Learning Hidden Patterns from Patient Multivariate Time Series Data Using Convolutional Neural Networks: A Case Study of Healthcare Cost Prediction
Leavey School of Business, Santa Clara University（圣克拉拉大学利维商学院）；David Eccles School of Business, University of Utah（犹他大学大卫埃克尔斯商学院）；University of Utah（犹他大学）；Cairo University（开罗大学）
Mohammad Amin Morid, Olivia R. Liu Sheng, Kensaku Kawamoto, Samir Abdelrahman
Objective: To develop an effective and scalable individual-level patient cost prediction method by automatically learning hidden temporal patterns from multivariate time series data in patient insurance claims using a convolutional neural network (CNN) architecture.
Methods: We used three years of medical and pharmacy claims data from 2013 to 2016 from a healthcare insurer, where data from the first two years were used to build the model to predict costs in the third year. The data consisted of the multivariate time series of cost, visit and medical features that were shaped as images of patients' health status (i.e., matrices with time windows on one dimension and the medical, visit and cost features on the other dimension). Patients' multivariate time series images were given to a CNN method with a proposed architecture. After hyper-parameter tuning, the proposed architecture consisted of three building blocks of convolution and pooling layers with an LReLU activation function and a customized kernel size at each layer for healthcare data. The proposed CNN learned temporal patterns became inputs to a fully connected layer.
Conclusions: Feature learning through the proposed CNN configuration significantly improved individual-level healthcare cost prediction. The proposed CNN was able to outperform temporal pattern detection methods that look for a pre-defined set of pattern shapes, since it is capable of extracting a variable number of patterns with various shapes. Temporal patterns learned from medical, visit and cost data made significant contributions to the prediction performance. Hyper-parameter tuning showed that considering three-month data patterns has the highest prediction accuracy. Our results showed that patients' images extracted from multivariate time series data are different from regular images, and hence require unique designs of CNN architectures.
Santa Clara University（圣克拉拉大学）；University of Utah（犹他大学）
Traditional machine learning methods face two main challenges in dealing with healthcare predictive analytics tasks. First, the high-dimensional nature of healthcare data needs labor-intensive and time-consuming processes to select an appropriate set of features for each new task. Second, these methods depend on feature engineering to capture the sequential nature of patient data, which may not adequately leverage the temporal patterns of the medical events and their dependencies. Recent deep learning methods have shown promising performance for various healthcare prediction tasks by addressin…
University of Technology Sydney（悉尼科技大学）；The University of Queensland（昆士兰大学）
Understanding patients' journeys in healthcare system is a fundamental prepositive task for a broad range of AI-based healthcare applications. This task aims to learn an informative representation that can comprehensively encode hidden dependencies among medical events and its inner entities, and then the use of encoding outputs can greatly benefit the downstream application-driven tasks. A patient journey is a sequence of electronic health records (EHRs) over time that is organized at multiple levels: patient, visits and medical codes. The key challenge of patient journey understanding is to …
The percentage of patients hospitalized due to hyponatremia is getting higher. Hyponatremia is the deficiency of sodium electrolyte in the human serum. This deficiency might indulge adverse effects and also associated with longer hospital stay or mortality, if it wasnt actively treated and managed. This work predicts the futuristic sodium levels of patients based on their history of health problems using multilayer perceptron and multivariate linear regression algorithm. This work analyses the patients age, information about other disease such as diabetes, pneumonia, liver-disease, malignancy,…
University of Illinois Urbana-Champaign（伊利诺伊大学厄巴纳-香槟分校）；Harvard Medical School（哈佛医学院）；Beth Israel Deaconess Medical Center（贝斯以色列女执事医疗中心）
The vast amount of health data has been continuously collected for each patient, providing opportunities to support diverse healthcare predictive tasks such as seizure detection and hospitalization prediction. Existing models are mostly trained on other patients data and evaluated on new patients. Many of them might suffer from poor generalizability. One key reason can be overfitting due to the unique information related to patient identities and their data collection environments, referred to as patient covariates in the paper. These patient covariates usually do not contribute to predicting …
