{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T11:32:04Z","timestamp":1774611124241,"version":"3.50.1"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,10,11]],"date-time":"2021-10-11T00:00:00Z","timestamp":1633910400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,10,11]],"date-time":"2021-10-11T00:00:00Z","timestamp":1633910400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100018936","name":"Universit\u00e4tsklinikum Heidelberg","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100018936","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Inform Decis Mak"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The medication process is complex and error-prone. To avoid medication errors, a medication order should fulfil certain criteria, such as good readability and comprehensiveness. In this context, a computerized physician order entry (CPOE) system can be helpful. This study aims to investigate the distinct effects on the quality of prescription documentation of a CPOE system implemented on general wards in a large tertiary care hospital.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>In a retrospective analysis, the prescriptions of two groups of 160 patients each were evaluated, with data collected before and after the introduction of a CPOE system. According to nationally available recommendations on prescription documentation, it was assessed whether each prescription fulfilled the established 20 criteria for a safe, complete, and actionable prescription. The resulting fulfilment scores (prescription-<jats:italic>Fscores<\/jats:italic>) were compared between the pre-implementation and the post-implementation group and a multivariable analysis was performed to identify the effects of further covariates, i.e., the prescription category, the ward, and the number of concurrently prescribed drugs. Additionally, the fulfilment of the 20 criteria was assessed at an individual criterion-level (denoted criteria-<jats:italic>Fscores<\/jats:italic>).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The overall mean prescription-<jats:italic>Fscore<\/jats:italic> increased from 57.4%\u2009\u00b1\u200912.0% (n\u2009=\u20091850 prescriptions) before to 89.8%\u2009\u00b1\u20097.2% (n\u2009=\u20091592 prescriptions) after the implementation (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). At the level of individual criteria, criteria-<jats:italic>Fscores<\/jats:italic> significantly improved in most criteria (n\u2009=\u200914), with 6 criteria reaching a total score of 100% after CPOE implementation. Four criteria showed no statistically significant difference and in two criteria, criteria-<jats:italic>Fscores<\/jats:italic> deteriorated significantly. A multivariable analysis confirmed the large impact of the CPOE implementation on prescription-<jats:italic>Fscores<\/jats:italic> which was consistent when adjusting for the confounding potential of further covariates.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>While the quality of prescription documentation generally increases with implementation of a CPOE system, certain criteria are difficult to fulfil even with the help of a CPOE system. This highlights the need to accompany a CPOE implementation with a thorough evaluation that can provide important information on possible improvements of the software, training needs of prescribers, or the necessity of modifying the underlying clinical processes.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12911-021-01607-6","type":"journal-article","created":{"date-parts":[[2021,10,11]],"date-time":"2021-10-11T09:06:16Z","timestamp":1633943176000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["The impact of a computerized physician order entry system implementation on 20 different criteria of medication documentation\u2014a before-and-after study"],"prefix":"10.1186","volume":"21","author":[{"given":"Viktoria","family":"Jungreithmayr","sequence":"first","affiliation":[]},{"given":"Andreas D.","family":"Meid","sequence":"additional","affiliation":[]},{"name":"Implementation