Machine learning and artificial intelligence: applications in healthcare epidemiology
Open accessAbstract
Artificial intelligence (AI) refers to the performance of tasks by machines ordinarily associated with human intelligence. Machine learning (ML) is a subtype of AI; it refers to the ability of computers to draw conclusions (ie, learn) from data without being directly programmed. ML builds from traditional statistical methods and has drawn significant interest in healthcare epidemiology due to its potential for improving disease prediction and patient care. This review provides an overview of ML in healthcare epidemiology and practical examples of ML tools used to support healthcare decision making at 4 stages of hospital-based care: triage, diagnosis, treatment, and discharge. Examples include model-building efforts to assist emergency department triage, predicting time before septic shock onset, detecting community-acquired pneumonia, and classifying COVID-19 disposition risk level. Increasing availability and quality of electronic health record (EHR) data as well as computing power provides opportunities for ML to increase patient safety, improve the efficiency of clinical management, and reduce healthcare costs.
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The Hinson et al. tool was rapidly integrated into clinical practice within the Johns Hopkins Health System, contributing to more consistent and reliable disposition decisions and improved bed allocation during the COVID-19 pandemic.
“This tool was rapidly integrated into clinical practice to support care decisions within the Johns Hopkins Health System, contributing to more consistent and reliable disposition decision and improved bed allocation during the pandemic [26].”
From Integrating machine learning and artificial intelligence in life-course epidemiology: pathways to innovative public health solutions (2024) · cites this paper as [26]
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Cites
Regression Models and Life-Tables
Cox, D. R. (1972) · Journal of the Royal Statistical Society Series B: Statistical Methodology · doi:10.1111/j.2517-6161.1972.tb00899.x · Cited by 39,793 · see citing works
Regression Models and Life-Tables
Cox, D. R. (1992) · Springer Series in Statistics · doi:10.1007/978-1-4612-4380-9_37 · Cited by 26,297 · see citing works
The Elements of Statistical Learning
Hastie, T., Tibshirani, R., & Friedman, J. (2009) · Springer Series in Statistics · doi:10.1007/978-0-387-84858-7 · Cited by 25,970 · see citing works
An Introduction to Statistical Learning
James, G., Witten, D., Hastie, T., & Tibshirani, R. (2013) · Springer Texts in Statistics · doi:10.1007/978-1-4614-7138-7 · Cited by 12,106 · see citing works
Early goal-directed therapy in the treatment of severe sepsis and septic shock
Rivers, E., Nguyen, B., Havstad, S., Ressler, J., Muzzin, A., Knoblich, B., Peterson, E., & Tomlanovich, M. (2001) · New England Journal of Medicine · doi:10.1056/nejmoa010307 · Cited by 10,743 · see citing works
I.—COMPUTING MACHINERY AND INTELLIGENCE
TURING, A. M. (1950) · Mind · doi:10.1093/mind/lix.236.433 · Cited by 10,290 · cited 5× · see citing works
“53 Implementation of alerts, such as the sepsis alert described above, have 2 implementation issues: (1) they need to be specific enough to avoid alert fatigue and (2) they need to be implemented in a way that does not disrupt provider work flow.”
InfluentialAngus, D. C., Linde-Zwirble, W. T., Lidicker, J., Clermont, G., Carcillo, J., & Pinsky, M. R. (2001) · Critical Care Medicine · doi:10.1097/00003246-200107000-00002 · Cited by 8,503 · see citing works
Computing Machinery and Intelligence (1950)
Turing, A. M. (2004) · doi:10.1093/oso/9780198250791.003.0017 · Cited by 6,120 · see citing works
Some Studies in Machine Learning Using the Game of Checkers
Samuel, A. L. (1959) · IBM Journal of Research and Development · doi:10.1147/rd.33.0210 · Cited by 4,443 · see citing works
Statistical Modeling: The Two Cultures (with comments and a rejoinder by the author)
Breiman, L. (2001) · Statistical Science · doi:10.1214/ss/1009213726 · Cited by 4,340 · see citing works
An overview of clinical decision support systems: Benefits, risks, and strategies for success
Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020) · npj Digital Medicine · doi:10.1038/s41746-020-0221-y · Cited by 3,019 · see citing works
Statistics versus machine learning
Bzdok, D., Altman, N., & Krzywinski, M. (2018) · Nature Methods · doi:10.1038/nmeth.4642 · Cited by 1,508 · see citing works
Machine Learning and Health Care Disparities in Dermatology
Adamson, A. S., & Smith, A. (2018) · JAMA Dermatology · doi:10.1001/jamadermatol.2018.2348 · Cited by 639 · see citing works
Nationwide Trends of Severe Sepsis in the 21st Century (2000–2007)
Kumar, G., Kumar, N., Taneja, A., Kaleekal, T. S., Tarima, S. S., McGinley, E. L., Jimenez, E. J., Mohan, A., Khan, R. A., Whittle, J., et al. (2011) · CHEST Journal · doi:10.1378/chest.11-0352 · Cited by 615 · see citing works
A targeted real-time early warning score (TREWScore) for septic shock.
