Effective modeling of electronic health records (EHR) is rapidly becoming an important topic in both academia and industry. A recent study showed that using the graphical structure underlying EHR data (e.g. relationship between diagnoses and treatments) improves the performance of prediction tasks such as heart failure prediction. However, EHR data do not always contain complete structure information. Moreover, when it comes to claims data, structure information is completely unavailable to begin with. Under such circumstances, can we still do better than just treating EHR data as a flat-structured bag-of-features? In this paper, we study the possibility of jointly learning the hidden structure of EHR while performing supervised prediction tasks on EHR data. Specifically, we discuss that Transformer is a suitable basis model to learn the hidden EHR structure, and propose Graph Convolutional Transformer, which uses data statistics to guide the structure learning process. The proposed model consistently outperformed previous approaches empirically, on both synthetic data and publicly available EHR data, for various prediction tasks such as graph reconstruction and readmission prediction, indicating that it can serve as an effective general-purpose representation learning algorithm for EHR data.
Widespread adoption of electronic health records (EHRs) has fueled the development of using machine learning to build prediction models for various clinical outcomes. This process is often constrained by having a relatively small number of patient records for training the model. We demonstrate that using patient representation schemes inspired from techniques in natural language processing can increase the accuracy of clinical prediction models by transferring information learned from the entire patient population to the task of training a specific model, where only a subset of the population …
KAIST（韩国科学技术院）；MIT（麻省理工学院）；Asan Medical Center（峨山医学中心）；University of Ulsan College of Medicine（蔚山大学医学院）
Substantial increase in the use of Electronic Health Records (EHRs) has opened new frontiers for predictive healthcare. However, while EHR systems are nearly ubiquitous, they lack a unified code system for representing medical concepts. Heterogeneous formats of EHR present a substantial barrier for the training and deployment of state-of-the-art deep learning models at scale. To overcome this problem, we introduce Description-based Embedding, DescEmb, a code-agnostic description-based representation learning framework for predictive modeling on EHR. DescEmb takes advantage of the flexibility o…
The task of matching co-referent records is known among other names as rocord linkage. For large record-linkage problems, often there is little or no labeled data available, but unlabeled data shows a reasonable clear structure. For such problems, unsupervised or semi-supervised methods are preferable to supervised methods. In this paper, we describe a hierarchical graphical model framework for the linakge-problem in an unsupervised setting. In addition to proposing new methods, we also cast existing unsupervised probabilistic record-linkage methods in this framework. Some of the techniques we…
Electronic health records (EHR) are rich heterogeneous collection of patient health information, whose broad adoption provides great opportunities for systematic health data mining. However, heterogeneous EHR data types and biased ascertainment impose computational challenges. Here, we present mixEHR, an unsupervised generative model integrating collaborative filtering and latent topic models, which jointly models the discrete distributions of data observation bias and actual data using latent disease-topic distributions. We apply mixEHR on 12.8 million phenotypic observations from the MIMIC d…
The past decade has seen an explosion in the amount of digital information stored in electronic health records (EHR). While primarily designed for archiving patient clinical information and administrative healthcare tasks, many researchers have found secondary use of these records for various clinical informatics tasks. Over the same period, the machine learning community has seen widespread advances in deep learning techniques, which also have been successfully applied to the vast amount of EHR data. In this paper, we review these deep EHR systems, examining architectures, technical aspects, …
Symphony Health, a division of Icon, plc（Icon公众有限公司旗下Symphony Health）；University of Maine（缅因大学）；Grand Canyon University（大峡谷大学）
It is common for researchers to holdout data from a study pool to be used for external validation as well as for future research, and the same desire is true to those using machine learning modeling research. For this discussion, the purpose of the holdout sample it is preserve data for research studies that will be analysis-naive and randomly selected from the full dataset. Analysis-naive are records that are not used for testing or training machine learning (ML) models and records that do not participate in any aspect of the current machine learning study. The methodology suggested for creat…