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…
University of Toronto（多伦多大学）；Vector Institute（向量学院）；Adobe（奥多比）；Microsoft Research（微软研究院）
Reinforcement Learning (RL) has recently been applied to sequential estimation and prediction problems identifying and developing hypothetical treatment strategies for septic patients, with a particular focus on offline learning with observational data. In practice, successful RL relies on informative latent states derived from sequential observations to develop optimal treatment strategies. To date, how best to construct such states in a healthcare setting is an open question. In this paper, we perform an empirical study of several information encoding architectures using data from septic pat…
Objective: Improving geographical access remains a key issue in determining the sufficiency of regional medical resources during health policy design. However, patient choices can be the result of the complex interactivity of various factors. The aim of this study is to propose a deep neural network approach to model the complex decision of patient choice in travel distance to access care, which is an important indicator for policymaking in allocating resources. Method: We used the 4-year nationwide insurance data of Taiwan and accumulated the possible features discussed in earlier literature.…
As hospitals move towards automating and integrating their computing systems, more fine-grained hospital operations data are becoming available. These data include hospital architectural drawings, logs of interactions between patients and healthcare professionals, prescription data, procedures data, and data on patient admission, discharge, and transfers. This has opened up many fascinating avenues for healthcare-related prediction tasks for improving patient care. However, in order to leverage off-the-shelf machine learning software for these tasks, one needs to learn structured representatio…
Incorporating a human-in-the-loop system when deploying automated decision support is critical in healthcare contexts to create trust, as well as provide reliable performance on a patient-to-patient basis. Deep learning methods while having high performance, do not allow for this patient-centered approach due to the lack of uncertainty representation. Thus, we present a framework of uncertainty representation evaluated for medical image segmentation, using MCU-Net which combines a U-Net with Monte Carlo Dropout, evaluated with four different uncertainty metrics. The framework augments this by …
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…
KAIST（韩国科学技术院）；AITRICS；Yonsei University College of Medicine（延世大学医学院）
We present a personalized and reliable prediction model for healthcare, which can provide individually tailored medical services such as diagnosis, disease treatment, and prevention. Our proposed framework targets at making personalized and reliable predictions from time-series data, such as Electronic Health Records (EHR), by modeling two complementary components: i) a shared component that captures global trend across diverse patients and ii) a patient-specific component that models idiosyncratic variability for each patient. To this end, we propose a composite model of a deep neural network…
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…
Patient time series classification faces challenges in high degrees of dimensionality and missingness. In light of patient similarity theory, this study explores effective temporal feature engineering and reduction, missing value imputation, and change point detection methods that can afford similarity-based classification models with desirable accuracy enhancement. We select a piecewise aggregation approximation method to extract fine-grain temporal features and propose a minimalist method to impute missing values in temporal features. For dimensionality reduction, we adopt a gradient descent…
UiT The Arctic University of Norway（挪威北极大学）；Universidad Rey Juan Carlos（胡安·卡洛斯国王大学）；University Hospital of North Norway (UNN)（挪威北部大学医院）
A large fraction of the electronic health records consists of clinical measurements collected over time, such as blood tests, which provide important information about the health status of a patient. These sequences of clinical measurements are naturally represented as time series, characterized by multiple variables and the presence of missing data, which complicate analysis. In this work, we propose a surgical site infection detection framework for patients undergoing colorectal cancer surgery that is completely unsupervised, hence alleviating the problem of getting access to labelled traini…
Southampton Business School, University of Southampton（南安普顿大学南安普顿商学院）；Pontificia Universidad Javeriana（哈维里亚那天主教大学）；The University of Western Ontario（西安大略大学）；Mathematical Sciences, University of Southampton（南安普顿大学数学科学学院）
