Cross-Site Validation of Clinical Prediction Models on Cloud Data Warehouses: A Cross-Site Validation Agenda
DOI:
https://doi.org/10.66687/jc77c119Keywords:
Artificial Intelligence, Machine Learning, Medical Informatics, Decision Support Systems, Clinical, Reproducibility of ResultsAbstract
Cloud-hosted clinical data pipelines can harmonise hospital records while obscuring differences in coding, missingness and data provenance. This gap has consequences for interpreting performance outside carefully curated evaluation settings. The research question is whether it is possible to evaluate the transferability of prediction models across institutions using a traceable data-warehouse workflow. Previous work provides context for sampling, input validation and study boundaries [3–7]. The planned analysis uses a multi-institution protocol with source-hospital development data, held-out partner sites and time-based external validation. The technical pipeline must remain auditable: prior work on storage operations provides system-level context [1], while a second source identifies infrastructure conditions relevant to data continuity [2], rather than patient-level outcomes. Under matched evaluation conditions, the protocol compares local versus pooled models after identical coding rules, feature windows and missing-data checks. Methodological sources are used to specify transparent comparison and reporting practices [8–12]. The cross-site extension holds out an entire institution or deployment location rather than relying only on random test splits. Performance will be judged using calibration-in-the-large, discrimination, subgroup error and reproducibility of extracted cohorts. Interpretation will account for data lineage, hospital-specific coding shifts, delayed ingestion and governance of cross-site access. Between-site heterogeneity would be examined through prespecified subgroup estimates and transparent domain-shift diagnostics. The supplementary technical literature is used to identify plausible failure mechanisms [13–17]. No study result is assumed in advance; the analysis is designed to show both when the method helps and when it fails, with reporting context from the remaining sources [18–23].
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