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First published January 31, 2005 as JAMIA PrePrint; doi:10.1197/jamia.M1670
Journal of the American Medical Informatics Association 2005;12(3):322-330
© 2005 American Medical Informatics Association

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Submitted on August 11, 2004
Accepted on January 24, 2005

Information retrieval performance of probabilistically generated, problem-specific CPOE pick-lists: a pilot study

Adam S. Rothschild MD1* and Harold P. Lehmann MD, PhD2

Affiliation of the authors: 1 Columbia University, Department of Biomedical Informatics, New York, NY; 2 Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, MD

* To whom correspondence should be addressed.

Objective Preliminarily determine the feasibility of probabilistically generating problem-specific CPOE pick-lists from a database of explicitly-linked orders and problems from actual clinical cases.

Design In a pilot retrospective validation, physicians reviewed internal medicine cases consisting of the admission history and physical, and orders placed using CPOE during the first 24 hours after admission. They created coded problem lists and linked orders from individual cases to the problem for which they were most indicated. Problem-specific order pick-lists were generated by including a given order in a pick-list if the probability of linkage of order and problem (PLOP) equaled or exceeded a specified threshold. PLOP for a given linked order-problem pair was computed as its prevalence among the other cases in the experiment with the given problem. The orders that the reviewer linked to a given problem instance served as the reference standard to evaluate its system-generated pick-list.

Measurements Recall, precision, and length of the pick-lists.

Results Average recall reached a maximum of .67 with a precision of .17 and pick-list length of 31.22 at a PLOP threshold of 0. Average precision reached a maximum of .73 with a recall of .09 and pick-list length of .42 at a PLOP threshold of .9. Recall varied inversely with precision in classic information retrieval behavior.

Conclusion We preliminarily conclude that it is feasible to generate problem-specific CPOE pick-lists probabilistically from a database of explicitly-linked orders and problems. Further research is necessary to determine the usefulness of this approach in real-world settings.






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