Non-negative tensor factorization has been shown a practical solution to automatically discover phenotypes from the electronic health records (EHR) with minimal human supervision. Such methods generally require an input tensor describing the inter-modal interactions to be pre-established; however, the correspondence between different modalities (e.g., correspondence between medications and diagnoses) can often be missing in practice. Although heuristic methods can be applied to estimate them, they inevitably introduce errors, and leads to sub-optimal phenotype quality. This is particularly important for patients with complex health conditions (e.g., in critical care) as multiple diagnoses and medications are simultaneously present in the records. To alleviate this problem and discover phenotypes from EHR with unobserved inter-modal correspondence, we propose the collective hidden interaction tensor factorization (cHITF) to infer the correspondence between multiple modalities jointly with the phenotype discovery. We assume that the observed matrix for each modality is marginalization of the unobserved inter-modal correspondence, which are reconstructed by maximizing the likelihood of the observed matrices. Extensive experiments conducted on the real-world MIMIC-III dataset demonstrate that cHITF effectively infers clinically meaningful inter-modal correspondence, discovers phenotypes that are more clinically relevant and diverse, and achieves better predictive performance compared with a number of state-of-the-art computational phenotyping models.
University of Cambridge（剑桥大学）；The Alan Turing Institute（阿兰·图灵研究所）；Chung-Ang University（中央大学）
Clustering time-series data in healthcare is crucial for clinical phenotyping to understand patients' disease progression patterns and to design treatment guidelines tailored to homogeneous patient subgroups. While rich temporal dynamics enable the discovery of potential clusters beyond static correlations, two major challenges remain outstanding: i) discovery of predictive patterns from many potential temporal correlations in the multi-variate time-series data and ii) association of individual temporal patterns to the target label distribution that best characterizes the underlying clinical p…
University of Texas, Austin（得克萨斯大学奥斯汀分校）；Vanderbilt University（范德堡大学）；Emory University（埃默里大学）
It has been recently shown that sparse, nonnegative tensor factorization of multi-modal electronic health record data is a promising approach to high-throughput computational phenotyping. However, such approaches typically do not leverage available domain knowledge while extracting the phenotypes; hence, some of the suggested phenotypes may not map well to clinical concepts or may be very similar to other suggested phenotypes. To address these issues, we present a novel, automatic approach called PIVETed-Granite that mines existing biomedical literature (PubMed) to obtain cannot-link constrain…
IQIVA Inc.（艾昆纬公司）；University of Minnesota（明尼苏达大学）；University of Chicago（芝加哥大学）
Models have been proposed to extract temporal patterns from longitudinal electronic health records (EHR) for clinical predictive models. However, the common relations among patients (e.g., receiving the same medical treatments) were rarely considered. In this paper, we propose to learn patient similarity features as phenotypes from the aggregated patient-medical service matrix using non-negative matrix factorization. On real-world medical claim data, we show that the learned phenotypes are coherent within each group, and also explanatory and indicative of targeted diseases. We conducted experi…
Northwestern University Feinberg School of Medicine（西北大学范伯格医学院）
Background: The increasing adoption of electronic health records (EHR) across the US has created troves of computable data, to which machine learning methods have been applied to extract useful insights. EHR data, represented as a three-dimensional analogue of a matrix (tensor), is decomposed into two-dimensional factors that can be interpreted as computational phenotypes. Methods: We apply constrained tensor factorization to derive computational phenotypes and predict mortality in cohorts of patients with breast, prostate, colorectal, or lung cancer in the Northwestern Medicine Enterprise Dat…
Georgia Institute of Technology（佐治亚理工学院）；Health at Scale；INOVA；Sutter Health（萨特医疗）；Emory University（埃默里大学）