Henry, K. E., Hager, D. N., Pronovost, P. J., & Saria, S. (2015) · Science Translational Medicine · doi:10.1126/scitranslmed.aab3719 · Cited by 598 · see citing works
Grand challenges in clinical decision support
Sittig, D. F., Wright, A., Osheroff, J. A., Middleton, B., Teich, J. M., Ash, J. S., Campbell, E., & Bates, D. W. (2008) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2007.09.003 · Cited by 582 · see citing works
Machine Learning for Healthcare: On the Verge of a Major Shift in Healthcare Epidemiology
Wiens, J., & Shenoy, E. S. (2018) · Clinical Infectious Diseases · doi:10.1093/cid/cix731 · Cited by 574 · see citing works
Nguyen, H. B., Corbett, S. W., Steele, R., Banta, J., Clark, R. T., Hayes, S. R., Edwards, J., Cho, T. W., & Wittlake, W. A. (2007) · Critical Care Medicine · doi:10.1097/01.ccm.0000259463.33848.3d · Cited by 555 · see citing works
What is Machine Learning? A Primer for the Epidemiologist
Bi, Q., Goodman, K. E., Kaminsky, J., & Lessler, J. (2019) · American Journal of Epidemiology · doi:10.1093/aje/kwz189 · Cited by 522 · see citing works
Burden of Community-Acquired Pneumonia in North American Adults
File, T. M., & Marrie, T. J. (2010) · Postgraduate Medicine · doi:10.3810/pgm.2010.03.2130 · Cited by 472 · see citing works
Levin, S., Toerper, M., Hamrock, E., Hinson, J. S., Barnes, S., Gardner, H., Dugas, A., Linton, B., Kirsch, T., & Kelen, G. (2018) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2017.08.005 · Cited by 424 · see citing works
Self-citationMcCarthy, M. L., Zeger, S. L., Ding, R., Levin, S. R., Desmond, J. S., Lee, J., & Aronsky, D. (2009) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2009.03.006 · Cited by 367 · see citing works
Self-citationAustin, P. C., Tu, J. V., Ho, J. E., Levy, D. A., & Lee, D. S. (2013) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2012.11.008 · Cited by 340 · see citing works
Reasons For Physicians Not Adopting Clinical Decision Support Systems: Critical Analysis
Khairat, S., Marc, D. T., Crosby, W., & Sanousi, A. A. (2018) · JMIR Medical Informatics · doi:10.2196/medinform.8912 · Cited by 336 · see citing works
Triage Performance in Emergency Medicine: A Systematic Review
Hinson, J. S., Martínez, D. A., Cabral, S., George, K., Whalen, M. M., Hansoti, B., & Levin, S. (2018) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2018.09.022 · Cited by 298 · see citing works
Self-citationSebat, F., Musthafa, A. A., Johnson, D. B., Kramer, A. A., Shoffner, D., Eliason, M., Henry, K., & Spurlock, B. (2007) · Critical Care Medicine · doi:10.1097/01.ccm.0000287593.54658.89 · Cited by 201 · see citing works
Heart Rate Characteristics and Clinical Signs in Neonatal Sepsis
Griffin, M. P., Lake, D. E., O’Shea, T. M., et al. (2007) · Pediatric Research · doi:10.1203/01.pdr.0000252438.65759.af · Cited by 170 · see citing works
How to make predictions about future infectious disease risks
Woolhouse, M. E. J. (2011) · Philosophical Transactions of the Royal Society B Biological Sciences · doi:10.1098/rstb.2010.0387 · Cited by 160 · see citing works
Mistry, B., de Ramirez, S. S., Kelen, G. D., Schmitz, P. S. K., Balhara, K. S., Levin, S., Martínez, D. A., Psoter, K. J., Anton, X. P., & Hinson, J. S. (2017) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2017.09.036 · Cited by 160 · see citing works
Self-citationMcHugh, M., Tanabe, P. J., McClelland, M. S., & Khare, R. K. (2011) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2011.01240.x · Cited by 159 · see citing works
