E-prescribing rollout in Tehran brings workflow disruption and unexpected out-of-pocket costs

Electronic prescribing was introduced in Iran’s Social Security Organization (SSO) health facilities with the promise of safer, faster and more continuous care. But a qualitative study from Tehran suggests the transition has carried hidden costs for both patients and providers, including workflow disruption, fragmented care pathways and, in some cases, unexpected out-of-pocket payments despite insurance coverage.

The study, published in BMC Health Services Research, explored the experiences of patients and healthcare providers with e-prescribing in SSO-owned hospitals and outpatient facilities in Tehran. The SSO is an integrated payer–provider system, meaning a single organisation both insures patients and delivers their care, a structure the researchers say makes implementation challenges particularly consequential.

Between April and June 2024, the team conducted semi-structured interviews in Persian with 28 participants who had direct experience of e-prescribing: 15 patients and 13 healthcare providers. Participants were recruited through purposive sampling, and the two groups were interviewed and analysed separately, with data collection continuing until saturation was reached within each group. The study used conventional qualitative content analysis and was reported according to the COREQ reporting guidelines.

The analysis identified six interrelated themes. The first was unreliable digital infrastructure and system performance, with participants describing instability that disrupted everyday clinical work. The second was workflow friction and an increased time burden, as providers contended with delays and repeated interactions. The third theme captured disrupted insurance-linked access and financial burden, including patients who reported difficulties obtaining services through insurance-linked pathways and, in some cases, unintended out-of-pocket payments despite being insured.

The remaining themes concerned the organisation of care itself. Participants described fragmented care pathways and limited interoperability between systems, which contributed to delays and repeated encounters. A fifth theme highlighted unequal capacity to navigate digital care: older patients and people with limited digital skills experienced greater difficulties with the new electronic processes. The final theme, conditional acceptance and unrealised benefits, reflected a guarded reception of the technology among those living with its day-to-day consequences.

Taken together, the findings indicate that in this integrated payer–provider setting, the challenges of e-prescribing extended well beyond technical performance. System instability, infrastructure limitations and poor interoperability rippled into how care pathways functioned, who could access insured services, and how much patients ended up paying, the researchers report.

The authors conclude that reliable infrastructure, effective interoperability and user-centred implementation are essential for equitable and effective digital healthcare delivery. They also emphasise the need for safeguards that maintain access to insured services during system disruptions, so that digital transitions do not shift costs or barriers onto vulnerable patients.

As a qualitative study of 28 participants in a single city and a single payer–provider organisation, the research captures lived experience in depth but does not measure the frequency or magnitude of these problems across the wider health system. The authors note that the perspectives of patients and providers were deliberately paired to capture complementary viewpoints at the points of care and service delivery. Even so, the study offers a detailed account of how a digital prescribing system, designed to improve efficiency and safety, can produce unintended financial and organisational consequences when infrastructure, interoperability and user support lag behind the technology itself.

Subject of Research: Implementation challenges and unintended financial consequences of e-prescribing in an integrated payer–provider health system in Tehran, Iran

Article Title: Implementation challenges and unintended financial consequences of e-prescribing in an integrated payer–provider health system: a qualitative study from Tehran, Iran

Article References: Salehnia, N., & Salehnia, S. (2026). Implementation challenges and unintended financial consequences of e-prescribing in an integrated payer–provider health system: a qualitative study from Tehran, Iran. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15585-w

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15585-w

Keywords: e-prescribing, digital health, health information technology, qualitative research, Iran, Social Security Organization, out-of-pocket payments, health equity, interoperability, health services research, payer-provider integration, Tehran