• Donald A Szlosek and Jonathan Ferrett.
• Muskie School of Public Service, University of Southern Maine.
• EGEMS (Wash DC). 2016 Jan 1; 4 (3): 1222.

IntroductionAs the number of clinical decision support systems (CDSSs) incorporated into electronic medical records (EMRs) increases, so does the need to evaluate their effectiveness. The use of medical record review and similar manual methods for evaluating decision rules is laborious and inefficient. The authors use machine learning and Natural Language Processing (NLP) algorithms to accurately evaluate a clinical decision support rule through an EMR system, and they compare it against manual evaluation.MethodsModeled after the EMR system EPIC at Maine Medical Center, we developed a dummy data set containing physician notes in free text for 3,621 artificial patients records undergoing a head computed tomography (CT) scan for mild traumatic brain injury after the incorporation of an electronic best practice approach. We validated the accuracy of the Best Practice Advisories (BPA) using three machine learning algorithms-C-Support Vector Classification (SVC), Decision Tree Classifier (DecisionTreeClassifier), k-nearest neighbors classifier (KNeighborsClassifier)-by comparing their accuracy for adjudicating the occurrence of a mild traumatic brain injury against manual review. We then used the best of the three algorithms to evaluate the effectiveness of the BPA, and we compared the algorithm's evaluation of the BPA to that of manual review.ResultsThe electronic best practice approach was found to have a sensitivity of 98.8 percent (96.83-100.0), specificity of 10.3 percent, PPV = 7.3 percent, and NPV = 99.2 percent when reviewed manually by abstractors. Though all the machine learning algorithms were observed to have a high level of prediction, the SVC displayed the highest with a sensitivity 93.33 percent (92.49-98.84), specificity of 97.62 percent (96.53-98.38), PPV = 50.00, NPV = 99.83. The SVC algorithm was observed to have a sensitivity of 97.9 percent (94.7-99.86), specificity 10.30 percent, PPV 7.25 percent, and NPV 99.2 percent for evaluating the best practice approach, after accounting for 17 cases (0.66 percent) where the patient records had to be reviewed manually due to the NPL systems inability to capture the proper diagnosis.DiscussionCDSSs incorporated into EMRs can be evaluated in an automatic fashion by using NLP and machine learning techniques.

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