Phenotyping electronic health records (EHR) focuses on defining meaningful patient groups (e.g., heart failure group and diabetes group) and identifying the temporal evolution of patients in those groups. Tensor factorization has been an effective tool for phenotyping. Most of the existing works assume either a static patient representation with aggregate data or only model temporal data. However, real EHR data contain both temporal (e.g., longitudinal clinical visits) and static information (e.g., patient demographics), which are difficult to model simultaneously. In this paper, we propose Te…
Pohang University of Science and Technology（浦项科技大学）；Georgia Institute of Technology（佐治亚理工学院）；University of California, San Diego（加利福尼亚大学圣迭戈分校）
Tensor factorization models offer an effective approach to convert massive electronic health records into meaningful clinical concepts (phenotypes) for data analysis. These models need a large amount of diverse samples to avoid population bias. An open challenge is how to derive phenotypes jointly across multiple hospitals, in which direct patient-level data sharing is not possible (e.g., due to institutional policies). In this paper, we developed a novel solution to enable federated tensor factorization for computational phenotyping without sharing patient-level data. We developed secure 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 …
Columbia University（哥伦比亚大学）；Columbia University Medical Center（哥伦比亚大学医学中心）
Identifying a patient's key problems over time is a common task for providers at the point care, yet a complex and time-consuming activity given current electric health records. To enable a problem-oriented summarizer to identify a patient's comprehensive list of problems and their salience, we propose an unsupervised phenotyping approach that jointly learns a large number of phenotypes/problems across structured and unstructured data. To identify the appropriate granularity of the learned phenotypes, the model is trained on a target patient population of the same clinic. To enable the content…
Acute Kidney Injury (AKI) is a common clinical syndrome characterized by the rapid loss of kidney excretory function, which aggravates the clinical severity of other diseases in a large number of hospitalized patients. Accurate early prediction of AKI can enable in-time interventions and treatments. However, AKI is highly heterogeneous, thus identification of AKI sub-phenotypes can lead to an improved understanding of the disease pathophysiology and development of more targeted clinical interventions. This study used a memory network-based deep learning approach to discover AKI sub-phenotypes …
Stanford Center for Biomedical Informatics Research, Stanford University（斯坦福大学生物医学信息学研究中心）；USC Information Sciences Institute, University of Southern California（南加州大学信息科学研究所）
Electronic phenotyping is the task of ascertaining whether an individual has a medical condition of interest by analyzing their medical record and is foundational in clinical informatics. Increasingly, electronic phenotyping is performed via supervised learning. We investigate the effectiveness of multitask learning for phenotyping using electronic health records (EHR) data. Multitask learning aims to improve model performance on a target task by jointly learning additional auxiliary tasks and has been used in disparate areas of machine learning. However, its utility when applied to EHR data h…
The opioid epidemic in the United States claims over 40,000 lives per year, and it is estimated that well over two million Americans have an opioid use disorder. Over-prescription and misuse of prescription opioids play an important role in the epidemic. Individuals who are prescribed opioids, and who are diagnosed with opioid use disorder, have diverse underlying health states. Policy interventions targeting prescription opioid use, opioid use disorder, and overdose often fail to account for this variation. To identify latent health states, or phenotypes, pertinent to opioid use and opioid us…
RWTH Aachen University（亚琛工业大学）；INRIA（法国国家信息与自动化研究所）；CEA（法国原子能和替代能源委员会）；Department of Psychiatry and Psychotherapy（精神病学与心理治疗系）
High-quality data accumulation is now becoming ubiquitous in the health domain. There is increasing opportunity to exploit rich data from normal subjects to improve supervised estimators in specific diseases with notorious data scarcity. We demonstrate that low-dimensional embedding spaces can be derived from the UK Biobank population dataset and used to enhance data-scarce prediction of health indicators, lifestyle and demographic characteristics. Phenotype predictions facilitated by Variational Autoencoder manifolds typically scaled better with increasing unlabeled data than dimensionality r…
