Evidence map›Paper›PMID 33502331›Full record

ArticleJMIR medical informatics2021

Assessing the International Transferability of a Machine Learning Model for Detecting Medication Error in the General Internal Medicine Clinic: Multicenter Preliminary Validation Study.

Yen Po Harvey Chin, Wenyu Song, Chia En Lien, Chang Ho Yoon, Wei-Chen Wang, Jennifer Liu, Phung Anh Nguyen, Yi Ting Feng, Li Zhou, Yu Chuan Jack Li and 1 more

Abstract read
In one paragraph

Article in JMIR medical informatics, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Yen Po Harvey ChinDepartment of Biomedical Informatics, Harvard Medical School, Boston, MA, United States.ORCID https://orcid.org/0000-0001-8659-4046
Wenyu SongDepartment of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.ORCID https://orcid.org/0000-0001-6146-4093
Chia En LienDoctor of Public Health Program, Harvard TH Chan School of Public Health, Boston, MA, United States.ORCID https://orcid.org/0000-0003-4703-6628
Chang Ho YoonDepartment of Biomedical Informatics, Harvard Medical School, Boston, MA, United States.ORCID https://orcid.org/0000-0003-1356-0392
Wei-Chen WangDepartment of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, United States.ORCID https://orcid.org/0000-0002-9568-1069
Jennifer LiuDepartment of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.ORCID https://orcid.org/0000-0002-6606-7334
Phung Anh NguyenCollege of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei City, Taiwan.ORCID https://orcid.org/0000-0002-7436-9041
Yi Ting FengCollege of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei City, Taiwan.ORCID https://orcid.org/0000-0002-7271-1464
Li ZhouDivision of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.ORCID https://orcid.org/0000-0003-3998-8725
Yu Chuan Jack Li *Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei City, Taiwan.ORCID https://orcid.org/0000-0001-6497-4232
David Westfall Bates *Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.ORCID https://orcid.org/0000-0001-6268-1540

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAlthough most current medication error prevention systems are rule-based, these systems may result in alert fatigue because of poor accuracy. Previously, we had developed a machine learning (ML) model based on Taiwan's local databases (TLD) to address this issue. However, the international transferability of this model is unclear.

objectiveThis study examines the international transferability of a machine learning model for detecting medication errors and whether the federated learning approach could further improve the accuracy of the model.

methodsThe study cohort included 667,572 outpatient prescriptions from 2 large US academic medical centers. Our ML model was applied to build the original model (O model), the local model (L model), and the hybrid model (H model). The O model was built using the data of 1.34 billion outpatient prescriptions from TLD. A validation set with 8.98% (60,000/667,572) of the prescriptions was first randomly sampled, and the remaining 91.02% (607,572/667,572) of the prescriptions served as the local training set for the L model. With a federated learning approach, the H model used the association values with a higher frequency of co-occurrence among the O and L models. A testing set with 600 prescriptions was classified as substantiated and unsubstantiated by 2 independent physician reviewers and was then used to assess model performance.

resultsThe interrater agreement was significant in terms of classifying prescriptions as substantiated and unsubstantiated (κ=0.91; 95% CI 0.88 to 0.95). With thresholds ranging from 0.5 to 1.5, the alert accuracy ranged from 75%-78% for the O model, 76%-78% for the L model, and 79%-85% for the H model.

conclusionsOur ML model has good international transferability among US hospital data. Using the federated learning approach with local hospital data could further improve the accuracy of the model.

Indexed as

clinical decision supportelectronic health recordsmachine learningmedication alert systemspatient safety

Identifiers

PMID33502331
PMCPMC7875695

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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.