A machine learning–based clinical decision support system to identify prescriptions with a high risk of medication error

TLDR

The study aimed to evaluate a hybrid clinical decision support system for prioritizing prescription checks to reduce prescribing errors and improve patient safety. Using 10,716 patients and 133,179 orders, the hybrid system combined machine learning and rule‑based scoring of 25 features, and its predictions were validated by pharmacists over a 2‑week period and compared to existing CDS alerts and multicriteria queries. In validation, the hybrid system achieved AUROC 0.81 and AUPRC 0.75, outperforming the CDS system (0.65/0.56) and multicriteria query (0.68/0.56), demonstrating higher accuracy in detecting prescription errors.

Abstract

Abstract Objective To improve patient safety and clinical outcomes by reducing the risk of prescribing errors, we tested the accuracy of a hybrid clinical decision support system in prioritizing prescription checks. Materials and Methods Data from electronic health records were collated over a period of 18 months. Inferred scores at a patient level (probability of a patient’s set of active orders to require a pharmacist review) were calculated using a hybrid approach (machine learning and a rule-based expert system). A clinical pharmacist analyzed randomly selected prescription orders over a 2-week period to corroborate our findings. Predicted scores were compared with the pharmacist’s review using the area under the receiving-operating characteristic curve and area under the precision-recall curve. These metrics were compared with existing tools: computerized alerts generated by a clinical decision support (CDS) system and a literature-based multicriteria query prioritization technique. Data from 10 716 individual patients (133 179 prescription orders) were used to train the algorithm on the basis of 25 features in a development dataset. Predicted scores were compared with the pharmacist’s review using the area under the receiving-operating characteristic and precision-recall curves of our digital system were 0.81 and 0.75, respectively, thus demonstrating greater accuracy than the CDS system (0.65 and 0.56, respectively) and multicriteria query techniques (0.68 and 0.56, respectively). Results While the pharmacist analyzed 412 individual patients (3364 prescription orders) in an independent validation dataset, the areas under the receiving-operating characteristic and precision-recall curves of our digital system were 0.81 and 0.75, respectively, thus demonstrating greater accuracy than the CDS system (0.65 and 0.56, respectively) and multicriteria query techniques (0.68 and 0.56, respectively). Discussion Our innovative digital tool was notably more accurate than existing techniques (CDS system and multicriteria query) at intercepting potential prescription errors. Conclusions By primarily targeting high-risk patients, this novel hybrid decision support system improved the accuracy and reliability of prescription checks in a hospital setting.