This paper presents a physician ordering entry system in the ward (for medication prescriptions) by using scanning and image processing. Important design and operational issues that need to be considered by developers of similar end-user computer systems are presented. Then the scanning and imaging processing system (SIPS) is described. SIPS was developed for the Hong Kong Baptist Hospital (HKBH), Kowloon, Hong Kong and has been in successful operation for over three years in the hospital. The development of SIPS was based on end-user directed requirements. SIPS makes use of and integrates different information technologies, including scanning, bar code and other marks recognition, intelligent image capturing, server database access and retrieval, and network communication and printing. We observe that the end-user context has directed the design and development of the system. On the other hand, the use of SIPS led to the implementation of new operational procedures, resulting in improved quality healthcare delivery in the ward and increased productivity of the medical personel.