Abràmoff, M. D., Tobey, D., & Char, D. S. (2020) · American Journal of Ophthalmology · doi:10.1016/j.ajo.2020.02.022 · Cited by 140 · see citing works
An Electronic Emergency Triage System to Improve Patient Distribution by Critical Outcomes
Dugas, A. F., Kirsch, T. D., Toerper, M., Korley, F., Yenokyan, G., France, D., Hager, D., & Levin, S. (2016) · The Journal of Emergency Medicine · doi:10.1016/j.jemermed.2016.02.026 · Cited by 132 · see citing works
Self-citationComstedt, P., Storgaard, M., & Lassen, A. T. (2009) · Scandinavian Journal of Trauma Resuscitation and Emergency Medicine · doi:10.1186/1757-7241-17-67 · Cited by 125 · see citing works
Rozenbaum, M. H., Mangen, M.-J. J., Huijts, S. M., et al. (2015) · Vaccine · doi:10.1016/j.vaccine.2015.05.001 · Cited by 122 · see citing works
Assessing Missing Data Assumptions in EHR-Based Studies: A Complex and Underappreciated Task
Haneuse, S., Arterburn, D., & Daniels, M. J. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.0184 · Cited by 110 · see citing works
Early prediction of septic shock in hospitalized patients
Thiel, S. W., Rosini, J. M., Shannon, W. D., Doherty, J. A., Micek, S. T., & Kollef, M. H. (2010) · Journal of Hospital Medicine · doi:10.1002/jhm.530 · Cited by 103 · see citing works
Prediction of mortality in adult emergency department patients with sepsis
Vorwerk, C., Loryman, B., Coats, T., et al. (2009) · Emergency Medicine Journal · doi:10.1136/emj.2007.053298 · Cited by 96 · see citing works
Autoregressive Hidden Markov Models for the Early Detection of Neonatal Sepsis
Stanculescu, I., Williams, C. K. I., & Freer, Y. (2014) · IEEE Journal of Biomedical and Health Informatics · doi:10.1109/jbhi.2013.2294692 · Cited by 92 · see citing works
Data and Measurement Issues in the Analysis of Health Disparities
Bilheimer, L. T., & Klein, R. J. (2010) · Health Services Research · doi:10.1111/j.1475-6773.2010.01143.x · Cited by 82 · see citing works
Herasevich, V., Pieper, M. S., Pulido, J. N., & Gajic, O. (2011) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2011-000228 · Cited by 69 · see citing works
Automated electronic medical record sepsis detection in the emergency department
Nguyen, S. Q., Mwakalindile, E., Booth, J. S., Hogan, V., Morgan, J., Prickett, C. T., Donnelly, J. P., & Wang, H. E. (2014) · PeerJ · doi:10.7717/peerj.343 · Cited by 68 · see citing works
Martínez, D. A., Levin, S., Klein, E. Y., Parikh, C. R., Menez, S. P., Taylor, R. A., & Hinson, J. S. (2020) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2020.05.026 · Cited by 61 · see citing works
Self-citationCommunity-Acquired Pneumonia: The U.S. Perspective
Niederman, M. S. (2009) · Seminars in Respiratory and Critical Care Medicine · doi:10.1055/s-0029-1202937 · Cited by 55 · see citing works
Giuliano, K. K. (2007) · American Journal of Critical Care · doi:10.4037/ajcc2007.16.2.122 · Cited by 53 · see citing works
Allen, A. O., Mataraso, S. J., Siefkas, A. C., Burdick, H., Braden, G. L., Dellinger, R. P., McCoy, A., Pellegrini, E., Hoffman, J. L., Green‐Saxena, A., et al. (2020) · JMIR Public Health and Surveillance · doi:10.2196/22400 · Cited by 51 · see citing works
Chung, P., Scandlyn, J. N., Dayan, P. S., & Mistry, R. D. (2017) · American Journal of Infection Control · doi:10.1016/j.ajic.2017.06.005 · Cited by 33 · see citing works
Jiang, W., Siddiqui, S., Barnes, S., Barouch, L. A., Korley, F. K., Martínez, D. A., Toerper, M. F., Cabral, S., Hamrock, E., & Levin, S. (2019) · JMIR Medical Informatics · doi:10.2196/14756 · Cited by 30 · see citing works
