Electronic Health Records (EHR) are generated from clinical routine care recording valuable information of broad patient populations, which provide plentiful opportunities for improving patient management and intervention strategies in clinical practice. To exploit the enormous potential of EHR data, a popular EHR data analysis paradigm in machine learning is EHR representation learning, which first leverages the individual patient's EHR data to learn informative representations by a backbone, and supports diverse health-care downstream tasks grounded on the representations. Unfortunately, such a paradigm fails to access the in-depth analysis of patients' relevance, which is generally known as cohort studies in clinical practice. Specifically, patients in the same cohort tend to share similar characteristics, implying their resemblance in medical conditions such as symptoms or diseases. In this paper, we propose a universal COhort Representation lEarning (CORE) framework to augment EHR utilization by leveraging the fine-grained cohort information among patients. In particular, CORE first develops an explicit patient modeling task based on the prior knowledge of patients' diagnosis codes, which measures the latent relevance among patients to adaptively divide the cohorts for each patient. Based on the constructed cohorts, CORE recodes the pre-extracted EHR data representation from intra- and inter-cohort perspectives, yielding augmented EHR data representation learning. CORE is readily applicable to diverse backbone models, serving as a universal plug-in framework to infuse cohort information into healthcare methods for boosted performance. We conduct an extensive experimental evaluation on two real-world datasets, and the experimental results demonstrate the effectiveness and generalizability of CORE.
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.
Enhancing Spectral Embedding through Robust and Flexible Knowledge Transfer in Electronic Health Records
Harvard T.H. Chan School of Public Health（哈佛大学T.H. Chan公共卫生学院）；Dana-Farber Cancer Institute（达纳-法伯癌症研究所）；Harvard Medical School（哈佛医学院）；University of Pittsburgh（匹兹堡大学）
Data distribution impacts the performance and generalisability of contrastive learning-based foundation models of electrocardiograms
National Heart and Lung Institute, Imperial College London（伦敦帝国理工学院国家心肺研究所）；Chelsea and Westminster Hospital NHS Foundation Trust（切尔西和威斯敏斯特医院NHS基金会信托）；Zhongshan Hospital of Fudan University（复旦大学附属中山医院）；Shanghai Institute of Cardiovascular Diseases（上海市心血管病研究所）；National Clinical Research Centre for Interventional Medicine（国家介入医学临床研究中心）；Uppsala University（乌普萨拉大学）；Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center（范德堡大学医学中心临床与转化研究所）；Center for Digital Genomic Medicine, Department of Medicine, Vanderbilt University Medical Center（范德堡大学医学中心数字基因组医学中心）；Division of Cardiovascular Medicine, Vanderbilt University Medical Center（范德堡大学医学中心心血管内科）
VecAug: Unveiling Camouflaged Frauds with Cohort Augmentation for Enhanced Detection
National University of Singapore（新加坡国立大学）；Shopee Singapore（Shopee新加坡）；Zhejiang University（浙江大学）；University of Michigan（密歇根大学）；Beijing Institute of Technology（北京理工大学）
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 …
EVA-Net: Interpretable Anomaly Detection for Brain Health via Learning Continuous Aging Prototypes from One-Class EEG Cohorts
Qilu Hospital, ASU（青岛医院，亚利桑那州立大学）；Zhengzhou University（郑州大学）；University of Science and Technology Beijing（北京科技大学）；Southern University of Science and Technology（南方科技大学）；Qilu Hospital（青岛医院）
NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London（英国国立卫生研究院生物医学研究中心（位于南伦敦和莫兹利 NHS 基金会信托及伦敦国王学院））；University of Edinburgh（爱丁堡大学）；University College London（伦敦大学学院）
Multimorbidity research in mental health services requires data from physical health conditions which is traditionally limited in mental health care electronic health records. In this study, we aimed to extract data from physical health conditions from clinical notes using SemEHR. Data was extracted from Clinical Record Interactive Search (CRIS) system at South London and Maudsley Biomedical Research Centre (SLaM BRC) and the cohort consisted of all individuals who had received a primary or secondary diagnosis of severe mental illness between 2007 and 2018. Three pairs of annotators annotated …
IBM T. J. Watson Research Center（IBM T. J. 沃森研究中心）
Increased availability of electronic health records (EHR) has enabled researchers to study various medical questions. Cohort selection for the hypothesis under investigation is one of the main consideration for EHR analysis. For uncommon diseases, cohorts extracted from EHRs contain very limited number of records - hampering the robustness of any analysis. Data augmentation methods have been successfully applied in other domains to address this issue mainly using simulated records. In this paper, we present ODVICE, a data augmentation framework that leverages the medical concept ontology to sy…
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…
