removing illegibility of prescription (
n
= 22)
• No need to learn the spelling of common drugs and their exact dosage (registration of the exact dosage of drugs and number; n = 7) • Reduction of medication errors due to human errors ( n = 2) • Managing drug consumption and monitoring it and promoting the improvement of the culture of prescription drug use ( n = 1) • Increasing accuracy in drug registration ( n = 1) |
Improving prescription quality |
• Not being able to modify (correct, add, delete) after the prescription (
n
= 2)
• Delay in registration of drugs ( n = 2) • Need to enter data several times ( n = 1) • Incompleteness in terms of explaining side effects and drug dosage ( n = 1) • Typing the names of the drugs is sometimes difficult ( n = 1) • Specialized condition of some drugs ( n = 1) • Difficulty finding drugs by searching ( n = 1) |
Problems with prescription writing |
|
• Ease of obtaining of medicine by the patient (
n
= 4)
• The possibility of viewing drugs covered by insurance for the patient ( n = 3) • Warning that the person is not covered or the patient's insurance date has passed ( n = 1) |
Other |
• Reducing the effectiveness of drug administration (
n
= 1)
• Increase in drug prescription errors ( n = 1) • Lack of sufficient training for the medical staff regarding the e-prescribing ( n = 1) • Disruption of communication between doctor, patient, and pharmacy ( n = 1) |
Other |
Abbreviations: e-prescribing, electronic prescribing; n , frequency.
Discussion
Our findings revealed that physicians rated the efficiency and effectiveness of the e-prescribing system at average levels, with 49 and 55% of total scores, respectively. These findings indicate that the efficiency and effectiveness of the evaluated system have been fairly satisfied from doctors' perspectives. The present study demonstrated that the mean score of e-prescribing system efficiency was 47.47 ± 14.46. Moreover, the subdimensions of e-prescribing system efficiency (time, cost, and other) were also rated at an average level from the physicians' perspective, obtaining less than half of the total mean scores. These findings suggest that the e-prescribing system has not met the expectations of physicians in terms of efficiency either. Consistent with our findings, Wrzosek et al 10 found that approximately 33% of doctors agreed that using e-prescribing made their work easier. Additionally, around 20% of the doctors agreed that this system accelerated the performance of their duties. However, the results of other similar studies contradict these findings. For instance, in Iran, Raeesi et al 43 reported an efficiency rate of about 73% for the e-prescribing system from physicians' perspectives at a hospital affiliated with the SSO. Similarly, Bulut et al 2 revealed that 83% of the family physicians expressed satisfaction with the e-prescribing system in Turkey. The disparities in these findings can be attributed to the differing contexts of the studies. Raeesi et al 43 conducted their study in a private hospital affiliated with the SSO, where doctors typically use an e-prescribing system specific to such hospitals in Iran for clients covered by Social Security Insurance. In Turkey, family physicians also use an integrated e-prescribing system Medikal-Ulak (MEDULA) for e-prescribing. In contrast, the present study was conducted in government teaching hospitals where referring patients are covered by various insurance companies, and physicians are obligated to use different e-prescribing systems based on the client's insurance coverage.
Facilitating communication between health care providers, such as doctors, pharmacies, and pharmacists, and enabling collaborative care are essential aspects of health information technologies that can indicate the effectiveness of technology in patient care. 10 The mean score of e-prescribing system effectiveness was 36.09 ± 10.67, corresponding to 55% of the total score. Furthermore, the subdimensions of e-prescribing system effectiveness (patient safety and others) were also rated at an average level from physicians' perspectives, although they obtained more than half of the total mean scores. Similarly, in Iran, Raeesi et al 43 reported that the effectiveness of the e-prescribing system was approximately 77% from the doctors' perspectives. Conversely, in the United States, Lapane et al 46 found that 64% of the participants identified e-prescribing as highly effective. Wrzosek et al 10 reported that about 28% of the doctors believed that the e-prescribing system was effective in Poland, which is significantly lower than the rate found in the present study. In Turkey, Bulut et al 2 reported an 83% satisfaction rate among doctors with the e-prescribing system, which is much higher than the percentage obtained in the present study. Additionally, Lau et al found that more than 80% of physicians believed that the e-prescribing system improved prescribing, drug administration safety, and workflow. 47 These discrepancies can be attributed to variations in user-friendliness, collaborative care capabilities, measures to improve drug administration safety, and the ease of use of the systems by doctors in different studies. Therefore, considering the needs of the e-prescribing system users, especially doctors, during the designing phase and incorporating functions to enhance medication safety (such as the possibility of viewing all previously prescribed drugs for the patient, drug interactions, etc.), ensuring a user-friendly system design, and providing user training can be potential solutions to improve the efficiency and effectiveness of the e-prescribing system.
