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Accurate and efficient identification of complex chronic conditions in the electronic health record (EHR) is an important but challenging task that has historically relied on tedious clinician review and oversimplification of the disease. Here we adapt methods that allow for automated "noisy labeling" of positive and negative controls to create a "silver standard" for machine learning to automate identification of systemic lupus erythematosus (SLE). Our final model, which includes both structured data as well as text processing of clinical notes, outperformed all existing algorithms for SLE (AUC 0.97). In addition, we demonstrate how the probabilistic outputs of this model can be adapted to various clinical needs, selecting high thresholds when specificity is the priority and lower thresholds when a more inclusive patient population is desired. Deploying a similar methodology to other complex diseases has the potential to dramatically simplify the landscape of population identification in the EHR.Mesh termsElectronic Health Records, Machine Learning, Lupus Erythematosus, Phenotype, Algorithms.

Objective: To analyze the impact of factors in healthcare delivery on the net benefit of triggering an Advanced Care Planning (ACP) workflow based on predictions of 12-month mortality.Materials and Methods: We built a predictive model of 12-month mortality using electronic health record data and evaluated the impact of healthcare delivery factors on the net benefit of triggering an ACP workflow based on the models' predictions. Factors included nonclinical reasons that make ACP inappropriate: limited capacity for ACP, inability to follow up due to patient discharge, and availability of an outpatient workflow to follow up on missed cases. We also quantified the relative benefits of increasing capacity for inpatient ACP versus outpatient ACP.Results: Work capacity constraints and discharge timing can significantly reduce the net benefit of triggering the ACP workflow based on a model's predictions. However, the reduction can be mitigated by creating an outpatient ACP workflow. Given limited resources to either add capacity for inpatient ACP versus developing outpatient ACP capability, the latter is likely to provide more benefit to patient care.Discussion: The benefit of using a predictive model for identifying patients for interventions is highly dependent on the capacity to execute the workflow triggered by the model. We provide a framework for quantifying the impact of healthcare delivery factors and work capacity constraints on achieved benefit.Conclusion: An analysis of the sensitivity of the net benefit realized by a predictive model triggered clinical workflow to various healthcare delivery factors is necessary for making predictive models useful in practice. [ABSTRACT FROM AUTHOR]