Electronic Health Records (EHRs) provide vital contextual information to radiologists and other physicians when making a diagnosis. Unfortunately, because a given patient's record may contain hundreds of notes and reports, identifying relevant information within these in the short time typically allotted to a case is very difficult. We propose and evaluate models that extract relevant text snippets from patient records to provide a rough case summary intended to aid physicians considering one or more diagnoses. This is hard because direct supervision (i.e., physician annotations of snippets relevant to specific diagnoses in medical records) is prohibitively expensive to collect at scale. We propose a distantly supervised strategy in which we use groups of International Classification of Diseases (ICD) codes observed in 'future' records as noisy proxies for 'downstream' diagnoses. Using this we train a transformer-based neural model to perform extractive summarization conditioned on potential diagnoses. This model defines an attention mechanism that is conditioned on potential diagnoses (queries) provided by the diagnosing physician. We train (via distant supervision) and evaluate variants of this model on EHR data from Brigham and Women's Hospital in Boston and MIMIC-III (the latter to facilitate reproducibility). Evaluations performed by radiologists demonstrate that these distantly supervised models yield better extractive summaries than do unsupervised approaches. Such models may aid diagnosis by identifying sentences in past patient reports that are clinically relevant to a potential diagnosis.
Patient summarization is essential for clinicians to provide coordinated care and practice effective communication. Automated summarization has the potential to save time, standardize notes, aid clinical decision making, and reduce medical errors. Here we provide an upper bound on extractive summarization of discharge notes and develop an LSTM model to sequentially label topics of history of present illness notes. We achieve an F1 score of 0.876, which indicates that this model can be employed to create a dataset for evaluation of extractive summarization methods.
Modeling disease progression in healthcare administrative databases is complicated by the fact that patients are observed only at irregular intervals when they seek healthcare services. In a longitudinal cohort of 76,888 patients with chronic obstructive pulmonary disease (COPD), we used a continuous-time hidden Markov model with a generalized linear model to model healthcare utilization events. We found that the fitted model provides interpretable results suitable for summarization and hypothesis generation.
EHR2Path: Comprehensive Pathway-Level Modeling of Longitudinal Patient Trajectories from Multimodal Electronic Health Records
Technical University of Munich（慕尼黑技术大学）；TUM School of Computation, Information and Technology（慕尼黑技术大学计算、信息与技术学院）；Munich Center for Machine Learning (MCML)（慕尼黑机器学习中心）
University of Michigan（密歇根大学）；University of Michigan Medical School（密歇根大学医学院）
Objective: When patients develop acute respiratory failure, accurately identifying the underlying etiology is essential for determining the best treatment. However, differentiating between common medical diagnoses can be challenging in clinical practice. Machine learning models could improve medical diagnosis by aiding in the diagnostic evaluation of these patients. Materials and Methods: Machine learning models were trained to predict the common causes of acute respiratory failure (pneumonia, heart failure, and/or COPD). Models were trained using chest radiographs and clinical data from the e…
The scientific community continues to publish an overwhelming amount of new research related to COVID-19 on a daily basis, leading to much literature without little to no attention. To aid the community in understanding the rapidly flowing array of COVID-19 literature, we propose a novel BERT architecture that provides a brief yet original summarization of lengthy papers. The model continually learns on new data in online fashion while minimizing catastrophic forgetting, thus fitting to the need of the community. Benchmark and manual examination of its performance show that the model provide a…
Texas A&M University（德克萨斯农工大学）；Yale School of Medicine（耶鲁医学院）
Visual summarization of clinical data collected on patients contained within the electronic health record (EHR) may enable precise and rapid triage at the time of patient presentation to an emergency department (ED). The triage process is critical in the appropriate allocation of resources and in anticipating eventual patient disposition, typically admission to the hospital or discharge home. EHR data are high-dimensional and complex, but offer the opportunity to discover and characterize underlying data-driven patient phenotypes. These phenotypes will enable improved, personalized therapeutic…
The increase in availability of longitudinal electronic health record (EHR) data is leading to improved understanding of diseases and discovery of novel phenotypes. The majority of clustering algorithms focus only on patient trajectories, yet patients with similar trajectories may have different outcomes. Finding subgroups of patients with different trajectories and outcomes can guide future drug development and improve recruitment to clinical trials. We develop a recurrent neural network autoencoder to cluster EHR data using reconstruction, outcome, and clustering losses which can be weighted…
Xidian University（西安电子科技大学）；Robarts Research Institute（罗伯茨研究所）；Western University（韦仕敦大学）；University of Michigan（密歇根大学）
Electronic health records (EHRs) are usually highly dimensional, heterogeneous, and multimodal. Besides, the random recording of clinical variables results in high missing rates and uneven time intervals between adjacent records in the multivariate clinical time-series data extracted from EHRs. Current works using clinical time-series data for patient representation regard the patients' physiological status as a discrete process described by sporadically collected records. However, changes in the patient's physiological condition are continuous and dynamic processes. The perception of time and…
National Institute of Technology Karnataka Surathkal（卡纳塔克苏拉特卡尔国家理工学院）
Existing Clinical Decision Support Systems (CDSSs) largely depend on the availability of structured patient data and Electronic Health Records (EHRs) to aid caregivers. However, in case of hospitals in developing countries, structured patient data formats are not widely adopted, where medical professionals still rely on clinical notes in the form of unstructured text. Such unstructured clinical notes recorded by medical personnel can also be a potential source of rich patient-specific information which can be leveraged to build CDSSs, even for hospitals in developing countries. If such unstruc…
Rochester Center for Health Informatics（罗切斯特健康信息学中心）；Department of Medicine, Division of Nephrology（内科肾脏病学系）；Department of Medicine, Division of Infectious Diseases, University of Rochester Medical Center/Strong Memorial Hospital AIDS Center（罗切斯特大学医学中心/斯特朗纪念医院艾滋病中心内科传染病学系）；Clinical and Translational Science Institute, University of Rochester Medical Center（罗切斯特大学医学中心临床与转化科学研究所）
HIV RNA viral load (VL) is an important outcome variable in studies of HIV infected persons. There exists only a handful of methods which classify patients by viral load patterns. Most methods place limits on the use of viral load measurements, are often specific to a particular study design, and do not account for complex, temporal variation. To address this issue, we propose a set of four unambiguous computable characteristics (features) of time-varying HIV viral load patterns, along with a novel centroid-based classification algorithm, which we use to classify a population of 1,576 HIV posi…