In the present study, improving prescription quality, saving time and costs, and facilitating the prescribing process were the most frequent opportunities of the e-prescribing system from the doctors' perspectives. Similarly, Bulut et al 2 found that family physicians believed that saving time and cost, simplifying prescription writing, and improving medicine dispensing safety and quality were the main opportunities of the e-prescribing system. Moreover, Raeesi et al 43 reported that the ability to access the history of the patient's medications, control drug interactions, and speedup drug registration were among the most important opportunities for e-prescribing according to doctors, which is consistent with the results of the present study. Also, in the Lau et al 48 study, easy access to e-prescriptions, removal of the limitations of paper prescriptions, and an easier process of prescribing are mentioned as opportunities to use an e-prescription which are in-line with our results.
In this study, infrastructure, the e-prescribing system (software), internet connectivity issues, prescription writing problems, loss of time, and high cost were the most frequent challenges of the e-prescribing system from the physicians' perspectives. Similar to our results, Lau et al 48 in Australia introduced technological issues as a main barrier to accessing e-prescriptions. Bulut et al 2 reported similar results, where they identified technological infrastructure, system problems, internet network issues, and prescription writing as the main e-prescribing problems in Turkey. Likewise, in Iran, Raeesi et al 43 reported that prescription writing, being time-consuming, and user-unfriendliness of the software were the most frequent problems of the e-prescribing system, which is in-line with the findings of our study.
The Pearson's correlation test showed that time efficiency had a significant strong correlation with other efficiency and total efficiency. There were also significant correlations between cost efficiency and total efficiency, between total efficiency and other effectiveness and total effectiveness, and between total effectiveness and patient-safety effectiveness and other effectiveness. Additionally, there were significant but moderate correlations between all of the other variables. The two independent samples t -test showed a significant association between age and the dependent variables. Specifically, younger physicians rated the efficiency and effectiveness of the e-prescribing system at higher levels compared to older ones. Furthermore, the linear multiple regression model indicated a significant correlation between total efficiency and age, as well as between total effectiveness and age. These findings confirm that younger doctors perceived the e-prescribing system as more efficient and effective than the older ones.
Study Limitations
The generalizability of our findings may be limited to health care systems with distinct infrastructures, cultural backgrounds, or technological adoption levels; therefore, caution should be exercised in generalizing these findings to the entire country. It is recommended to conduct similar studies in other provinces to obtain a more accurate and comprehensive understanding of the results regarding the use of e-prescribing in the country. Our findings are based on the opinions of doctors who chose to participate in this study. Therefore, their opinions can be different from those who did not participate in the study, which can skew the findings.
This study subjectively measured the two main dimensions of efficiency and effectiveness of e-prescribing from the doctors' perspectives. Considering the crucial role of user-friendliness in the acceptance and optimal use of health information systems and their overall success, it is advisable to conduct specific and objective studies focusing on user-friendliness and other aspects of this system in the country. These studies would help in identifying and addressing existing problems more accurately.
Conclusion
The efficiency and effectiveness of the evaluated e-prescribing system and their subdimensions were rated at an average level from the physicians' perspective, which shows that they are fairly satisfied with the system. Despite the opportunities identified, such as saving time and costs, improving the prescription process, and enhancing the quality and safety of medicine dispensing, this system faces significant challenges. These challenges include the lack of technological infrastructure, internet connectivity issues, software problems, and prescription writing issues.
Therefore, to improve the efficiency and effectiveness of the system, it is essential to focus on strengthening the technological infrastructure and ensuring a reliable and stable internet network. Additionally, taking into account the user-friendliness aspects of the system and involving and training doctors during the design, implementation, and evaluation phases can be effective solutions. Our finding offers insightful information about how doctors see the e-prescribing system at teaching hospitals, which can 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.
Clinical Relevance Statement
The success of any health information system, including e-prescribing, relies on acceptance by users of that system. The e-prescribing system has been evaluated at an average level, which indicates that it does not meet the needs of physicians. It is necessary to upgrade the evaluated system according to the users' needs to improve its effectiveness and efficiency.
Multiple Choice Questions
-
What is the most common challenge of e-prescribing system from the point of view of doctors?
Writing a prescription
Delay in registration of medications
Designing problems of the e-prescribing system
Internet network problems
Correct Answer: The correct answer is option d. Internet network problems was the most common challenge of e-prescribing system from physicians' perspectives.
-
What is the most common opportunity of e-prescribing system from the physicians' perspectives?
Time-saving
Removing illegibility of prescription
Increasing accuracy in drug registration
Ease of obtaining of medicine by the patient
Correct Answer: The correct answer is option b. Removing illegibility of prescription was the most common opportunity of e-prescribing system from physicians' perspectives.
Acknowledgments
We are thankful to the physician users of the given e-prescribing system who participated in this study for sharing their valuable experiences.
Funding Statement
Funding None.
Conflict of Interest None declared.
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.
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