Enhancing Medication Safety with ML-Enhanced Decision Support Systems: A Comparative Analysis of Prescription Error Detection

Abstract

Background: Medication prescription errors are a global issue, leading to significant morbidity and mortality. Traditional rule-based Medical Decision Support Systems (MDSS) are often ineffective, generating numerous false alerts and failing to detect all potential errors. This study assesses a new anomaly detection system integrated with Electronic Health Records (EHR) to improve the accuracy and utility of medication error warnings. Methods: Anomalous prescription detection was implemented alongside an existing MDSS in a real-world inpatient setting over 18 months. The new system utilized Machine Learning (ML) combined with a rule-based MDSS to analyze historical EHR data. It aimed to identify and flag high-risk prescriptions through real-time anomaly detection. The performance of this hybrid system was compared against traditional MDSS and multicriteria query (MQ) methods. A clinical pharmacist reviewed 415 patients (3401 prescriptions) to validate the effectiveness of the system, assessing notifications for accuracy, clinical relevance, and practicality. Results: The ML-enhanced MDSS demonstrated superior performance compared to traditional systems. It achieved a 76% interception rate for prescriptions needing pharmacist review and a precision rate of 75%. The hybrid system outperformed traditional MDSS and MQ methods, with areas under the ROC and PRC curves of 0.84 and 0.79, respectively, compared to 0.66 and 0.57 for MDSS and 0.7 and 0.58 for MQ approaches. Conclusion: Integrating ML with rule-based MDSS significantly improves the detection of high-risk medication prescriptions, reducing false alerts and enhancing accuracy. This hybrid approach offers a more effective tool for identifying potential medication errors and improving patient safety in inpatient settings.