Generative Adversarial Networks (GANs) represent a promising class of generative networks that combine neural networks with game theory. From generating realistic images and videos to assisting musical creation, GANs are transforming many fields of arts and sciences. However, their application to healthcare has not been fully realized, more specifically in generating electronic health records (EHR) data. In this paper, we propose a framework for exploring the value of GANs in the context of continuous laboratory time series data. We devise an unsupervised evaluation method that measures the pr…
Identifying patients who will be discharged within 24 hours can improve hospital resource management and quality of care. We studied this problem using eight years of Electronic Health Records (EHR) data from Stanford Hospital. We fit models to predict 24 hour discharge across the entire inpatient population. The best performing models achieved an area under the receiver-operator characteristic curve (AUROC) of 0.85 and an AUPRC of 0.53 on a held out test set. This model was also well calibrated. Finally, we analyzed the utility of this model in a decision theoretic framework to identify regio…
University of Southern California（南加州大学）；AI Foundations, IBM Thomas J. Watson Research Center（IBM托马斯·J·沃森研究中心AI基础部门）；Binghamton University, SUNY（纽约州立大学宾汉姆顿大学）；IBM Thomas J. Watson Research Center（IBM托马斯·J·沃森研究中心）
The rapid growth of Electronic Health Records (EHRs), as well as the accompanied opportunities in Data-Driven Healthcare (DDH), has been attracting widespread interests and attentions. Recent progress in the design and applications of deep learning methods has shown promising results and is forcing massive changes in healthcare academia and industry, but most of these methods rely on massive labeled data. In this work, we propose a general deep learning framework which is able to boost risk prediction performance with limited EHR data. Our model takes a modified generative adversarial network …
Virginia Polytechnic Institute and State University (Virginia Tech)（弗吉尼亚理工学院暨州立大学（弗吉尼亚理工））
Deep learning models have demonstrated high-quality performance in areas such as image classification and speech processing. However, creating a deep learning model using electronic health record (EHR) data, requires addressing particular privacy challenges that are unique to researchers in this domain. This matter focuses attention on generating realistic synthetic data while ensuring privacy. In this paper, we propose a novel framework called correlation-capturing Generative Adversarial Network (CorGAN), to generate synthetic healthcare records. In CorGAN we utilize Convolutional Neural Netw…
Electronic Health Record (EHR) data can be represented as discrete counts over a high dimensional set of possible procedures, diagnoses, and medications. Supervised topic models present an attractive option for incorporating EHR data as features into a prediction problem: given a patient's record, we estimate a set of latent factors that are predictive of the response variable. However, existing methods for supervised topic modeling struggle to balance prediction quality and coherence of the latent factors. We introduce a novel approach, the prediction-focused topic model, that uses the superv…
Managing patients with chronic diseases is a major and growing healthcare challenge in several countries. A chronic condition, such as diabetes, is an illness that lasts a long time and does not go away, and often leads to the patient's health gradually getting worse. While recent works involve raw electronic health record (EHR) from hospitals, this work uses only financial records from health plan providers (medical claims) to predict diabetes disease evolution with a self-attentive recurrent neural network. The use of financial data is due to the possibility of being an interface to internat…
University of North Carolina at Charlotte（北卡罗来纳大学夏洛特分校）
Deep learning models have exhibited superior performance in predictive tasks with the explosively increasing Electronic Health Records (EHR). However, due to the lack of transparency, behaviors of deep learning models are difficult to interpret. Without trustworthiness, deep learning models will not be able to assist in the real-world decision-making process of healthcare issues. We propose a deep learning model based on Bayesian Neural Networks (BNN) to predict uncertainty induced by data noise. The uncertainty is introduced to provide model predictions with an extra level of confidence. Our …
The increased adoption of Electronic Health Records(EHRs) has brought changes to the way the patient care is carried out. The rich heterogeneous and temporal data space stored in EHRs can be leveraged by machine learning models to capture the underlying information and make clinically relevant predictions. This can be exploited to support public health activities such as pharmacovigilance and specifically mitigate the public health issue of Adverse Drug Events(ADEs). The aim of this article is, therefore, to investigate the various ways of handling temporal data for the purpose of detecting AD…
Peking University（北京大学）；Carnegie Mellon University（卡内基梅隆大学）；Mila - Québec AI Institute（米拉-魁北克人工智能研究所）；HEC Montréal（蒙特利尔高等商学院）