Team","sequence":"additional","affiliation":[]},{"given":"Janina","family":"Bittmann","sequence":"additional","affiliation":[]},{"given":"Markus","family":"Fabian","sequence":"additional","affiliation":[]},{"given":"Ulrike","family":"Klein","sequence":"additional","affiliation":[]},{"given":"Silvia","family":"Kugler","sequence":"additional","affiliation":[]},{"given":"Martin","family":"L\u00f6pprich","sequence":"additional","affiliation":[]},{"given":"Oliver","family":"Reinhard","sequence":"additional","affiliation":[]},{"given":"Lucienne","family":"Scholz","sequence":"additional","affiliation":[]},{"given":"Birgit","family":"Zeeh","sequence":"additional","affiliation":[]},{"given":"Wolfgang","family":"Bitz","sequence":"additional","affiliation":[]},{"given":"Till","family":"Bugaj","sequence":"additional","affiliation":[]},{"given":"Lars","family":"Kihm","sequence":"additional","affiliation":[]},{"given":"Stefan","family":"Kopf","sequence":"additional","affiliation":[]},{"given":"Anja","family":"Liemann","sequence":"additional","affiliation":[]},{"given":"Petra","family":"Wagenlechner","sequence":"additional","affiliation":[]},{"given":"Johanna","family":"Zemva","sequence":"additional","affiliation":[]},{"given":"Claudia","family":"Benkert","sequence":"additional","affiliation":[]},{"given":"Christian","family":"Merle","sequence":"additional","affiliation":[]},{"given":"Sergej","family":"Roman","sequence":"additional","affiliation":[]},{"given":"Stefan","family":"Welte","sequence":"additional","affiliation":[]},{"given":"Walter E.","family":"Haefeli","sequence":"additional","affiliation":[]},{"given":"Hanna M.","family":"Seidling","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2021,10,11]]},"reference":[{"key":"1607_CR1","doi-asserted-by":"publisher","unstructured":"Kohn LT, Corrigan JM, Donaldson MS. Errors in health care: a leading cause of death and injury. In: To err is human: building a safer health system. National Academies Press (US). https:\/\/doi.org\/10.17226\/9728. 2000.","DOI":"10.17226\/9728"},{"issue":"6","key":"1607_CR2","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1007\/s40264-020-00918-3","volume":"43","author":"FA Alqenae","year":"2020","unstructured":"Alqenae FA, Steinke D, Keers RN. Prevalence and nature of medication errors and medication-related harm following discharge from hospital to community settings: a systematic review. Drug Saf. 2020;43(6):517\u201337.","journal-title":"Drug Saf"},{"issue":"1","key":"1607_CR3","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1001\/jama.1995.03530010043033","volume":"274","author":"DW Bates","year":"1995","unstructured":"Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, et al. Incidence of adverse drug events and potential adverse drug events\u2014implications for prevention: ADE prevention study group. JAMA. 1995;274(1):29\u201334.","journal-title":"JAMA"},{"key":"1607_CR4","unstructured":"Medication Management Guideline. Health Care Association of New Jersey. 2012. https:\/\/www.hcanj.org\/files\/2013\/09\/hcanjbp_medmgmt13_050113_1.pdf. Accessed 12 Feb 2021."},{"issue":"2","key":"1607_CR5","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1016\/j.jcrc.2013.10.016","volume":"29","author":"ER Armada","year":"2014","unstructured":"Armada ER, Villamanan E, Lopez-de-Sa E, Rosillo S, Rey-Blas JR, Testillano ML, et al. Computerized physician order entry in the cardiac intensive care unit: effects on prescription errors and workflow conditions. J Crit Care. 2014;29(2):188\u201393.","journal-title":"J Crit Care"},{"key":"1607_CR6","unstructured":"Good prescribing practice. Medical Council of New Zealand. 2020. https:\/\/www.mcnz.org.nz\/assets\/standards\/ceae513c85\/Statement-on-good-prescribing-practice.pdf. Accessed 12 Feb 2021."},{"key":"1607_CR7","unstructured":"Guidelines for Good Prescribing in Primary Care. Lancashire Medicines Management Group. 2019. https:\/\/www.lancsmmg.nhs.uk\/media\/1162\/primary-care-good-prescribing-guide-version-22.pdf. Accessed 12 Feb 2021."},{"key":"1607_CR8","unstructured":"Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes: NICE guideline [NG5]. National Institute for Health and Care Excellence (NICE). 2015. https:\/\/www.nice.org.uk\/guidance\/ng5. Accessed 12 Feb 2021."