Iranian Physicians Rely on Workarounds and Peer Support to Manage Electronic Prescribing

Iranian physicians generally rate the technical side of electronic prescribing systems favorably, but a new mixed-methods study finds they frequently lean on informal coping strategies—workarounds, peer support, gradual adaptation, and selective use of features—to keep the technology from disrupting patient care. The study used an explanatory sequential mixed-methods design conducted in 2024. In the first, quantitative phase, 225 physicians completed a survey measuring their perceptions of electronic prescribing across technical, behavioral, and organizational dimensions.

Most participants—68.5 percent—were general practitioners, and a striking 84.9 percent agreed that paper prescriptions are prone to errors, underscoring the perceived need for digitization even among clinicians frustrated with it. The survey results revealed a clear hierarchy of satisfaction. Physicians scored the technical and behavioral aspects of the systems relatively high, at 4.07 on a five-point scale (standard deviation 0.76).

Perceived usefulness landed in the moderate range at 3.56 (0.78), while organizational support scored lowest of all, at 3.00 (0.96). In other words, doctors liked what the software could do but felt the institutions around it were not pulling their weight. To explain those numbers, the researchers moved to a qualitative phase, using purposive maximum variation sampling to recruit interviewees whose experiences could illuminate the survey patterns.

Semi-structured interviews were analyzed thematically, and the analysis surfaced 24 sub-themes spanning six dimensions: technical, practical, legal, organizational, managerial, and socio-cultural factors. This layered structure suggests that physicians' difficulties with electronic prescribing cannot be reduced to software quality alone. Workflow interruptions, managerial demands, and weak organizational backing repeatedly undermined what the technology could deliver on paper.

Faced with these gaps, physicians did not simply abandon the systems. Instead, they developed recognizable coping repertoires. Workarounds—informal shortcuts around rigid system features—were common, as was reliance on colleagues for troubleshooting rather than official help channels.

Many described a process of gradual adaptation, slowly folding the system into their routines, and others practiced selective use, engaging with the features they found reliable while sidestepping those they did not. The authors emphasize that these coping strategies were not random but shaped by the interplay of the six contextual dimensions they identified. Legal concerns, socio-cultural expectations, and managerial practices all influenced how physicians responded to the technology.

The study's conclusions point toward practical fixes. Enhancing system usability and providing targeted, continuous training, the researchers argue, could strengthen physicians' coping strategies and improve the effective use of electronic prescribing in clinical practice. Some limitations are worth noting.

The study was conducted at a single Iranian university's affiliated hospitals and clinics, and the survey relied on self-reported perceptions rather than objective measures of prescribing quality or system performance. The predominance of general practitioners in the sample may also shape how the findings generalize to specialists.

Subject of Research: Physicians' coping strategies and engagement with electronic prescribing systems in Iranian hospitals and clinics

Article Title: How do Iranian physicians cope with electronic prescribing systems? An explanatory sequential mixed-methods study

Article References: Mousavi, S. M., Raadabadi, M., Bahariniya, S., Rahmani, E., Dehghan Niri, A., & Dehghanpour, F. (2026). How do Iranian physicians cope with electronic prescribing systems? An explanatory sequential mixed-methods study. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15944-7

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15944-7

Keywords: electronic prescribing, physicians, Iran, mixed-methods, health information technology, workarounds, organizational support, workflow, implementation science, Yazd, thematic analysis, health services research