Using machine learning to develop smart reflex testing protocols.
J Am Med Inform Assoc
; 31(2): 416-425, 2024 Jan 18.
Article
em En
| MEDLINE
| ID: mdl-37812770
ABSTRACT
OBJECTIVE:
Reflex testing protocols allow clinical laboratories to perform second line diagnostic tests on existing specimens based on the results of initially ordered tests. Reflex testing can support optimal clinical laboratory test ordering and diagnosis. In current clinical practice, reflex testing typically relies on simple "if-then" rules; however, this limits the opportunities for reflex testing since most test ordering decisions involve more complexity than traditional rule-based approaches would allow. Here, using the analyte ferritin as an example, we propose an alternative machine learning-based approach to "smart" reflex testing.METHODS:
Using deidentified patient data, we developed a machine learning model to predict whether a patient getting CBC testing will also have ferritin testing ordered. We evaluate applications of this model to reflex testing by assessing its performance in comparison to possible rule-based approaches.RESULTS:
Our underlying machine learning models performed moderately well in predicting ferritin test ordering (AUC=0.731 in reference to actual ordering) and demonstrated promising potential to underlie key clinical applications. In contrast, none of the many traditionally framed, rule-based, hypothetical reflex protocols we evaluated offered sufficient agreement with actual ordering to be clinically feasible. Using chart review, we further demonstrated that the strategic deployment of our model could avoid important ferritin test ordering errors.CONCLUSIONS:
Machine learning may provide a foundation for new types of reflex testing with enhanced benefits for clinical diagnosis.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Reflexo
/
Aprendizado de Máquina
Tipo de estudo:
Guideline
/
Prognostic_studies
Limite:
Humans
Idioma:
En
Revista:
J Am Med Inform Assoc
Assunto da revista:
INFORMATICA MEDICA
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Estados Unidos