Contrastive Learning on Multimodal Analysis of Electronic Health Records
Harvard T.H. Chan School of Public Health（哈佛T.H. 柏林公共卫生学院）；Harvard Medical School（哈佛医学院）；Rutgers University（罗格斯大学）；National University of Singapore（新加坡国立大学）
Electronic health record (EHR) systems capture a wealth of multimodal clinical data, encompassing both structured clinical codes and unstructured clinical notes. Yet, many EHR-focused studies have traditionally examined these modalities in isolation or combined them using simplistic methods, overlooking the intrinsic synergy between them. In reality, these modalities are deeply interconnected, each containing clinically relevant and complementary information that, when integrated effectively, can provide a more comprehensive understanding of patient health. Despite the success of multimodal contrastive learning in vision-language applications, its potential remains under-explored in multimodal EHR, particularly in terms of theoretical understanding. To support statistical analysis of multimodal EHR data, we propose a multimodal feature embedding generative model and design a multimodal contrastive loss to learn EHR feature representations. Our theoretical analysis demonstrates the effectiveness of multimodal learning over single-modality learning and connects the solution of the loss function to the singular value decomposition of a pointwise mutual information matrix. This connection leads to a privacy-preserving algorithm tailored for multimodal EHR representation learning. Simulation studies show that the proposed algorithm performs well under a variety of configurations. We further validate its clinical utility using real-world EHR data.
Contrastive learning has demonstrated promising performance in image and text domains either in a self-supervised or a supervised manner. In this work, we extend the supervised contrastive learning framework to clinical risk prediction problems based on longitudinal electronic health records (EHR). We propose a general supervised contrastive loss $\mathcal{L}_{\text{Contrastive Cross Entropy} } + λ\mathcal{L}_{\text{Supervised Contrastive Regularizer}}$ for learning both binary classification (e.g. in-hospital mortality prediction) and multi-label classification (e.g. phenotyping) in a unified…
University of Cambridge（剑桥大学）；MRC Epidemiology Unit（医学研究委员会流行病学组）；Alan Turing Institute（艾伦·图灵研究所）
Human Activity Recognition (HAR) constitutes one of the most important tasks for wearable and mobile sensing given its implications in human well-being and health monitoring. Motivated by the limitations of labeled datasets in HAR, particularly when employed in healthcare-related applications, this work explores the adoption and adaptation of SimCLR, a contrastive learning technique for visual representations, to HAR. The use of contrastive learning objectives causes the representations of corresponding views to be more similar, and those of non-corresponding views to be more different. After …
Indiana University Bloomington（印第安纳大学伯明顿分校）；Renmin University of China（中国人民大学）；University of Texas at Austin（德克萨斯大学奥斯汀分校）；Icahn School of Medicine at Mount Sinai（西奈山伊坎医学院）
Electronic Health Record (EHR) data has been of tremendous utility in Artificial Intelligence (AI) for healthcare such as predicting future clinical events. These tasks, however, often come with many challenges when using classical machine learning models due to a myriad of factors including class imbalance and data heterogeneity (i.e., the complex intra-class variances). To address some of these research gaps, this paper leverages the exciting contrastive learning framework and proposes a novel contrastive regularized clinical classification model. The contrastive loss is found to substantial…
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 …
Label-scarce, high-dimensional domains such as healthcare present a challenge for modern machine learning techniques. To overcome the difficulties posed by a lack of labeled data, we explore an "order-contrastive" method for self-supervised pre-training on longitudinal data. We sample pairs of time segments, switch the order for half of them, and train a model to predict whether a given pair is in the correct order. Intuitively, the ordering task allows the model to attend to the least time-reversible features (for example, features that indicate progression of a chronic disease). The same fea…
We introduce COLA, a self-supervised pre-training approach for learning a general-purpose representation of audio. Our approach is based on contrastive learning: it learns a representation which assigns high similarity to audio segments extracted from the same recording while assigning lower similarity to segments from different recordings. We build on top of recent advances in contrastive learning for computer vision and reinforcement learning to design a lightweight, easy-to-implement self-supervised model of audio. We pre-train embeddings on the large-scale Audioset database and transfer th…
