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Machine learning in clinical practice: prospects and pitfalls

Ian A Scott, David Cook, Enrico W Coiera and Brent Richards
Med J Aust 2019; 211 (5): . || doi: 10.5694/mja2.50294
Published online: 2 September 2019

Machine learning has huge potential to enhance clinical decision making, but there are still many limitations

Machine learning (ML), a subdiscipline of artificial intelligence, encompasses a family of computerised (machine) methods that identify (learn) patterns in large (training) datasets not detectable to humans (Box 1). Identified patterns are then encoded in a computer model or algorithm which is then tested and validated on new data. Three basic ML types exist (Box 2), with supervised and reinforcement learning being used most frequently.


  • 1 Princess Alexandra Hospital, Brisbane, QLD
  • 2 University of Queensland, Brisbane, QLD
  • 3 Centre for Health Informatics, Macquarie University, Sydney, NSW
  • 4 Gold Coast Hospital and Health Service, Gold Coast, QLD


Correspondence: ian.scott@health.qld.gov.au

Competing interests:

Brent Richards has received non‐financial support from Amazon Web Services and non‐financial support from Microsoft.

  • 1. Esteva A, Robicquet A, Ramsundar B, et al. A guide to deep learning in healthcare. Nature Med 2019; 25: 24–29.
  • 2. Naylor CD. On the prospects for a (deep) learning health care system. JAMA 2018; 320: 1099–1100.
  • 3. Rajkomar A, Dean J, Kohane I. Machine learning in medicine. N Engl J Med 2019; 380: 1347–1358.
  • 4. Topol EJ. High‐performance medicine: the convergence of human and artificial intelligence. Nature Med 2019; 25: 44–56.
  • 5. Ting DSW, Cheung CY‐L, Lim G, et al. Development and validation of a deep learning system for diabetic retinopathy and related eye diseases using retinal images from multiethnic populations with diabetes. JAMA 2017; 318: 2211–2223.
  • 6. Gulshan V, Peng L, Coram M, et al. Development and validation of a deep learning algorithm for detection of diabetic retinopathy in retinal fundus photographs. JAMA 2016; 316: 2402–2410.
  • 7. Abràmoff MD, Lavin PT, Birch M, et al. Pivotal trial of an autonomous AI‐based diagnostic system for detection of diabetic retinopathy in primary care offices. npj Digit Med 2018; 1: 39.
  • 8. Esteva A, Kuprel B, Novoa RA. Dermatologist‐level classification of skin cancer with deep neural networks. Nature 2017; 542: 115–118.
  • 9. Ehteshami Bejnordi B, Veta M, van Diest PJ, et al. Diagnostic assessment of deep learning algorithms for detection of lymph node metastases in women with breast cancer. JAMA 2017; 318: 2199–2210.
  • 10. Zhang J, Gajjala S, Agrawal P, et al. Fully automated echocardiogram interpretation in clinical practice. Feasibility and diagnostic accuracy. Circulation 2018; 138: 1623–1635.
  • 11. Rajkomar A, Oren E, Chen K, et al. Scalable and accurate deep learning with electronic health records. npj Digit Med 2018; 1: 18.
  • 12. Taylor RA, Pare JR, Venkatesh AK, et al. Prediction of in‐hospital mortality in emergency department patients with sepsis: a local big data‐driven, machine learning approach. Acad Emerg Med 2016; 23: 269–278.
  • 13. Rughani AI, Dumont TM, Lu Z, et al. Use of an artificial neural network to predict head injury outcome: clinical article. J Neurosurg 2010; 113: 585–590.
  • 14. Zazzi M, Incardona F, Rosen‐Zvi M, et al. Predicting response antiretroviral treatment by machine learning: the EuResist project. Intervirology 2012; 55: 123–127.
  • 15. Komorowski M, Celi LA, Badawi O, et al. The artificial intelligence clinician learns optimal treatment strategies for sepsis in intensive care. Nature Med 2018; 24: 1716–1720.
  • 16. Nemati S, Ghassemi MM, Clifford GD. Optimal medication dosing from suboptimal clinical examples: a deep reinforcement learning approach. Conf Proc IEEE Eng Med Biol Soc 2016; 2016: 2978–2981.
  • 17. Ni Y, Kennebeck S, Dexheimer JW, et al. Automated clinical trial eligibility prescreening: increasing the efficiency of patient identification for clinical trials in the emergency department. J Am Med Inform Assoc 2015; 22: 166–178.
  • 18. Stephenson N, Shane E, Chase J, et al. Survey of machine learning techniques in drug discovery. Curr Drug Metab 2019; 20: 185–193.
  • 19. Maali Y, Perez‐Concha O, Coiera E, et al. Predicting 7‐day, 30‐day and 60‐day all‐cause unplanned readmission: a case study of a Sydney hospital. BMC Med Inform Decis Mak 2018; 18: 1.
  • 20. Nanayakkara S, Fogarty S, Tremeer M, et al. Characterising risk of in‐hospital mortality following cardiac arrest using machine learning: a retrospective international registry study. PLoS Med 2018; 15: e1002709.
  • 21. Gorodeski EZ, Ishwaran H, Kogalur UR, et al. Use of hundreds of electrocardiographic biomarkers for prediction of mortality in postmenopausal women: the Women's Health Initiative. Circ Cardiovasc Qual Outcomes 2011; 4: 521–532.
  • 22. Caruana R, Lou Y, Gehrke J, et al. Intelligible models for healthcare: predicting pneumonia risk and hospital 30‐day readmission. Proceedings of the 21st ACM SIGKDD International Conference on Knowledge Discovery and Data Mining; 2015 Aug 10‐13; Sydney, Australia. https://www.microsoft.com/en-us/research/wp-content/uploads/2017/06/KDD2015FinalDraftIntelligibleModels4HealthCare_igt143e-caruanaA.pdf (viewed Nov 2018).
  • 23. Ross C, Swetlitz I. IBM pitched its Watson supercomputer as a revolution in cancer care. It's nowhere close. STAT Investigation. 5 Sept 2017. https://www.statnews.com/2017/09/05/watson-ibm-cancer/ (viewed Nov 2018).
  • 24. National Institute for Heath and Care Excellence. Evidence standards framework for digital health technologies. London: NICE, 2019. https://www.nice.org.uk/Media/Default/About/what-we-do/our-programmes/evidence-standards-framework/digital-evidence-standards-framework.pdf (viewed Mar 2019).
  • 25. Shimabukuro DW, Barton CW, Feldman MD, et al. Effect of a machine learning‐based severe sepsis prediction algorithm on patient survival and hospital length of stay: a randomised clinical trial. BMJ Open Resp Res 2017; 4: e000234.
  • 26. Coiera E, Ammenwerth E, Georgiou A, Magrabi F. Does health informatics have a replication crisis? J Am Med Inform Assoc 2018; 25: 963–968.

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