Clinical outcome prediction based on the Electronic Health Record (EHR) plays a crucial role in improving the quality of healthcare. Conventional deep sequential models fail to capture the rich temporal patterns encoded in the longand irregular clinical event sequences. We make the observation that clinical events at a long time scale exhibit strongtemporal patterns, while events within a short time period tend to be disordered co-occurrence. We thus propose differentiated mechanisms to model clinical events at different time scales. Our model learns hierarchical representationsof event sequen…
Rice University（莱斯大学）；Baylor College of Medicine（贝勒医学院）
In neuroscience, researchers seek to uncover the connectivity of neurons from large-scale neural recordings or imaging; often people employ graphical model selection and estimation techniques for this purpose. But, existing technologies can only record from a small subset of neurons leading to a challenging problem of graph selection in the presence of extensive latent variables. Chandrasekaran et al. (2012) proposed a convex program to address this problem that poses challenges from both a computational and statistical perspective. To solve this problem, we propose an incredibly simple soluti…
The modelling of Electronic Health Records (EHRs) has the potential to drive more efficient allocation of healthcare resources, enabling early intervention strategies and advancing personalised healthcare. However, EHRs are challenging to model due to their realisation as noisy, multi-modal data occurring at irregular time intervals. To address their temporal nature, we treat EHRs as samples generated by a Temporal Point Process (TPP), enabling us to model what happened in an event with when it happened in a principled way. We gather and propose neural network parameterisations of TPPs, collec…
The Center for Complex Engineering Systems at KACST and MIT（沙特阿拉伯国王阿卜杜勒阿齐兹科技城（KACST）和麻省理工学院（MIT）复杂工程系统中心）；MIT（麻省理工学院（MIT））
An estimated 180 papers focusing on deep learning and EHR were published between 2010 and 2018. Despite the common workflow structure appearing in these publications, no trusted and verified software framework exists, forcing researchers to arduously repeat previous work. In this paper, we propose Cardea, an extensible open-source automated machine learning framework encapsulating common prediction problems in the health domain and allows users to build predictive models with their own data. This system relies on two components: Fast Healthcare Interoperability Resources (FHIR) -- a standardiz…
University of Cambridge（剑桥大学）；The Alan Turing Institute（艾伦·图灵研究所）；University of California Los Angeles（加州大学洛杉矶分校）
Analyzing electronic health records (EHR) poses significant challenges because often few samples are available describing a patient's health and, when available, their information content is highly diverse. The problem we consider is how to integrate sparsely sampled longitudinal data, missing measurements informative of the underlying health status and fixed demographic information to produce estimated survival distributions updated through a patient's follow up. We propose a nonparametric probabilistic model that generates survival trajectories from an ensemble of Bayesian trees that learns …
We show how to learn low-dimensional representations (embeddings) of patient visits from the corresponding electronic health record (EHR) where International Classification of Diseases (ICD) diagnosis codes are removed. We expect that these embeddings will be useful for the construction of predictive statistical models anticipated to drive personalized medicine and improve healthcare quality. These embeddings are learned using a deep neural network trained to predict ICD diagnosis categories. We show that our embeddings capture relevant clinical informations and can be used directly as input t…
Federated learning opens a number of research opportunities due to its high communication efficiency in distributed training problems within a star network. In this paper, we focus on improving the communication efficiency for fully decentralized federated learning over a graph, where the algorithm performs local updates for several iterations and then enables communications among the nodes. In such a way, the communication rounds of exchanging the common interest of parameters can be saved significantly without loss of optimality of the solutions. Multiple numerical simulations based on large…
Georgia Institute of Technology（佐治亚理工学院）；Google Brain（谷歌大脑）；IBM Research（IBM研究院）；Sutter Health（萨特医疗）；HINT Consultants（HINT咨询公司）
Deep learning models exhibit state-of-the-art performance for many predictive healthcare tasks using electronic health records (EHR) data, but these models typically require training data volume that exceeds the capacity of most healthcare systems. External resources such as medical ontologies are used to bridge the data volume constraint, but this approach is often not directly applicable or useful because of inconsistencies with terminology. To solve the data insufficiency challenge, we leverage the inherent multilevel structure of EHR data and, in particular, the encoded relationships among…
Centers for Disease Control and Prevention（美国疾病控制与预防中心）
