Obstacles to effective model deployment in healthcare.

Despite an exponential increase in publications on clinical prediction models over recent years, the number of models deployed in clinical practice remains fairly limited. In this paper, we identify common obstacles that impede effective deployment of prediction models in healthcare, and investigate their underlying causes. We observe a key underlying cause behind most obstacles - the improper development and evaluation of prediction models. Inherent heterogeneities in clinical data complicate the development and evaluation of clinical prediction models. Many of these heterogeneities in clinical data are unreported because they are deemed to be irrelevant, or due to privacy concerns. We provide real-life examples where failure to handle heterogeneities in clinical data, or sources of biases, led to the development of erroneous models. The purpose of this paper is to familiarize modeling practitioners with common sources of biases and heterogeneities in clinical data, both of which have to be dealt with to ensure proper development and evaluation of clinical prediction models. Proper model development and evaluation, together with complete and thorough reporting, are important prerequisites for a prediction model to be effectively deployed in healthcare.