Understanding patterns of diagnoses, medications, procedures, and laboratory tests from electronic health records (EHRs) and health insurer claims is important for understanding disease risk and for efficient clinical development, which often require rules-based curation in collaboration with clinicians. We extended an unsupervised phenotyping algorithm, mixEHR, to an online version allowing us to use it on order of magnitude larger datasets including a large, US-based claims dataset and a rich regional EHR dataset. In addition to recapitulating previously observed disease groups, we discovere…
Northwestern University（西北大学）；Vanderbilt University Medical Center（范德堡大学医学中心）；Columbia University（哥伦比亚大学）
Systemic lupus erythematosus (SLE) is a rare autoimmune disorder characterized by an unpredictable course of flares and remission with diverse manifestations. Lupus nephritis, one of the major disease manifestations of SLE for organ damage and mortality, is a key component of lupus classification criteria. Accurately identifying lupus nephritis in electronic health records (EHRs) would therefore benefit large cohort observational studies and clinical trials where characterization of the patient population is critical for recruitment, study design, and analysis. Lupus nephritis can be recognize…
PheME: A deep ensemble framework for improving phenotype prediction from multi-modal data
Xi’an Jiaotong-Liverpool University（西交利物浦大学）；Wuhan University（武汉大学）；Rice University（莱斯大学）；Texas A&M University（德克萨斯农工大学）；University of Texas Health Science Center（德克萨斯大学健康科学中心）；UTHealth Houston School of Biomedical Informatics（德克萨斯大学休斯顿健康科学中心生物医学信息学院）
本文提出 PheME 深度集成框架，融合结构化 EHR 与临床笔记的单模态和多模态模型，以提升七种疾病的表型预测性能。
Otto-von-Guericke University（奥托·冯·格里克大学）；University of Regensburg（雷根斯堡大学）
Clinical records frequently include assessments of the characteristics of patients, which may include the completion of various questionnaires. These questionnaires provide a variety of perspectives on a patient's current state of well-being. Not only is it critical to capture the heterogeneity given by these perspectives, but there is also a growing demand for developing cost-effective technologies for clinical phenotyping. Filling out many questionnaires may be a strain for the patients and therefore costly. In this work, we propose COBALT -- a cost-based layer selector model for detecting p…
Lawrence Livermore National Laboratory（劳伦斯利弗莫尔国家实验室）；Kaiser Permanente Division of Research（凯撒永久医疗研究部）
We develop an unsupervised probabilistic model for heterogeneous Electronic Health Record (EHR) data. Utilizing a mixture model formulation, our approach directly models sequences of arbitrary length, such as medications and laboratory results. This allows for subgrouping and incorporation of the dynamics underlying heterogeneous data types. The model consists of a layered set of latent variables that encode underlying structure in the data. These variables represent subject subgroups at the top layer, and unobserved states for sequences in the second layer. We train this model on episodic dat…
RELEAP: Reinforcement-Enhanced Label-Efficient Active Phenotyping for Electronic Health Records
Department of Biostatistics and Bioinformatics, Duke University（生物统计学与生物信息学系，杜克大学）；Cancer Prevention and Control Research Program, Duke Cancer Institute（癌症预防与控制研究计划，杜克癌症研究所）；Department of Population Health Sciences, Duke University School of Medicine（流行病学与公共卫生科学系，杜克大学医学院）；Centre for Quantitative Medicine, Duke-NUS Medical School（定量医学中心，杜克-新加坡医学学校）；Programme in Health Services and Systems Research, Duke-NUS Medical School（健康服务与系统研究计划，杜克-新加坡医学学校）；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）；Department of Biostatistics, Peking University Health Science Center（生物统计学系，北京大学医学部）；Beijing International Center for Mathematical Research, Peking University（北京国际数学研究中心，北京大学）
Generating Synthetic Electronic Health Record Data: a Methodological Scoping Review with Benchmarking on Phenotype Data and Open-Source Software
Department of Biostatistics, University of Michigan（生物统计学系，密歇根大学）；Department of Biomedical Informatics and Data Science, Yale University（生物医学信息学与数据科学系，耶鲁大学）；Department of Biostatistics, Yale University（生物统计学系，耶鲁大学）
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…
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, …
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）
Memorial Sloan Kettering Cancer Center（纪念斯隆凯特琳癌症中心）；Weill Cornell Medicine（威尔康奈尔医学院）；ETH Zürich（苏黎世联邦理工学院）；University Hospital Zürich（苏黎世大学医院）；Swiss Institute for Bioinformatics（瑞士生物信息学研究所）；University Carlos III in Madrid（马德里卡洛斯三世大学）；Harvard University（哈佛大学）；University of Basel（巴塞尔大学）；University Hospital Basel（巴塞尔大学医院）；Swiss Data Science Center（瑞士数据科学中心）