Low attendance levels in medical appointments have been associated with poor health outcomes and efficiency problems for service providers. To address this problem, healthcare managers could aim at improving attendance levels or minimizing the operational impact of no-shows by adapting resource allocation policies. However, given the uncertainty of patient behaviour, generating relevant information regarding no-show probabilities could support the decision-making process for both approaches. In this context many researchers have used multiple regression models to identify patient and appointme…
University of Illinois at Chicago（伊利诺伊大学芝加哥分校）；Amazon（亚马逊）；Northwestern University（西北大学）
Distributed representations have been used to support downstream tasks in healthcare recently. Healthcare data (e.g., electronic health records) contain multiple modalities of data from heterogeneous sources that can provide complementary information, alongside an added dimension to learning personalized patient representations. To this end, in this paper we propose a novel unsupervised encoder-decoder model, namely Mixed Pooling Multi-View Attention Autoencoder (MPVAA), that generates patient representations encapsulating a holistic view of their medical profile. Specifically, by first learni…
Multivariate time series (MTS) have become increasingly common in healthcare domains where human vital signs and laboratory results are collected for predictive diagnosis. Recently, there have been increasing efforts to visualize healthcare MTS data based on star charts or parallel coordinates. However, such techniques might not be ideal for visualizing a large MTS dataset, since it is difficult to obtain insights or interpretations due to the inherent high dimensionality of MTS. In this paper, we propose 'm-TSNE': a simple and novel framework to visualize high-dimensional MTS data by projecti…
Universitat Politècnica de Catalunya（加泰罗尼亚理工大学）；Institut Català de la Salut（加泰罗尼亚卫生研究所）
In this paper we present a method for the unsupervised clustering of high-dimensional binary data, with a special focus on electronic healthcare records. We present a robust and efficient heuristic to face this problem using tensor decomposition. We present the reasons why this approach is preferable for tasks such as clustering patient records, to more commonly used distance-based methods. We run the algorithm on two datasets of healthcare records, obtaining clinically meaningful results.
Stevens Institute of Technology（斯蒂文斯理工学院）；Virginia Tech（弗吉尼亚理工大学）；IBM Research（IBM研究）
Accurate and explainable health event predictions are becoming crucial for healthcare providers to develop care plans for patients. The availability of electronic health records (EHR) has enabled machine learning advances in providing these predictions. However, many deep learning based methods are not satisfactory in solving several key challenges: 1) effectively utilizing disease domain knowledge; 2) collaboratively learning representations of patients and diseases; and 3) incorporating unstructured text. To address these issues, we propose a collaborative graph learning model to explore pat…
The potential of Reinforcement Learning (RL) has been demonstrated through successful applications to games such as Go and Atari. However, while it is straightforward to evaluate the performance of an RL algorithm in a game setting by simply using it to play the game, evaluation is a major challenge in clinical settings where it could be unsafe to follow RL policies in practice. Thus, understanding sensitivity of RL policies to the host of decisions made during implementation is an important step toward building the type of trust in RL required for eventual clinical uptake. In this work, we pe…
Multimodal electronic health record (EHR) data are widely used in clinical applications. Conventional methods usually assume that each sample (patient) is associated with the unified observed modalities, and all modalities are available for each sample. However, missing modality caused by various clinical and social reasons is a common issue in real-world clinical scenarios. Existing methods mostly rely on solving a generative model that learns a mapping from the latent space to the original input space, which is an unstable ill-posed inverse problem. To relieve the underdetermined system, we …
Identifying Subgroups of ICU Patients Using End-to-End Multivariate Time-Series Clustering Algorithm Based on Real-World Vital Signs Data
Soochow University（苏州大学）；Advanced Institute of Information Technology, Peking University（北京大学信息技术高等研究院）；National Institute of Health Data Science, Peking University（北京大学健康医疗大数据国家研究院）；Peking University People’s Hospital（北京大学人民医院）