ETH Zürich（苏黎世联邦理工学院）；Max Planck Institute for Intelligent Systems（马克斯·普朗克智能系统研究所）；Technical University of Denmark（丹麦技术大学）；KTH Stockholm（瑞典皇家理工学院）；CIFAR Azrieli Global Scholar（CIFAR Azrieli 全球学者计划）；GlaxoSmithKline（葛兰素史克）
The widespread adoption of electronic health records (EHRs) and subsequent increased availability of longitudinal healthcare data has led to significant advances in our understanding of health and disease with direct and immediate impact on the development of new diagnostics and therapeutic treatment options. However, access to EHRs is often restricted due to their perceived sensitive nature and associated legal concerns, and the cohorts therein typically are those seen at a specific hospital or network of hospitals and therefore not representative of the wider population of patients. Here, we…
University of Magdeburg（马格德堡大学）；University of Jena（耶拿大学）；University of Leipzig（莱比锡大学）
An accurate assessment of the cardiovascular system and prediction of cardiovascular diseases (CVDs) are crucial. Measured cardiac blood flow data provide insights about patient-specific hemodynamics, where many specialized techniques have been developed for the visual exploration of such data sets to better understand the influence of morphological and hemodynamic conditions on CVDs. However, there is a lack of machine learning approaches techniques that allow a feature-based classification of heart-healthy people and patients with CVDs. In this work, we investigate the potential of morpholog…
The Effect of Epidemiological Cohort Creation on the Machine Learning Prediction of Homelessness and Police Interaction Outcomes Using Administrative Health Care Data
University of Calgary（卡尔加里大学）；Schulich School of Engineering（舒立克工程学院）；Hotchkiss Brain Institute（霍奇基斯脑研究所）；Cumming School of Medicine（卡明医学院）
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…
Flatiron Health Inc.（Flatiron健康公司）；New York University School of Medicine（纽约大学医学院）；Massachusetts Institute of Technology（麻省理工学院）
Objective Electronic health records (EHRs) are a promising source of data for health outcomes research in oncology. A challenge in using EHR data is that selecting cohorts of patients often requires information in unstructured parts of the record. Machine learning has been used to address this, but even high-performing algorithms may select patients in a non-random manner and bias the resulting cohort. To improve the efficiency of cohort selection while measuring potential bias, we introduce a technique called Model-Assisted Cohort Selection (MACS) with Bias Analysis and apply it to the select…
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…
Due to patient privacy protection concerns, machine learning research in healthcare has been undeniably slower and limited than in other application domains. High-quality, realistic, synthetic electronic health records (EHRs) can be leveraged to accelerate methodological developments for research purposes while mitigating privacy concerns associated with data sharing. The current state-of-the-art model for synthetic EHR generation is generative adversarial networks, which are notoriously difficult to train and can suffer from mode collapse. Denoising Diffusion Probabilistic Models, a class of …
A medical coding language model trained on clinical narratives from a population-wide cohort of 1.8 million patients
University of Copenhagen（哥本哈根大学）；Corti（Corti公司）；Novo Nordisk Foundation Center for Protein Research（诺和诺德基金会蛋白质研究中心）；Danish Research Institute for Suicide Prevention（丹麦自杀预防研究所）；Mental Health Centre Copenhagen（哥本哈根精神卫生中心）
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, …
A Generative Approach for Semantic Auditing of Electronic Health Records
School of Biomedical Engineering, Faculty of Engineering, Tel Aviv University（特拉维夫大学生物医学工程学院，工程学院）；AI and Data Science Center of Tel Aviv University (TAD)（特拉维夫大学人工智能与数据科学中心（TAD））；Safra Center for Bioinformatics, Tel Aviv University（特拉维夫大学萨弗拉生物信息学中心）
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.
The University of Sheffield（谢菲尔德大学）；Universitat Pompeu Fabra（庞培法布拉大学）；University of Oxford（牛津大学）；Queen Mary University of London（伦敦玛丽女王大学）
The exploitation of large-scale population data has the potential to improve healthcare by discovering and understanding patterns and trends within this data. To enable high throughput analysis of cardiac imaging data automatically, a pipeline should comprise quality monitoring of the input images, segmentation of the cardiac structures, assessment of the segmentation quality, and parsing of cardiac functional indexes. We present a fully automatic, high throughput image parsing workflow for the analysis of cardiac MR images, and test its performance on the UK Biobank (UKB) cardiac dataset. The…
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 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 …
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…
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…
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…
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…