},{"issue":"15","key":"1607_CR9","doi-asserted-by":"publisher","first-page":"1311","DOI":"10.1001\/jama.280.15.1311","volume":"280","author":"DW Bates","year":"1998","unstructured":"Bates DW, Leape LL, Cullen DJ, Laird N, Petersen LA, Teich JM, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA. 1998;280(15):1311\u20136.","journal-title":"JAMA"},{"issue":"4","key":"1607_CR10","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1136\/jamia.1999.00660313","volume":"6","author":"DW Bates","year":"1999","unstructured":"Bates DW, Teich JM, Lee J, Seger D, Kuperman GJ, Ma\u2019Luf N, et al. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc JAMIA. 1999;6(4):313\u201321.","journal-title":"J Am Med Inform Assoc JAMIA"},{"issue":"1","key":"1607_CR11","doi-asserted-by":"publisher","first-page":"R21","DOI":"10.1186\/cc3983","volume":"10","author":"K Colpaert","year":"2006","unstructured":"Colpaert K, Claus B, Somers A, Vandewoude K, Robays H, Decruyenaere J. Impact of computerized physician order entry on medication prescription errors in the intensive care unit: a controlled cross-sectional trial. Critical care (London, England). 2006;10(1):R21.","journal-title":"Critical care (London, England)"},{"issue":"7","key":"1607_CR12","doi-asserted-by":"publisher","first-page":"e0134101","DOI":"10.1371\/journal.pone.0134101","volume":"10","author":"F Hernandez","year":"2015","unstructured":"Hernandez F, Majoul E, Montes-Palacios C, Antignac M, Cherrier B, Doursounian L, et al. An observational study of the impact of a computerized physician order entry system on the rate of medication errors in an orthopaedic surgery unit. PLoS ONE. 2015;10(7):e0134101.","journal-title":"PLoS ONE"},{"issue":"1","key":"1607_CR13","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1007\/s11096-018-0747-0","volume":"41","author":"N Rouayroux","year":"2019","unstructured":"Rouayroux N, Calmels V, Bachelet B, Sallerin B, Divol E. Medication prescribing errors: a pre- and post-computerized physician order entry retrospective study. Int J Clin Pharm. 2019;41(1):228\u201336.","journal-title":"Int J Clin Pharm"},{"issue":"5","key":"1607_CR14","doi-asserted-by":"publisher","first-page":"R516","DOI":"10.1186\/cc3793","volume":"9","author":"R Shulman","year":"2005","unstructured":"Shulman R, Singer M, Goldstone J, Bellingan G. Medication errors: a prospective cohort study of hand-written and computerised physician order entry in the intensive care unit. Critical care (London, England). 2005;9(5):R516\u201321.","journal-title":"Critical care (London, England)"},{"issue":"6","key":"1607_CR15","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.1136\/amiajnl-2013-001745","volume":"20","author":"JI Westbrook","year":"2013","unstructured":"Westbrook JI, Baysari MT, Li L, Burke R, Richardson KL, Day RO. The safety of electronic prescribing: manifestations, mechanisms, and rates of system-related errors associated with two commercial systems in hospitals. J Am Med Inform Assoc JAMIA. 2013;20(6):1159\u201367.","journal-title":"J Am Med Inform Assoc JAMIA"},{"issue":"2","key":"1607_CR16","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1093\/jamia\/ocw145","volume":"24","author":"M Prgomet","year":"2017","unstructured":"Prgomet M, Li L, Niazkhani Z, Georgiou A, Westbrook JI. Impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay, and mortality in intensive care units: a systematic review and meta-analysis. J Am Med Inform Assoc JAMIA. 2017;24(2):413\u201322.","journal-title":"J Am Med Inform Assoc JAMIA"},{"issue":"2","key":"1607_CR17","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1093\/jamia\/ocw119","volume":"24","author":"CL Brown","year":"2017","unstructured":"Brown CL, Mulcaster HL, Triffitt KL, Sittig DF, Ash JS, Reygate K, et al. A systematic review of the types and causes of prescribing errors generated from using computerized provider order entry systems in primary and secondary care. J Am Med Inform Assoc JAMIA. 