A variety of methods existing for generating synthetic electronic health records (EHRs), but they are not capable of generating unstructured text, like emergency department (ED) chief complaints, history of present illness or progress notes. Here, we use the encoder-decoder model, a deep learning algorithm that features in many contemporary machine translation systems, to generate synthetic chief complaints from discrete variables in EHRs, like age group, gender, and discharge diagnosis. After being trained end-to-end on authentic records, the model can generate realistic chief complaint text …
We study the problem of detecting adverse drug events in electronic healthcare records. The challenge in this work is to aggregate heterogeneous data types involving diagnosis codes, drug codes, as well as lab measurements. An earlier framework proposed for the same problem demonstrated promising predictive performance for the random forest classifier by using only lab measurements as data features. We extend this framework, by additionally including diagnosis and drug prescription codes, concurrently. In addition, we employ a recursive feature selection mechanism on top, that extracts the top…
University of Wisconsin - Madison（威斯康星大学麦迪逊分校）；Marshfield Clinic Research Foundation（马什菲尔德诊所研究基金会）
Accurate estimation of healthcare costs is crucial for healthcare systems to plan and effectively negotiate with insurance companies regarding the coverage of patient-care costs. Greater accuracy in estimating healthcare costs would provide mutual benefit for both health systems and the insurers that support these systems by better aligning payment models with patient-care costs. This study presents the results of a generalizable machine learning approach to predicting medical events built from 40 years of data from >860,000 patients pertaining to >6,700 prescription medications, courtesy of M…
Adherence can be defined as "the extent to which patients take their medications as prescribed by their healthcare providers"[Osterberg and Blaschke, 2005]. World Health Organization's reports point out that, in developed countries, only about 50% of patients with chronic diseases correctly follow their treatments. This severely compromises the efficiency of long-term therapy and increases the cost of health services. We propose in this paper different models of patient drug consumption in breast cancer treatments. The aim of these different approaches is to predict medication non-adherence wh…
University of Pennsylvania（宾夕法尼亚大学）；Biomedical and Translational Informatics Institute/Geisinger（生物医学与转化信息学研究所/盖辛格）
Electronic health records are an increasingly important resource for understanding the interactions between patient health, environment, and clinical decisions. In this paper we report an empirical study of predictive modeling of several patient outcomes using three state-of-the-art machine learning methods. Our primary goal is to validate the models by interpreting the importance of predictors in the final models. Central to interpretation is the use of feature importance scores, which vary depending on the underlying methodology. In order to assess feature importance, we compared univariate …
Vanderbilt University（范德堡大学）；Vanderbilt University Medical Center（范德堡大学医学中心）
Sharing electronic health records (EHRs) on a large scale may lead to privacy intrusions. Recent research has shown that risks may be mitigated by simulating EHRs through generative adversarial network (GAN) frameworks. Yet the methods developed to date are limited because they 1) focus on generating data of a single type (e.g., diagnosis codes), neglecting other data types (e.g., demographics, procedures or vital signs) and 2) do not represent constraints between features. In this paper, we introduce a method to simulate EHRs composed of multiple data types by 1) refining the GAN model, 2) ac…
Imperial College London（帝国理工学院）；Accenture Labs（埃森哲实验室）
Class imbalance can often degrade predictive performance of supervised learning algorithms. Balanced classes can be obtained by oversampling exact copies, with noise, or interpolation between nearest neighbours (as in traditional SMOTE methods). Oversampling tabular data using augmentation, as is typical in computer vision tasks, can be achieved with deep generative models. Deep generative models are effective data synthesisers due to their ability to capture complex underlying distributions. Synthetic data in healthcare can enhance interoperability between healthcare providers by ensuring pat…
University of Massachusetts（马萨诸塞大学）；Bedford VAMC and CHOIR（贝德福德退伍军人医疗中心与CHOIR）
Sequence labeling for extraction of medical events and their attributes from unstructured text in Electronic Health Record (EHR) notes is a key step towards semantic understanding of EHRs. It has important applications in health informatics including pharmacovigilance and drug surveillance. The state of the art supervised machine learning models in this domain are based on Conditional Random Fields (CRFs) with features calculated from fixed context windows. In this application, we explored various recurrent neural network frameworks and show that they significantly outperformed the CRF models.