Self-citationSchorr, C. (2008) · Yearbook of Critical Care Medicine · doi:10.1016/s0734-3299(08)70557-4 · Cited by 20 · see citing works
Martínez, D. A., Cai, J., Oke, J. B., Jarrell, A. S., Feijoo, F., Appelbaum, J., Klein, E. Y., Barnes, S., & Levin, S. (2020) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocaa033 · Cited by 9 · see citing works
Self-citationHenry, K. E., Paxton, C., Kim, K. S., Pham, J. C., & Saria, S. (2014) · Critical Care Medicine · doi:10.1097/01.ccm.0000457596.46586.cd · Cited by 3 · see citing works
Issues in Community-Acquired Pneumonia
Fong, I. W. (2020) · Springer eBooks · doi:10.1007/978-3-030-36966-8_3 · Cited by 2 · see citing works
Jones, G. F., Amoah, J., Klein, E. Y., et al. (2021) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofab291 · Cited by 2 · see citing works
Self-citationFabre, V., Fabre, V., Jones, G. A., et al. (2020) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofaa439.213 · Cited by 1 · see citing works
Flagged first, then by citations
Research works printed but not linked: 4
- [22]HCUP facts and figures: statistics on hospital-based care in the United States, 2009. Agency for Healthcare Research and Quality website. www.hcup-us.ahrq.gov/reports. Published 2011. Accessed August 21, 2021. 22514803
- [31]Henry K, Paxton C, Kim KS, Pham J, Saria S. 63: Rews: real-time early warning score for septic shock. Crit Care Med 2014; 42: A1384.
- [41]Niederman MS. Community-acquired pneumonia: the US perspective. Semin Respir Crit Care Med 2009; 30: 179– 188. 19296418
- [47]Adamson AS, Smith A. Machine learning and healthcare disparities in dermatology. JAMA Dermatol 2018; 154: 1247– 1248. 30073260
Cited by
Sorted by citations
Chen, S., Yu, J., Chamouni, S., Wang, Y., & Li, Y. (2024) · BMC Medicine · doi:10.1186/s12916-024-03566-x · Cited by 73 · see citing works
“This requires close collaboration between researchers, policymakers, and community stakeholders to ensure that ML and AI models are developed and applied in a manner that addresses real-world health challenges and promotes health equity [71].”
Background
- Authors
- Hamilton, A. J., Strauss, A. T., Martinez, D. A., Hinson, J. S., Levin, S., Lin, G., & Klein, E. Y.
- Affiliations
- Center for Disease Dynamics, Economics & Policy (US)
- Johns Hopkins University (US)
- Corresponding author
- Klein, Eili Y.
- Venue
- Antimicrobial Stewardship & Healthcare Epidemiology
- Publisher
- Cambridge University Press (CUP)
- Published
- 2021
- Volume
- 1
- Issue
- 1
- Pages
- e28-e28
- ISSN
- 2732-494X (ISSN-L)
- PMC
- PMC9495400
- OpenAlex
- W3203678358
- Cited by
- 58
- References
- 53
- Citations by year
- 2026: 10 · 2025: 20 · 2024: 18 · 2023: 7 · 2022: 3
- FWCI
- 0.51
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Antimicrobial Stewardship & Healthcare Epidemiology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Centers for Disease Control and Prevention (U01CK000589)
- Topics
- Physical Sciences › Computer Science › Artificial Intelligence › Machine Learning in Healthcare
- Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
- Health Sciences › Health Professions › Health Information Management › Artificial Intelligence in Healthcare
- Keywords
- machine learning, artificial intelligence, hospital epidemiology, disease prediction, clinical decision support, emergency department triage, electronic health records, patient safety, health care costs
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