2017;24(2):432\u201340.","journal-title":"J Am Med Inform Assoc JAMIA"},{"issue":"10","key":"1607_CR18","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.1001\/jama.293.10.1197","volume":"293","author":"R Koppel","year":"2005","unstructured":"Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE, et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA. 2005;293(10):1197\u2013203.","journal-title":"JAMA"},{"key":"1607_CR19","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.ijmedinf.2017.12.022","volume":"111","author":"V Korb-Savoldelli","year":"2018","unstructured":"Korb-Savoldelli V, Boussadi A, Durieux P, Sabatier B. Prevalence of computerized physician order entry systems-related medication prescription errors: a systematic review. Int J Med Informatics. 2018;111:112\u201322.","journal-title":"Int J Med Informatics"},{"issue":"4","key":"1607_CR20","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1007\/s11096-013-9771-2","volume":"35","author":"E Villamanan","year":"2013","unstructured":"Villamanan E, Larrubia Y, Ruano M, Velez M, Armada E, Herrero A, et al. Potential medication errors associated with computer prescriber order entry. Int J Clin Pharm. 2013;35(4):577\u201383.","journal-title":"Int J Clin Pharm"},{"key":"1607_CR21","unstructured":"Gute Verordnungspraxis in der Arzneimitteltherapie. Aktionsb\u00fcndnis Patientensicherheit e.V. 2020. https:\/\/www.aps-ev.de\/handlungsempfehlungen\/. Accessed 12 Feb 2021."},{"issue":"7","key":"1607_CR22","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1080\/0266476042000214501","volume":"31","author":"S Ferrari","year":"2004","unstructured":"Ferrari S, Cribari-Neto F. Beta regression for modelling rates and proportions. J Appl Stat. 2004;31(7):799\u2013815.","journal-title":"J Appl Stat"},{"issue":"1","key":"1607_CR23","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1037\/1082-989X.11.1.54","volume":"11","author":"M Smithson","year":"2006","unstructured":"Smithson M, Verkuilen J. A better lemon squeezer? Maximum-likelihood regression with beta-distributed dependent variables. Psychol Methods. 2006;11(1):54\u201371.","journal-title":"Psychol Methods"},{"issue":"1","key":"1607_CR24","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1080\/15427600903578136","volume":"7","author":"D Zimprich","year":"2010","unstructured":"Zimprich D. Modeling change in skewed variables using mixed beta regression models. Res Hum Dev. 2010;7(1):9\u201326.","journal-title":"Res Hum Dev"},{"issue":"1","key":"1607_CR25","doi-asserted-by":"publisher","first-page":"82","DOI":"10.3102\/1076998610396895","volume":"37","author":"J Verkuilen","year":"2012","unstructured":"Verkuilen J, Smithson M. Mixed and mixture regression models for continuous bounded responses using the beta distribution. J Educ Behav Stat. 2012;37(1):82\u2013113.","journal-title":"J Educ Behav Stat"},{"issue":"1","key":"1607_CR26","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1007\/s00038-016-0901-1","volume":"62","author":"M Te Grotenhuis","year":"2017","unstructured":"Te Grotenhuis M, Pelzer B, Eisinga R, Nieuwenhuis R, Schmidt-Catran A, Konig R. When size matters: advantages of weighted effect coding in observational studies. Int J Public Health. 2017;62(1):163\u20137.","journal-title":"Int J Public Health"},{"issue":"7","key":"1607_CR27","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1093\/oxfordjournals.aje.a009511","volume":"147","author":"FB Hu","year":"1998","unstructured":"Hu FB, Goldberg J, Hedeker D, Flay BR, Pentz MA. Comparison of population-averaged and subject-specific approaches for analyzing repeated binary outcomes. Am J Epidemiol. 1998;147(7):694\u2013703.","journal-title":"Am J Epidemiol"},{"issue":"7","key":"1607_CR28","doi-asserted-by":"publisher","first-page":"e15653","DOI":"10.2196\/15653","volume":"8","author":"TN Poly","year":"2020","unstructured":"Poly TN, Islam MM, Yang HC, Li YJ. Appropriateness of overridden alerts in computerized physician order entry: systematic review. JMIR Med Inform. 2020;8(7):e15653.","journal-title":"JMIR Med Inform"},{"issue":"10","key":"1607_CR29","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1007\/s00228-017-2274-7","volume":"73","author":"PR Mills","year":"2017","unstructured":"Mills PR, Weidmann AE, Stewart D. Hospital electronic prescribing system implementation impact on discharge information communication and prescribing errors: a before and after study. Eur J Clin Pharmacol. 