Machine learning models to detect and predict patient safety events using electronic health records: A systematic review

Introduction: Identifying patient safety events using electronic health records (EHRs) and automated machine learning-based detection methods can help improve the efficiency and quality of healthcare service provision. Objective: This study aimed to systematically review machine learning-based methods and techniques, as well as their results for patient safety event management using EHRs. Methods: We reviewed the studies that focused on machine learning techniques, including automatic prediction and detection of patient safety events and medical errors through EHR analysis to manage patient safety events. The data were collected by searching Scopus, PubMed (Medline), Web of Science, EMBASE, and IEEE Xplore databases. Results: After screening, 41 papers were reviewed. Support vector machine (SVM), random forest, conditional random field (CRF), and bidirectional long short-term memory with conditional random field (BiLSTM-CRF) algorithms were mostly applied to predict, identify, and classify patient safety events using EHRs; however, they had different performances. BiLSTM-CRF was employed in most of the studies to extract and identify concepts, e. g., adverse drug events (ADEs) and adverse drug reactions (ADRs), as well as relationships between drug and severity, drug and ADEs, drug and ADRs. Recurrent neural networks (RNN) and BiLSTM-CRF had the best results in detecting ADEs compared to other patient safety events. Linear classifiers and Naive Bayes (NB) had the highest performance for ADR detection. Logistic regression had the best results in detecting surgical site infections. According to the findings, the quality of articles has non-significantly improved in recent years, but they had low average scores. Conclusions: Machine learning can be useful in automatic detection and prediction of patient safety events. However, most of these algorithms have not yet been externally validated or prospectively tested. Therefore, further studies are required to improve the performance of these automated systems.