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A call for better validation of opioid overdose risk algorithms
Duncan C McElfresh1,2, Lucia Chen1, Elizabeth Oliva2
1Department of Health Policy, Stanford University, Stanford, California, USA.
Summary
Clinical decision support (CDS) systems require rigorous validation to prevent patient harm, especially in opioid risk prediction. Higher standards for CDS validation are crucial for safe clinical practice.
Area of Science:
- Health Informatics
- Clinical Decision Support Systems
- Predictive Modeling
Background:
- Clinical decision support (CDS) systems using predictive models can enhance clinical decision-making.
- Inadequate validation of these systems poses risks of clinician misdirection and patient harm.
- This is particularly critical for CDS systems in opioid prescribing, where errors can have severe consequences.
Purpose of the Study:
- To emphasize the necessity of robust clinical and technical validation for predictive models in CDS.
- To highlight the risks associated with insufficiently validated CDS systems in opioid risk prediction.
- To advocate for higher validation standards among CDS developers, deployers, and users.
Main Methods:
- Review of existing guidance for validating predictive models and CDS systems.
- Case study analysis of two national-scale CDS systems in the US for predicting adverse opioid-related events: STORM (Veterans Health Administration) and NarxCare (commercial).
Main Results:
- Existing validation guidance is not consistently followed and lacks legal enforcement.
- The study examines two specific CDS systems, STORM and NarxCare, used for opioid risk stratification.
- The findings underscore the gap between proposed validation standards and current practices.
Conclusions:
- There is a critical need for enhanced clinical and technical validation of CDS systems, particularly those predicting opioid risk.
- Current practices fall short of recommended validation standards, necessitating a call for higher adherence.
- Implementing stricter validation protocols is essential to ensure patient safety and improve the reliability of CDS tools.
Keywords:
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