L3S Research Center, Leibniz University（莱布尼茨大学L3S研究中心）；University of Applied Sciences Osnabrück（奥斯纳布吕克应用科学大学）；University of Applied Sciences and Arts Hannover（汉诺威应用科学与艺术大学）
Mining health data can lead to faster medical decisions, improvement in the quality of treatment, disease prevention, reduced cost, and it drives innovative solutions within the healthcare sector. However, health data is highly sensitive and subject to regulations such as the General Data Protection Regulation (GDPR), which aims to ensure patient's privacy. Anonymization or removal of patient identifiable information, though the most conventional way, is the first important step to adhere to the regulations and incorporate privacy concerns. In this paper, we review the existing anonymization t…
Recognizing the patient's emotions using deep learning techniques has attracted significant attention recently due to technological advancements. Automatically identifying the emotions can help build smart healthcare centers that can detect depression and stress among the patients in order to start the medication early. Using advanced technology to identify emotions is one of the most exciting topics as it defines the relationships between humans and machines. Machines learned how to predict emotions by adopting various methods. In this survey, we present recent research in the field of using …
Bakar Computational Health Sciences Institute, University of California, San Francisco（加州大学旧金山分校巴卡尔计算健康科学研究所）
Clinical data for ambulatory care, which accounts for 90% of the nations healthcare spending, is characterized by relatively small sample sizes of longitudinal data, unequal spacing between visits for each patient, with unequal numbers of data points collected across patients. While deep learning has become state-of-the-art for sequence modeling, it is unknown which methods of time aggregation may be best suited for these challenging temporal use cases. Additionally, deep models are often considered uninterpretable by physicians which may prevent the clinical adoption, even of well performing …
The increasing availability of healthcare data requires accurate analysis of disease diagnosis, progression, and realtime monitoring to provide improved treatments to the patients. In this context, Machine Learning (ML) models are used to extract valuable features and insights from high-dimensional and heterogeneous healthcare data to detect different diseases and patient activities in a Smart Healthcare System (SHS). However, recent researches show that ML models used in different application domains are vulnerable to adversarial attacks. In this paper, we introduce a new type of adversarial …
Studies suggest that one in three US adults use the Internet to diagnose or learn about a health concern. However, such access to health information online could exacerbate the disparities in health information availability and use. Health information seeking behavior (HISB) refers to the ways in which individuals seek information about their health, risks, illnesses, and health-protective behaviors. For patients engaging in searches for health information on digital media platforms, health literacy divides can be exacerbated both by their own lack of knowledge and by algorithmic recommendatio…
Data Distribution Dynamics in Real-World WiFi-Based Patient Activity Monitoring for Home Healthcare
University of North Carolina at Chapel Hill（北卡罗来纳大学教堂山分校）；University of Texas Health Science Center at San Antonio（德克萨斯大学圣安东尼奥健康科学中心）；University of Texas at San Antonio（德克萨斯大学圣安东尼奥分校）；Florida State University（佛罗里达州立大学）；Bosch Research and Technology Center（博世研究技术中心）
Harvard T.H. Chan School of Public Health（哈佛陈曾熙公共卫生学院）；Wellframe Inc.（Wellframe公司）
It is not clear how to target patients who are most likely to benefit from digital care management programs ex-ante, a shortcoming of current risk score based approaches. This study focuses on defining impactability by identifying those patients most likely to benefit from technology enabled care management, delivered through a digital health platform, including a mobile app and clinician web dashboard. Anonymized insurance claims data were used from a commercially insured population across several U.S. states and combined with inferred sociodemographic data and data derived from the patient-h…
Developing reliable workload predictive models can affect many aspects of clinical decision making procedure. The primary challenge in healthcare systems is handling the demand uncertainty over the time. This issue becomes more critical for the healthcare facilities that provide service for chronic disease treatment because of the need for continuous treatments over the time. Although some researchers focused on exploring the methods for workload prediction recently, few types of research mainly focused on forecasting a quantitative measure for the workload of healthcare providers. Also, among…
