When Validation Fails: Cross-Institutional Blood Pressure Prediction and the Limits of Electronic Health Record-Based Models

ArXi:2507.19530v2 Announce Type: replace-cross External validation remains rare in healthcare machine learning despite being critical for establishing real-world feasibility. We developed an ensemble framework to predict blood pressure from electronic health records, incorporating rigorous data leakage prevention. Internal validation on the MIMIC-III dataset yielded moderate performance for systolic (R^2 = 0.248, RMSE = 14.84 mmHg) and diastolic (R^2 = 0.297, RMSE = 8.27 mmHg) blood pressure. However, external validation on the eICU dataset revealed substantial generalization challenges.