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Although polymerase chain reaction (PCR) and point of care (POC) antigen testing capacities have been massively expanded, they are often very time-consuming and cost-intensive and, in some cases, lack appropriate performance. To meet these challenges, we propose the COVIDAL classifier for AI-based diagnosis of symptomatic COVID-19 subjects in hospitals based on laboratory parameters. We evaluate the algorithm's performance by unique multicenter data with approximately 4,000 patients and an extraordinary high ratio of SARS-CoV-2-positive patients. We analyze the influence of data preparation, flexibility in optimization targets, as well as the selection of the test set on the COVIDAL outcome. The algorithm is compared with standard AI, PCR, POC antigen testing and manual classifications of seven physicians by a decision theoretic scoring model including performance metrics, turnaround times and cost. Thereby, we define health care settings in which a certain classifier for COVID-19 diagnosis is to be applied. We find sensitivities, specificities, and accuracies of the COVIDAL algorithm of up to 90 percent. Our scoring model suggests using PCR testing for a focus on performance metrics. For turnaround times, POC antigen testing should be used. If balancing performance, turnaround times, and cost is of interest, as, for example, in the emergency department, COVIDAL is superior based on the scoring model.<\/jats:p>","DOI":"10.1145\/3567431","type":"journal-article","created":{"date-parts":[[2022,12,24]],"date-time":"2022-12-24T11:20:49Z","timestamp":1671880849000},"page":"1-16","update-policy":"https:\/\/doi.org\/10.1145\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["COVIDAL: A Machine Learning Classifier for Digital COVID-19 Diagnosis in German Hospitals"],"prefix":"10.1145","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8300-1249","authenticated-orcid":false,"given":"Christina C.","family":"Bartenschlager","sequence":"first","affiliation":[{"name":"Chair of Health Care Operations\/Health Information Management, Faculty of Business and Economics, Faculty of Medicine, University of Augsburg, Universit\u00e4tsstra\u00dfe 16, Augsburg, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6008-044X","authenticated-orcid":false,"given":"Stefanie S.","family":"Ebel","sequence":"additional","affiliation":[{"name":"Chair of Health Care Operations\/Health Information Management, Faculty of Business and Economics, Faculty of Medicine, University of Augsburg, Universit\u00e4tsstra\u00dfe 16, Augsburg, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4022-6971","authenticated-orcid":false,"given":"Sebastian","family":"Kling","sequence":"additional","affiliation":[{"name":"Chair of Health Care Operations\/Health Information Management, Faculty of Business and Economics, Faculty of Medicine, University of Augsburg, Universit\u00e4tsstra\u00dfe 16, Augsburg, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5446-7170","authenticated-orcid":false,"given":"Janne","family":"Vehreschild","sequence":"additional","affiliation":[{"name":"Department II of Internal Medicine, Hematology\/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany; Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7231-3741","authenticated-orcid":false,"given":"Lutz T.","family":"Zabel","sequence":"additional","affiliation":[{"name":"Laboratory Medicine, Alb Fils Kliniken GmbH, Eichertstra\u00dfe 3, G\u00f6ppingen, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3875-5367","authenticated-orcid":false,"given":"Christoph D.","family":"Spinner","sequence":"additional","affiliation":[{"name":"Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Department of Internal Medicine II, Ismaninger Str. 22, Munich, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8166-994X","authenticated-orcid":false,"given":"Andreas","family":"Schuler","sequence":"additional","affiliation":[{"name":"Gastroenterology, Alb Fils Kliniken GmbH, Eichertstra\u00dfe 3, G\u00f6ppingen, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6144-3874","authenticated-orcid":false,"given":"Axel R.","family":"Heller","sequence":"additional","affiliation":[{"name":"Anaesthesiology and Operative Intensive Care Medicine, Medical Faculty, University of Augsburg, Stenglinstrasse 2, Augsburg, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0265-3828","authenticated-orcid":false,"given":"Stefan","family":"Borgmann","sequence":"additional","affiliation":[{"name":"Hygiene and Infectiology, Klinikum Ingolstadt, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1514-1183","authenticated-orcid":false,"given":"Reinhard","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Laboratory Medicine and Microbiology, Medical Faculty, University of Augsburg, Stenglinstrasse 2, Augsburg, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7493-7080","authenticated-orcid":false,"given":"Siegbert","family":"Rieg","sequence":"additional","affiliation":[{"name":"Clinic for Internal Medicine II - Infectiology, University Hospital Freiburg, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4026-6837","authenticated-orcid":false,"given":"Helmut","family":"Messmann","sequence":"additional","affiliation":[{"name":"Clinic for Internal Medicine III - Gastroenterology and Infectious Diseases, University Hospital Augsburg, Stenglinstra\u00dfe 2, Augsburg, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5967-5238","authenticated-orcid":false,"given":"Martin","family":"Hower","sequence":"additional","affiliation":[{"name":"Department of Pneumology, Infectious Diseases and Intensive Care, Klinikum Dortmund gGmbH, Hospital of University Witten\/Herdecke, Dortmund, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2700-4795","authenticated-orcid":false,"given":"Jens O.","family":"Brunner","sequence":"additional","affiliation":[{"name":"Chair of Health Care Operations\/Health Information Management, Faculty of Business and Economics, Faculty of Medicine, University of Augsburg, Universit\u00e4tsstra\u00dfe 16, Augsburg, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0007-8014","authenticated-orcid":false,"given":"Frank","family":"Hanses","sequence":"additional","affiliation":[{"name":"Emergency Department, University Hospital Regensburg, Germany; 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