DOI: 10.1101/19013029Nov 27, 2019Paper

An application of machine learning to assist medication order review by pharmacists in a health care center

MedRxiv : the Preprint Server for Health Sciences
Maxime Thibault, D. Lebel

Abstract

The objective of this study was to determine if it is feasible to use machine learning to evaluate how a medication order is contextually appropriate for a patient, in order to assist order review by pharmacists. A neural network was constructed using as input the sequence of word2vec embeddings of the 30 previous orders, as well as the currently active medications, pharmacological classes and ordering department, to predict the next order. The model was trained with data from 2013 to 2017, optimized using 5-fold cross-validation, and tested on orders from 2018. A survey was developed to obtain pharmacist ratings on a sample of 20 orders, which were compared with predictions. The training set included 1 022 272 orders. The test set included 95 310 orders. Baseline training set top 1, top 10 and top 30 accuracy using a dummy classifier were respectively 4.5\%, 23.6\% and 44.1\%. Final test set accuracies were, respectively, 44.4\%, 69.9\% and 80.4\%. Populations in which the model performed the best were obstetrics and gynecology patients and newborn babies (either in or out of neonatal intensive care). Pharmacists agreed poorly on their ratings of sampled orders with a Fleiss kappa of 0.283. The breakdown of metrics by populati...Continue Reading

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