The recent adoption of Electronic Health Records (EHRs) by health care providers has introduced an important source of data that provides detailed and highly specific insights into patient phenotypes over large cohorts. These datasets, in combination with machine learning and statistical approaches, generate new opportunities for research and clinical care. However, many methods require the patient representations to be in structured formats, while the information in the EHR is often locked in unstructured texts designed for human readability. In this work, we develop the methodology to automa…
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…
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 …
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 …
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…
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…
Electronic health record (EHR) data is collected by individual institutions and often stored across locations in silos. Getting access to these data is difficult and slow due to security, privacy, regulatory, and operational issues. We show, using ICU data from 58 different hospitals, that machine learning models to predict patient mortality can be trained efficiently without moving health data out of their silos using a distributed machine learning strategy. We propose a new method, called Federated-Autonomous Deep Learning (FADL) that trains part of the model using all data sources in a dist…
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…
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…
In the electronic health record, using clinical notes to identify entities such as disorders and their temporality (e.g. the order of an event relative to a time index) can inform many important analyses. However, creating training data for clinical entity tasks is time consuming and sharing labeled data is challenging due to privacy concerns. The information needs of the COVID-19 pandemic highlight the need for agile methods of training machine learning models for clinical notes. We present Trove, a framework for weakly supervised entity classification using medical ontologies and expert-gene…
Hong Kong Polytechnic University（香港理工大学）；Sony AI（索尼人工智能）；Nara Institute of Science and Technology（奈良先端科学技術大学院大学）；University of Alberta（阿尔伯塔大学）；Osaka University（大阪大学）
Clinicians prescribe antibiotics by looking at the patient's health record with an experienced eye. However, the therapy might be rendered futile if the patient has drug resistance. Determining drug resistance requires time-consuming laboratory-level testing while applying clinicians' heuristics in an automated way is difficult due to the categorical or binary medical events that constitute health records. In this paper, we propose a novel framework for rapid clinical intervention by viewing health records as graphs whose nodes are mapped from medical events and edges as correspondence between…
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 …
Text classification tasks which aim at harvesting and/or organizing information from electronic health records are pivotal to support clinical and translational research. However these present specific challenges compared to other classification tasks, notably due to the particular nature of the medical lexicon and language used in clinical records. Recent advances in embedding methods have shown promising results for several clinical tasks, yet there is no exhaustive comparison of such approaches with other commonly used word representations and classification models. In this work, we analyse…
In medicine, researchers often seek to infer the effects of a given treatment on patients' outcomes. However, the standard methods for causal survival analysis make simplistic assumptions about the data-generating process and cannot capture complex interactions among patient covariates. We introduce the Dynamic Survival Transformer (DynST), a deep survival model that trains on electronic health records (EHRs). Unlike previous transformers used in survival analysis, DynST can make use of time-varying information to predict evolving survival probabilities. We derive a semi-synthetic EHR dataset …
Objective: The generalizability of clinical large language models is usually ignored during the model development process. This study evaluated the generalizability of BERT-based clinical NLP models across different clinical settings through a breast cancer phenotype extraction task. Materials and Methods: Two clinical corpora of breast cancer patients were collected from the electronic health records from the University of Minnesota and the Mayo Clinic, and annotated following the same guideline. We developed three types of NLP models (i.e., conditional random field, bi-directional long short…
