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Record W4296471666 · doi:10.1093/jamia/ocac143

Computer clinical decision support that automates personalized clinical care: a challenging but needed healthcare delivery strategy

2022· article· en· W4296471666 on OpenAlexaff
Alan H. Morris, Christopher M. Horvat, Brian C. Stagg, David W. Grainger, Michael J. Lanspa, James F. Orme, Terry P. Clemmer, Lindell K. Weaver, Frank O Thomas, Colin K. Grissom, Ellie Hirshberg, Thomas D. East, C. Jane Wallace, Michael Young, Dean F. Sittig, Mary R. Suchyta, James E. Pearl, Antinio Pesenti, Michela Bombino, Eduardo Beck, Katherine Sward, Charlene Weir, Shobha Phansalkar, Gordon R. Bernard, Bruce Thompson, Roy G. Brower, Jonathon D. Truwit, Jay S. Steingrub, R Duncan Hiten, Douglas F. Willson, Jerry J. Zimmerman, Vinay Nadkarni, Adrienne G. Randolph, Martha A. Q. Curley, Christopher J. L. Newth, Jacques Lacroix, Michael S. D. Agus, Kang Hoe Lee, Bennett P. deBoisblanc, Frederick A. Moore, R. Scott Evans, Dean Sorenson, Anthony Wong, Michael V. Boland, W. Dere, Alan S. Crandall, Julio C. Facelli, Stanley M. Huff, Peter J. Haug, Ulrike Pielmeier, Stephen Edward Rees, Dan Stieper Karbing, Steen Andreassen, Eddy Fan, Roberta M. Goldring, Kenneth I. Berger, Beno W. Oppenheimer, E. Wesley Ely, Brian W. Pickering, David Schoenfeld, Irena Tocino, Russell S. Gonnering, Peter J. Pronovost, Lucy A. Savitz, Didier Dreyfuss, Arthur S. Slutsky, James D. Crapo, Michael R. Pinsky, Brent C. James, Donald M. Berwick

Bibliographic record

VenueJournal of the American Medical Informatics Association · 2022
Typearticle
Languageen
FieldHealth Professions
TopicElectronic Health Records Systems
Canadian institutionsUniversity of TorontoSt. Michael's HospitalUniversité de Montréal
FundersNational Center for Advancing Translational SciencesNational Eye InstituteNational Heart, Lung, and Blood InstituteNational Institutes of Health
KeywordsHealthcare deliveryHealth careClinical decision support systemDecision support systemComputer sciencePersonalized medicineClinical decision makingHealth care deliveryMedicineArtificial intelligenceIntensive care medicineBioinformatics

Abstract

fetched live from OpenAlex

How to deliver best care in various clinical settings remains a vexing problem. All pertinent healthcare-related questions have not, cannot, and will not be addressable with costly time- and resource-consuming controlled clinical trials. At present, evidence-based guidelines can address only a small fraction of the types of care that clinicians deliver. Furthermore, underserved areas rarely can access state-of-the-art evidence-based guidelines in real-time, and often lack the wherewithal to implement advanced guidelines. Care providers in such settings frequently do not have sufficient training to undertake advanced guideline implementation. Nevertheless, in advanced modern healthcare delivery environments, use of eActions (validated clinical decision support systems) could help overcome the cognitive limitations of overburdened clinicians. Widespread use of eActions will require surmounting current healthcare technical and cultural barriers and installing clinical evidence/data curation systems. The authors expect that increased numbers of evidence-based guidelines will result from future comparative effectiveness clinical research carried out during routine healthcare delivery within learning healthcare systems.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.

How this classification was reachedexpand

Full frame distilled prediction

Teacher imitation

Not calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.

metaresearch head score (Codex)0.025
metaresearch head score (Gemma)0.003
Version: codex-gemma-dda1882f352aValidation status: machine_predicted_unvalidated
Candidate categoriesScience and technology studies, Research integrity
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Observational · Consensus signal: none
GenreCandidate signal: Empirical · Consensus signal: Empirical
Teacher disagreement score0.369
Threshold uncertainty score1.000

Codex and Gemma teacher scores by category

CategoryCodexGemma
Metaresearch0.0250.003
Meta-epidemiology (narrow)0.0000.000
Meta-epidemiology (broad)0.0010.001
Bibliometrics0.0000.001
Science and technology studies0.0010.000
Scholarly communication0.0000.000
Open science0.0010.001
Research integrity0.0000.005
Insufficient payload (model declined to judge)0.0000.000

Machine scores (provisional)

The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.

Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.

Opus teacher head0.080
GPT teacher head0.471
Teacher spread0.391 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one teacher head, not a consensus.

Study designObservational
Domainnot available
GenreEmpirical

How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".

Quick stats

Citations19
Published2022
Admission routes1
Has abstractyes

Explore more

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