Identifying Mentions of Pain in Mental Health Records Text: A Natural Language Processing Approach
Institute of Psychiatry, Psychology and Neurosciences, King’s College London（伦敦国王学院精神病学、心理学与神经科学研究所）；Health Data Research UK（英国健康数据研究中心）；South London and Maudsley Biomedical Research Centre（南伦敦和莫兹利生物医学研究中心）；The South London and Maudsley NHS Foundation Trust（南伦敦和莫兹利国民保健信托基金会）
MultiModel Research（MultiModel 研究公司）；Baystate Health（贝州健康系统）；Baystate Medical Center（贝州医疗中心）
Employing a machine learning approach we predict, up to 24 hours prior, a diagnosis of severe sepsis. Strongly predictive models are possible that use only text reports from the Electronic Health Record (EHR), and omit structured numerical data. Unstructured text alone gives slightly better performance than structured data alone, and the combination further improves performance. We also discuss advantages of using unstructured EHR text for modeling, as compared to structured EHR data.
University of Massachusetts Amherst（马萨诸塞大学阿默斯特分校）；University of Massachusetts Lowell（马萨诸塞大学洛厄尔分校）；Bedford VA Medical Center（贝德福德退伍军人事务医疗中心）
Question: Can an encoder-decoder architecture pretrained on a large dataset of longitudinal electronic health records improves patient outcome predictions? Findings: In this prognostic study of 6.8 million patients, our denoising sequence-to-sequence prediction model of multiple outcomes outperformed state-of-the-art models scuh pretrained BERT on a broad range of patient outcomes, including intentional self-harm and pancreatic cancer. Meaning: Deep bidirectional and autoregressive representation improves patient outcome prediction.
University of Illinois at Chicago（伊利诺伊大学芝加哥分校）；CSCI Consulting Inc.（CSCI咨询公司）；The Ohio State University（俄亥俄州立大学）；Regenstrief Institute（雷根斯特里夫研究所）；Indiana University School of Medicine（印第安纳大学医学院）
Due to the rapid growth of information available about individual patients, most physicians suffer from information overload when they review patient information in health information technology systems. In this manuscript, we present a novel hybrid dynamic and multi-collaborative filtering method to improve information retrieval from electronic health records. This method recommends relevant information from electronic health records for physicians during patient visits. It models information search dynamics using a Markov model. It also leverages the key idea of collaborative filtering, orig…
Time-Aware Attention for Enhanced Electronic Health Records Modeling
Department of Statistics and Data Science, National University of Singapore（统计与数据科学系，新加坡国立大学）；School of Computing, National University of Singapore（计算学院，新加坡国立大学）；Department of Biostatistics, Harvard T.H. Chan School of Public Health, USA（生物统计学系，哈佛T.H. Chan公共卫生学院，美国）
Northeastern University（东北大学）；University of Maryland（马里兰大学）；New York University School of Medicine（纽约大学医学院）；NYU Langone Health（纽约大学朗格尼健康中心）
Comorbid chronic conditions are common among people with type 2 diabetes. We developed an Artificial Intelligence algorithm, based on Reinforcement Learning (RL), for personalized diabetes and multi-morbidity management with strong potential to improve health outcomes relative to current clinical practice. In this paper, we modeled glycemia, blood pressure and cardiovascular disease (CVD) risk as health outcomes using a retrospective cohort of 16,665 patients with type 2 diabetes from New York University Langone Health ambulatory care electronic health records in 2009 to 2017. We trained a RL …
With the successful adoption of machine learning on electronic health records (EHRs), numerous computational models have been deployed to address a variety of clinical problems. However, due to the heterogeneity of EHRs, models trained on different patient groups suffer from poor generalizability. How to mitigate domain shifts between the source patient group where the model is built upon and the target one where the model will be deployed becomes a critical issue. In this paper, we propose a data augmentation method to facilitate domain adaptation, which leverages knowledge from the source pa…
The wide implementation of electronic health record (EHR) systems facilitates the collection of large-scale health data from real clinical settings. Despite the significant increase in adoption of EHR systems, this data remains largely unexplored, but presents a rich data source for knowledge discovery from patient health histories in tasks such as understanding disease correlations and predicting health outcomes. However, the heterogeneity, sparsity, noise, and bias in this data present many complex challenges. This complexity makes it difficult to translate potentially relevant information i…
