ArticleJournal of the American Medical Informatics Association : JAMIA2016
OrderRex: clinical order decision support and outcome predictions by data-mining electronic medical records.
Article in Journal of the American Medical Informatics Association : JAMIA, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
29 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Use of electronic medical records in development and validation of risk prediction models of hospital readmission: systematic review.BMJ (Clinical research ed.) · 2020Pooled it
- Use of predictive algorithms in-home monitoring of chronic obstructive pulmonary disease and asthma: A systematic review.Chronic respiratory disease · 2016Pooled it
- OrderRex clinical user testing: a randomized trial of recommender system decision support on simulated cases.Journal of the American Medical Informatics Association : JAMIA · 2020Trial
- Monitoring strategies for continuous evaluation of deployed clinical prediction models.Journal of biomedical informatics · 2025Article
- Identifying time patterns in Huntington's disease trajectories using dynamic time warping-based clustering on multi-modal data.Scientific reports · 2025Article
- Exploring long-term breast cancer survivors' care trajectories using dynamic time warping-based unsupervised clustering.Journal of the American Medical Informatics Association : JAMIA · 2024Article
- Article
- A voice-based digital assistant for intelligent prompting of evidence-based practices during ICU rounds.Journal of biomedical informatics · 2023Article
- DEPLOYR: a technical framework for deploying custom real-time machine learning models into the electronic medical record.Journal of the American Medical Informatics Association : JAMIA · 2023Article
- Graph-based clinical recommender: Predicting specialists procedure orders using graph representation learning.Journal of biomedical informatics · 2023Article
- Avoiding Biased Clinical Machine Learning Model Performance Estimates in the Presence of Label Selection.AMIA Joint Summits on Translational Science proceedings. AMIA Joint Summits on Translational Science · 2023Article
- Impact of computerised provider order entry on the quality and quantity of clinical information included with investigation requests: an interrupted time series analysis.BMJ open quality · 2023Article
- A Data-Driven Algorithm to Recommend Initial Clinical Workup for Outpatient Specialty Referral: Algorithm Development and Validation Using Electronic Health Record Data and Expert Surveys.JMIR medical informatics · 2022Article
- First-step validation of a text message-based application for newborn clinical management among pediatricians.BMC pediatrics · 2020Article
- The bird's-eye view: A data-driven approach to understanding patient journeys from claims data.Journal of the American Medical Informatics Association : JAMIA · 2020Article
- Predicting Inpatient Medication Orders From Electronic Health Record Data.Clinical pharmacology and therapeutics · 2020Article
- Article
- Physician Usage and Acceptance of a Machine Learning Recommender System for Simulated Clinical Order Entry.AMIA Joint Summits on Translational Science proceedings. AMIA Joint Summits on Translational Science · 2020Article
- A virtual molecular tumor board to improve efficiency and scalability of delivering precision oncology to physicians and their patients.JAMIA open · 2019Article
- Predicting emergency department orders with multilabel machine learning techniques and simulating effects on length of stay.Journal of the American Medical Informatics Association : JAMIA · 2019Article
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
objectiveTo answer a "grand challenge" in clinical decision support, the authors produced a recommender system that automatically data-mines inpatient decision support from electronic medical records (EMR), analogous to Netflix or Amazon.com's product recommender. MATERIALS AND
methodsEMR data were extracted from 1 year of hospitalizations (>18K patients with >5.4M structured items including clinical orders, lab results, and diagnosis codes). Association statistics were counted for the ∼1.5K most common items to drive an order recommender. The authors assessed the recommender's ability to predict hospital admission orders and outcomes based on initial encounter data from separate validation patients.
resultsCompared to a reference benchmark of using the overall most common orders, the recommender using temporal relationships improves precision at 10 recommendations from 33% to 38% (P < 10(-10)) for hospital admission orders. Relative risk-based association methods improve inverse frequency weighted recall from 4% to 16% (P < 10(-16)). The framework yields a prediction receiver operating characteristic area under curve (c-statistic) of 0.84 for 30 day mortality, 0.84 for 1 week need for ICU life support, 0.80 for 1 week hospital discharge, and 0.68 for 30-day readmission. DISCUSSION: Recommender results quantitatively improve on reference benchmarks and qualitatively appear clinically reasonable. The method assumes that aggregate decision making converges appropriately, but ongoing evaluation is necessary to discern common behaviors from "correct" ones.
conclusionsCollaborative filtering recommender algorithms generate clinical decision support that is predictive of real practice patterns and clinical outcomes. Incorporating temporal relationships improves accuracy. Different evaluation metrics satisfy different goals (predicting likely events vs. "interesting" suggestions).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.