international journal of medical informatics 78 ( 2 0 0 9 ) 199–207 journal homepage: www.intl.elsevierhealth.com/journals/ijmi CPOE in Iran—A viable prospect? Physicians’ opinions on using CPOE in an Iranian teaching hospital Alireza Kazemi a,b,c,* , Johan Ellenius a , Shahram Tofighi d , Aref Salehi e , Fatemeh Eghbalian f , Uno G. Fors a a Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden b Management Information Systems (MIS) Centre, Hamadan University of Medical Sciences, Hamadan, Iran c National Public Health Management Centre (NPMC), Tabriz, Iran d Research Centre for Strategic Studies on Health Care, Baqyatallah University of Medical Sciences, Tehran, Iran e Department of Cardiology, Gorgan University of Medical Sciences, Gorgan, Iran f Department of Paediatrics, Hamadan University of Medical Sciences, Hamadan, Iran article info Article history: Received 30 March 2008 Received in revised form 10 July 2008 Accepted 10 July 2008 Keywords: Medical Order Entry Systems Decision support systems, clinical Adverse effects Medication errors Iran abstract Background: In recent years, the theory that on-line clinical decision support systems can improve patients’ safety among hospitalised individuals has gained greater acceptance. However, the feasibility of implementing such a system in a middle or low-income country has rarely been studied. Understanding the current prescription process and a proper needs assessment of prescribers can act as the key to successful implementation. Objectives: The aim of this study was to explore physicians’ opinions on the current prescrip- tion process, and the expected benefits and perceived obstacles to employ Computerised Physician Order Entry in an Iranian teaching hospital. Methods: Initially, the interview guideline was developed through focus group discussions with eight experts. Then semi-structured interviews were held with 19 prescribers. After verbatim transcription, inductive thematic analysis was performed on empirical data. Forty hours of on-looker observations were performed in different wards to explore the current prescription process. Results: The current prescription process was identified as a physician-centred, top-down, model, where prescribers were found to mostly rely on their memories as well as being over- confident. Some errors may occur during different paper-based registrations, transcriptions and transfers. Physician opinions on Computerised Physician Order Entry were categorised into expected benefits and perceived obstacles. Confidentiality issues, reduction of medica- tion errors and educational benefits were identified as three themes in the expected benefits category. High cost, social and cultural barriers, data entry time and problems with technical support emerged as four themes in the perceived obstacles category. Conclusions: The current prescription process has a high possibility of medication errors. Although there are different barriers confronting the implementation and continuation of ∗ Corresponding author at: Medical Informatics Group, Department of Learning, Informatics, Management and Ethics (LIME), Berzelius väg 3, Karolinska Institutet, SE-171 77, Stockholm, Sweden. Tel.: +46 8 52483926; fax: +46 8 52483600. E-mail addresses: Alireza.kazemi@ki.se, dr alireza kazemi@yahoo.com (A. Kazemi). 1386-5056/$ – see front matter © 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijmedinf.2008.07.004