SmartAlert: Implementing Machine Learning-Driven Clinical Decision Support for Inpatient Lab Utilization Reduction

April S. Liang; Fatemeh Amrollahi; Yixing Jiang; Conor K. Corbin; Grace Y. E. Kim; David Mui; Trevor Crowell; Aakash Acharya; Sreedevi Mony; Soumya Punnathanam; Jack McKeown; Margaret Smith; Steven Lin; Arnold Milstein; Kevin Schulman; Jason Hom; Michael A. Pfeffer; Tho D. Pham; David Svec; Weihan Chu; Lisa Shieh; Christopher Sharp; Stephen P. Ma; Jonathan H. Chen

arXiv · 2512.04354

SmartAlert: Implementing Machine Learning-Driven Clinical Decision Support for Inpatient Lab Utilization Reduction

View original source ↗Read source document ↗Export metadata ↓

Abstract

Repetitive laboratory testing unlikely to yield clinically useful information is a common practice that burdens patients and increases healthcare costs. Education and feedback interventions have limited success, while general test ordering restrictions and electronic alerts impede appropriate clinical care. We introduce and evaluate SmartAlert, a machine learning (ML)-driven clinical decision support (CDS) system integrated into the electronic health record that predicts stable laboratory results to reduce unnecessary repeat testing. This case study describes the implementation process, challenges, and lessons learned from deploying SmartAlert targeting complete blood count (CBC) utilization in a randomized controlled pilot across 9270 admissions in eight acute care units across two hospitals between August 15, 2024, and March 15, 2025. Results show significant decrease in number of CBC results within 52 hours of SmartAlert display (1.54 vs 1.82, p <0.01) without adverse effect on secondary safety outcomes, representing a 15% relative reduction in repetitive testing. Implementation lessons learned include interpretation of probabilistic model predictions in clinical contexts, stakeholder engagement to define acceptable model behavior, governance processes for deploying a complex model in a clinical environment, user interface design considerations, alignment with clinical operational priorities, and the value of qualitative feedback from end users. In conclusion, a machine learning-driven CDS system backed by a deliberate implementation and governance process can provide precision guidance on inpatient laboratory testing to safely reduce unnecessary repetitive testing.

Explore related subjects

cs.LG cs.HC

Keep this discovery

Explore connections, maps & timelines

BibTeX RIS

April S. Liang, Fatemeh Amrollahi, Yixing Jiang, Conor K. Corbin, Grace Y. E. Kim, David Mui, Trevor Crowell, Aakash Acharya, Sreedevi Mony, Soumya Punnathanam, Jack McKeown, Margaret Smith, Steven Lin, Arnold Milstein, Kevin Schulman, Jason Hom, Michael A. Pfeffer, Tho D. Pham, David Svec, Weihan Chu, Lisa Shieh, Christopher Sharp, Stephen P. Ma, Jonathan H. Chen. 2025-12-04. SmartAlert: Implementing Machine Learning-Driven Clinical Decision Support for Inpatient Lab Utilization Reduction. https://arxiv.org/abs/2512.04354

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related papers

arXiv2026

Rollout Total Correlation for Deep Reinforcement Learning

Learning task-relevant representations is crucial for reinforcement learning. Recent approaches aim to learn such representations by improving the temporal consistency in the observed transitions. However, they only consider individual transitions and can fail to achieve long-term consistency. Instead, we argue that capturing aspects of the state that correlate with other states and actions of the trajectory---even more distant in the future---could further help in extracting task-relevant information. Hence, in this paper we investigate how to learn representations by maximizing the rollout total correlation, the correlation among all learned representations and actions within the trajectories produced by the agent. For improving rollout total correlation, we propose to combine two complementary lower bounds based on a generative and a discriminative model, combined with a simple and effective technique of chunk-wise mini-batching. Furthermore, we propose an intrinsic reward based on the learned representation for better exploration. Experimental evaluations on a set of challenging image-based simulated control tasks show that our method achieves better sample efficiency, and robustness to both white noise and natural video backgrounds compared to leading baselines.

cs.LG↗

arXiv2026

Reward Shaping to Mitigate Reward Hacking in RLHF

Reinforcement learning from human feedback (RLHF) is widely used to align large language models (LLMs) with human preferences. However, RLHF remains vulnerable to \emph{reward hacking}, whereby a policy exploits imperfections in the reward function instead of learning the intended behavior, thereby undermining alignment. Although reward shaping can stabilize RLHF training and partially mitigate reward hacking, shaping methods and their underlying design principles have not been systematically investigated. To address this gap, we conduct a comprehensive study of prevalent reward-shaping techniques. Our analysis identifies two key design principles: (1) the reinforcement-learning reward should be bounded, and (2) it should grow rapidly at first and then gradually saturate. Motivated by these principles, we propose Preference as Reward (PAR), a novel method that uses the latent preferences encoded in the reward model as the reinforcement-learning signal. We further show that PAR possesses two variance-reduction properties that stabilize RLHF training and substantially widen the practical window for early stopping. Our evaluation consists of two parts. First, we compare PAR with several other reward-shaping strategies using Proximal Policy Optimization (PPO) as the reinforcement-learning algorithm and Gemma2-2B as the base model. Second, we compare PAR with the vanilla baseline (i.e., unshaped reward) across four base models and four reinforcement-learning algorithms. In the first set of experiments, PAR consistently outperforms other reward-shaping methods and also reflects high data efficiency and robustness. The second set of experiments shows that PAR is particularly effective for actor-critic RL algorithms when value estimates become unstable and demonstrates its effectiveness across different base models. The code is available at https://github.com/PorUna-byte/PAR.

cs.LG↗

arXiv2026

Trajectory Entropy Reinforcement Learning for Robust Robot Motor Skill Learning

Simplicity is a critical inductive bias for designing data-driven controllers, especially when robustness is important. Despite the impressive results of deep reinforcement learning in complex control tasks, it is prone to capturing intricate and spurious correlations between observations and actions, leading to failure under slight perturbations to the environment. To tackle this problem, in this work we introduce a novel inductive bias towards simple policies in reinforcement learning. The simplicity inductive bias is introduced by minimizing the entropy of entire action trajectories, corresponding to the number of bits required to describe information in action trajectories after the agent observes state trajectories. Our reinforcement learning agent, Trajectory Entropy Reinforcement Learning, is optimized to minimize the trajectory entropy while maximizing rewards. We show that the trajectory entropy can be effectively estimated by learning a variational parameterized action prediction model, and use the prediction model to construct an information-regularized reward function. Furthermore, we construct a practical algorithm that enables the joint optimization of models, including the policy and the prediction model. Experimental evaluations on several high-dimensional locomotion tasks show that our learned policies produce more cyclical and consistent action trajectories, and achieve superior performance, and robustness to noise and dynamic changes than the state-of-the-art.

cs.LG↗