2017;73(10):1279\u201386.","journal-title":"Eur J Clin Pharmacol"},{"issue":"9","key":"1607_CR30","doi-asserted-by":"publisher","first-page":"e2","DOI":"10.1136\/archdischild-2016-311535.20","volume":"101","author":"A Tsyben","year":"2016","unstructured":"Tsyben A, Gooding N, Kelsall W. Assessing the impact of a newly introduced electronic prescribing system across a paediatric department: lessons learned. Arch Dis Childhood. 2016;101(9):e2.","journal-title":"Arch Dis Childhood."},{"issue":"3","key":"1607_CR31","doi-asserted-by":"publisher","first-page":"e19","DOI":"10.1111\/j.1445-5994.2011.02697.x","volume":"42","author":"MJ Dooley","year":"2012","unstructured":"Dooley MJ, Wiseman M, Gu G. Prevalence of error-prone abbreviations used in medication prescribing for hospitalised patients: multi-hospital evaluation. Intern Med J. 2012;42(3):e19-22.","journal-title":"Intern Med J"},{"key":"1607_CR32","unstructured":"ISMP List of error-prone abbreviations, symbols and dose designations. Institute for Safe Medication Practices. 2021. https:\/\/www.ismp.org\/recommendations\/error-prone-abbreviations-list. Accessed 15 Feb 2021."},{"issue":"4","key":"1607_CR33","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1197\/jamia.M2419","volume":"16","author":"Z Niazkhani","year":"2009","unstructured":"Niazkhani Z, Pirnejad H, Berg M, Aarts J. The impact of computerized provider order entry systems on inpatient clinical workflow: a literature review. J Am Med Inform Assoc JAMIA. 2009;16(4):539\u201349.","journal-title":"J Am Med Inform Assoc JAMIA"},{"issue":"10","key":"1607_CR34","doi-asserted-by":"publisher","first-page":"908","DOI":"10.1111\/j.1553-2712.2008.00235.x","volume":"15","author":"PV Asaro","year":"2008","unstructured":"Asaro PV, Boxerman SB. Effects of computerized provider order entry and nursing documentation on workflow. Acad Emerg Med Off J Soc Acad Emerg Med. 2008;15(10):908\u201315.","journal-title":"Acad Emerg Med Off J Soc Acad Emerg Med"},{"issue":"5","key":"1607_CR35","doi-asserted-by":"publisher","first-page":"1928","DOI":"10.1111\/1475-6773.12581","volume":"52","author":"KM Cresswell","year":"2017","unstructured":"Cresswell KM, Lee L, Mozaffar H, Williams R, Sheikh A. Sustained user engagement in health information technology: the long road from implementation to system optimization of computerized physician order entry and clinical decision support systems for prescribing in hospitals in England. Health Serv Res. 2017;52(5):1928\u201357.","journal-title":"Health Serv Res"},{"issue":"4","key":"1607_CR36","doi-asserted-by":"publisher","first-page":"268","DOI":"10.7326\/M16-2607","volume":"167","author":"TJ VanderWeele","year":"2017","unstructured":"VanderWeele TJ, Ding P. Sensitivity analysis in observational research: introducing the E-value. Ann Intern Med. 2017;167(4):268\u201374.","journal-title":"Ann Intern Med"}],"container-title":["BMC Medical Informatics and Decision Making"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-021-01607-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12911-021-01607-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-021-01607-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,11]],"date-time":"2021-10-11T09:08:40Z","timestamp":1633943320000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedinformdecismak.biomedcentral.com\/articles\/10.1186\/s12911-021-01607-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,11]]},"references-count":36,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1607"],"URL":"https:\/\/doi.org\/10.1186\/s12911-021-01607-6","relation":{},"ISSN":["1472-6947"],"issn-type":[{"value":"1472-6947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,11]]},"assertion":[{"value":"29 April 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 August 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 October 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the responsible Ethics Committee of the Medical Faculty of Heidelberg (S-453\/2019). Informed consent was not applicable due to the retrospective nature of the data analysis.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Hanna M. Seidling is a member of the Editorial Board of BMC Medical Informatics and Decision Making. The authors declare that they have no further competing interests with regard to this work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"279"}}