This work explores how self-supervised learning can be universally used to discover speaker-specific features towards enabling personalized speech enhancement models. We specifically address the few-shot learning scenario where access to cleaning recordings of a test-time speaker is limited to a few seconds, but noisy recordings of the speaker are abundant. We develop a simple contrastive learning procedure which treats the abundant noisy data as makeshift training targets through pairwise noise injection: the model is pretrained to maximize agreement between pairs of differently deformed iden…
Vast quantities of person-generated health data (wearables) are collected but the process of annotating to feed to machine learning models is impractical. This paper discusses ways in which self-supervised approaches that use contrastive losses, such as SimCLR and BYOL, previously applied to the vision domain, can be applied to high-dimensional health signals for downstream classification tasks of various diseases spanning sleep, heart, and metabolic conditions. To this end, we adapt the data augmentation step and the overall architecture to suit the temporal nature of the data (wearable trace…
MIT（麻省理工学院）；Broad Institute of MIT and Harvard（麻省理工学院和哈佛大学博德研究所）；Massachusetts General Hospital（麻省总医院）；Massachusetts General Hospital Research Institute（麻省总医院研究所）；Harvard Medical School（哈佛医学院）；Harvard-MIT Division of Health Sciences and Technology（哈佛-麻省理工卫生科学与技术部）
Supervised machine learning applications in health care are often limited due to a scarcity of labeled training data. To mitigate this effect of small sample size, we introduce a pre-training approach, Patient Contrastive Learning of Representations (PCLR), which creates latent representations of ECGs from a large number of unlabeled examples. The resulting representations are expressive, performant, and practical across a wide spectrum of clinical tasks. We develop PCLR using a large health care system with over 3.2 million 12-lead ECGs, and demonstrate substantial improvements across multipl…
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…
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…
The paper presents a systematic review of state-of-the-art approaches to identify patient cohorts using electronic health records. It gives a comprehensive overview of the most commonly de-tected phenotypes and its underlying data sets. Special attention is given to preprocessing of in-put data and the different modeling approaches. The literature review confirms natural language processing to be a promising approach for electronic phenotyping. However, accessibility and lack of natural language process standards for medical texts remain a challenge. Future research should develop such standar…
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…
Accurate real-time monitoring systems of influenza outbreaks help public health officials make informed decisions that may help save lives. We show that information extracted from cloud-based electronic health records databases, in combination with machine learning techniques and historical epidemiological information, have the potential to accurately and reliably provide near real-time regional predictions of flu outbreaks in the United States.
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…
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…
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…
We propose multivariate nonstationary Gaussian processes for jointly modeling multiple clinical variables, where the key parameters, length-scales, standard deviations and the correlations between the observed output, are all time dependent. We perform posterior inference via Hamiltonian Monte Carlo (HMC). We also provide methods for obtaining computationally efficient gradient-based maximum a posteriori (MAP) estimates. We validate our model on synthetic data as well as on electronic health records (EHR) data from Kaiser Permanente (KP). We show that the proposed model provides better predict…
This paper presents an example of how demographical characteristics of patients influence their susceptibility to certain medical conditions. In this paper, we investigate the association of health conditions to age of patients in a heterogeneous population. We show that besides the symptoms a patients is having, the age has the potential of aiding the diagnostic process in hospitals. Working with Electronic Health Records (EHR), we show that medical conditions group into clusters that share distinctive population age densities. We use Electronic Health Records from Brazil for a period of 15 m…
The rich longitudinal individual level data available from electronic health records (EHRs) can be used to examine treatment effect heterogeneity. However, estimating treatment effects using EHR data poses several challenges, including time-varying confounding, repeated and temporally non-aligned measurements of covariates, treatment assignments and outcomes, and loss-to-follow-up due to dropout. Here, we develop the Subgroup Discovery for Longitudinal Data (SDLD) algorithm, a tree-based algorithm for discovering subgroups with heterogeneous treatment effects using longitudinal data by combini…
