Best practices for authors of healthcare-related artificial intelligence manuscripts
Open accessAbstract
Since its inception in 2017, npj Digital Medicine has attracted a disproportionate number of manuscripts reporting on uses of artificial intelligence. This field has matured rapidly in the past several years. There was initial fascination with the algorithms themselves (machine learning, deep learning, convoluted neural networks) and the use of these algorithms to make predictions that often surpassed prevailing benchmarks. As the discipline has matured, individuals have called attention to aberrancies in the output of these algorithms. In particular, criticisms have been widely circulated that algorithmically developed models may have limited generalizability due to overfitting to the training data and may systematically perpetuate various forms of biases inherent in the training data, including race, gender, age, and health state or fitness level (Challen et al. BMJ Qual. Saf. 28:231–237, 2019; O’neil. Weapons of Math Destruction: How Big Data Increases Inequality and Threatens Democracy, Broadway Book, 2016). Given our interest in publishing the highest quality papers and the growing volume of submissions using AI algorithms, we offer a list of criteria that authors should consider before submitting papers to npj Digital Medicine .
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The algorithm developed for this program was trained and evaluated on large amounts of data following best practices.
“Although the algorithm developed for this program was trained and evaluated on large amounts of data following best practices,35 it has yet to be validated or tested using data outside of the current WMHP.”
From Using Machine Learning to Match Clients and Therapy Providers: Evaluating Clinical Quality and Cost of Care (2025) · cites this paper as [35]
The sections on datasets and model development describe best practices for training, validation, and testing. They do not discuss the WMHP algorithm, establish how much data it used, or show that it followed those practices. (LLM, conf=0.85)
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Cites
CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials
Schulz, K. F., Altman, D. G., Moher, D., & for the CONSORT Group* (2010) · Annals of Internal Medicine · doi:10.7326/0003-4819-152-11-201006010-00232 · Cited by 3,824 · see citing works
Calculating the sample size required for developing a clinical prediction model
Riley, R. D., Ensor, J., Snell, K. I. E., Harrell, F. E., Martin, G. P., Reitsma, J. B., Moons, K. G. M., Collins, G., & van Smeden, M. (2020) · BMJ · doi:10.1136/bmj.m441 · Cited by 2,917 · see citing works
Potential Biases in Machine Learning Algorithms Using Electronic Health Record Data
Gianfrancesco, M. A., Tamang, S., Yazdany, J., & Schmajuk, G. (2018) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2018.3763 · Cited by 1,395 · see citing works
Cross-validation failure: Small sample sizes lead to large error bars
Varoquaux, G. (2018) · NeuroImage · doi:10.1016/j.neuroimage.2017.06.061 · Cited by 897 · see citing works
Hidden stratification causes clinically meaningful failures in machine learning for medical imaging
Oakden-Rayner, L., Dunnmon, J., Carneiro, G., & Re, C. (2020) · Proceedings of the ACM Conference on Health, Inference, and Learning · doi:10.1145/3368555.3384468 · Cited by 411 · see citing works
Benchmarking deep learning models on large healthcare datasets
Purushotham, S., Meng, C., Che, Z., & Liu, Y. (2018) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2018.04.007 · Cited by 406 · see citing works
Flagged first, then by citations
Research works printed but not linked: 9
- [1]Challen R Artificial intelligence, bias and clinical safety BMJ Qual. Saf. 2019 28 231 237 10.1136/bmjqs-2018-008370 PMC6560460 30636200 · DOI · Paper page
- [3]Liu Y Chen PHC Krause J Peng L How to read articles that use machine learning: users’ guides to the medical literature Jama 2019 322 1806 1816 10.1001/jama.2019.16489 31714992 · DOI
- [4]Deeny SR Steventon A Making sense of the shadows: priorities for creating a learning healthcare system based on routinely collected data BMJ Qual. Saf. 2015 24 505 515 10.1136/bmjqs-2015-004278 PMC4515981 26065466 · DOI
- [5]Schaekermann M Understanding expert disagreement in medical data analysis through structured adjudication Proc. ACM Hum.-Computer Interact. 2019 3 1 23 10.1145/3359178 · DOI
- [10]Luijken K Groenwold RH Van Calster B Steyerberg EW van Smeden M Impact of predictor measurement heterogeneity across settings on the performance of prediction models: a measurement error perspective Stat. Med. 2019 38 3444 3459 10.1002/sim.8183 31148207 PMC6619392 · DOI
- [11]Van Calster B McLernon DJ Van Smeden M Wynants L Steyerberg EW Calibration: the Achilles heel of predictive analytics BMC Med. 2019 17 1 7 10.1186/s12916-018-1207-3 31842878 PMC6912996 · DOI
- [13]Zheng, A. Evaluating Machine Learning Models: a Beginner’s Guide to Key Concepts and Pitfalls (O'Reilly Media, 2015).
- [14]Rose S Machine learning for prediction in electronic health data JAMA Netw. Open 2018 1 e181404 e181404 10.1001/jamanetworkopen.2018.1404 30646089 · DOI
- [16]Cabitza F Rasoini R Gensini GF Unintended consequences of machine learning in medicine JAMA 2017 318 517 518 10.1001/jama.2017.7797 28727867 · DOI · Paper page
Cited by
Sorted by citations
Cai, Y., Cai, Y.-Q., Tang, L.-Y., Wang, Y.-H., Gong, M., Jing, T.-C., Li, H.-J., Li-Ling, J., Hu, W., Yin, Z., et al. (2024) · BMC Medicine · doi:10.1186/s12916-024-03273-7 · Cited by 122 · see citing works
Lee, J. L., Billovits, C., Chen, S.-Y., Wickham, R. E., Kocher, B., Chen, C. E., & Lungu, A. (2025) · Value in Health · doi:10.1016/j.jval.2025.06.002 · Cited by 8 · see citing works
- Authors
- Kakarmath, S., Esteva, A., Arnaout, R., Harvey, H., Kumar, S., Muse, E., Dong, F., Wedlund, L., & Kvedar, J.
- Affiliations
- Massachusetts General Hospital (US)
- Salesforce (United States) (US)
- University of California, San Francisco (US)
- University of Memphis (US)
- Scripps Research Institute (US)
- University of Strathclyde (GB)
- Harvard University (US)
- Corresponding author
- Kvedar, Joseph
- ORCID
- Venue
- npj Digital Medicine
- Published
- 2020-10-16
- Volume
- 3
- Issue
- 1
- Pages
- 134-134
- ISSN
- 2398-6352 (ISSN-L)
- PMC
- PMC7567805
- OpenAlex
- W3093512442
- Cited by
- 46
- References
- 6
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 6 · 2023: 8 · 2022: 11 · 2021: 10
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- npj Digital Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Strathprints: The University of Strathclyde institutional repository (University of Strathclyde) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Heart, Lung, and Blood Institute (K08HL125945, R01HL150394)
- Topics
- Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
- Social Sciences › Arts and Humanities › History and Philosophy of Science › Academic Writing and Publishing
- Social Sciences › Safety Research › Ethics and Social Impacts of AI
- Keywords
- artificial intelligence in healthcare, reporting quality, algorithmic bias, overfitting, generalizability, training data bias
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