Contributions from computational intelligence to healthcare data processing

80 p.The increasing ability to gather, store and process health care information, through the electronic health records and improved communication methods opens the door for new applications intended to improve health care in many different ways. Crucial to this evolution is the development of new computational intelligence tools, related to machine learning and statistics. In this thesis we have dealt with two case studies involving health data. The first is the monitoring of children with respiratory diseases in the pediatric intensive care unit of a hospital. The alarm detection is stated as a classification problem predicting the triage selected by the nurse or medical doctor. The second is the prediction of readmissions leading to hospitalization in an emergency department of a hospital. Both problems have great impact in economic and personal well being. We have tackled them with a rigorous methodological approach, obtaining results that may lead to a real life implementation. We have taken special care in the treatment of the data imbalance. Finally we make propositions to bring these techniques to the clinical environment

A Machine Learning Framework for Length of Stay Minimization in Healthcare Emergency Department

The emergency departments (EDs) in most hospitals, especially in middle-and-low-income countries, need techniques for minimizing the waiting time of patients. The application and utilization of appropriate methods can enhance the number of patients treated, improve patients’ satisfaction, reduce healthcare costs, and lower morbidity and mortality rates which are often associated with poor healthcare facilities, overcrowding, and low availability of healthcare professionals.  Modeling the length of stay (LOS) of patients in healthcare systems is a challenge that must be addressed for sound decision-making regarding capacity planning and resource allocation. This paper presents a machine learning (ML) framework for predicting a patient’s LOS within the ED. A study of the services in the ED of a tertiary healthcare facility in Uyo, Nigeria was conducted to gain insights into its operational procedures and evaluate the impact of certain parameters on LOS. Then, a computer simulation of the system was performed in R programming language using data obtained from records in the hospital. Finally, the performance of four ML classifiers involved in patients’ LOS prediction: Classification and Regression Tree (CART), Random Forest (RF), K-Nearest Neighbour (K-NN), and Support Vector Machine (SVM), were evaluated and results indicate that SVM outperforms others with the highest coefficient of determination (R2) score of 0.986984 and least mean square error (MSE) value of 0.358594. The result demonstrates the capability of ML techniques to effectively assess the performance of healthcare systems and accurately predict patients’ LOS to mitigate the low physician-patient ratio and improve throughput

A Systematic Review of Knowledge Visualization Approaches Using Big Data Methodology for Clinical Decision Support

This chapter reports on results from a systematic review of peer-reviewed studies related to big data knowledge visualization for clinical decision support (CDS). The aims were to identify and synthesize sources of big data in knowledge visualization, identify visualization interactivity approaches for CDS, and summarize outcomes. Searches were conducted via PubMed, Embase, Ebscohost, CINAHL, Medline, Web of Science, and IEEE Xplore in April 2019, using search terms representing concepts of: big data, knowledge visualization, and clinical decision support. A Google Scholar gray literature search was also conducted. All references were screened for eligibility. Our review returned 3252 references, with 17 studies remaining after screening. Data were extracted and coded from these studies and analyzed using a PICOS framework. The most common audience intended for the studies was healthcare providers (n = 16); the most common source of big data was electronic health records (EHRs) (n = 12), followed by microbiology/pathology laboratory data (n = 8). The most common intervention type was some form of analysis platform/tool (n = 7). We identified and classified studies by visualization type, user intent, big data platforms and tools used, big data analytics methods, and outcomes from big data knowledge visualization of CDS applications

Validation Of An Emr Prioritization Tool For Diabetes Population Health

The goal of evidence based population health aligned with financial outcomes is to effectively and efficiently manage a defined population to promote wellness, prevent disease progression and manage chronic conditions and acute events. A prerequisite to this model, which is in its early stages of evolution, is an electronic trace of patient information across continuum of care (COC) providers spanning hospitals, physician offices, home health programs, skilled nursing facilities, retailers, payers and new entrants. The information captured along the information trace can be mined from a data repository to analyze cohort specific evidence based care models. A newly formed, large academic employee Accountable Care Organization (ACO) designed and implemented a chronic care program, beginning with a diabetes cohort pilot. An innovative Electronic Medical Record (EMR) prioritization tool was designed according to Design for Six Sigma principles to scope data element additions to the EMR related to weighted outcome measures such as readmission, complications, ED visit reductions and presenteeism at work. Sixteen diabetes care area data categories were prioritized to include compliance, symptoms, diabetes specific risk factors and relationship to biometric indicators. The original prioritization tool and process was further validated via a survey of national experts and a literature evaluation conducted by an expert diabetes physician. Ten of the top eleven prioritized diabetes care areas were consistent between the baseline and survey group. The literature evaluation provided additional research, further substantiating the EMR prioritization data categories The prioritization tool and validation process can be replicated by experienced clinicians and applied to additional chronic conditions. This may be valuable for the prioritization of additional EMR metrics that are relevant to care, business and clinical attributes. Most importantly its application to real time EMR based evidence based population health will benefit populations of patients

Simulation and Modeling for Improving Access to Care for Underserved Populations

Indiana University-Purdue University Indianapolis (IUPUI)This research, through partnership with seven Community Health Centers (CHCs) in Indiana, constructed effective outpatient appointment scheduling systems by determining care needs of CHC patients, designing an infrastructure for meaningful use of patient health records and clinic operational data, and developing prediction and simulation models for improving access to care for underserved populations. The aims of this study are 1) redesigning appointment scheduling templates based on patient characteristics, diagnoses, and clinic capacities in underserved populations; 2) utilizing predictive modeling to improve understanding the complexity of appointment adherence in underserved populations; and 3) developing simulation models with complex data to guide operational decision-making in community health centers. This research addresses its aims by applying a multi-method approach from different disciplines, such as statistics, industrial engineering, computer science, health informatics, and social sciences. First, a novel method was developed to use Electronic Health Record (EHR) data for better understanding appointment needs of the target populations based on their characteristics and reasons for seeking health, which helped simplify, improve, and redesign current appointment type and duration models. Second, comprehensive and informative predictive models were developed to better understand appointment non-adherence in community health centers. Logistic Regression, Naïve Bayes Classifier, and Artificial Neural Network found factors contributing to patient no-show. Predictors of appointment non-adherence might be used by outpatient clinics to design interventions reducing overall clinic no-show rates. Third, a simulation model was developed to assess and simulate scheduling systems in CHCs, and necessary steps to extract information for simulation modeling of scheduling systems in CHCs are described. Agent-Based Models were built in AnyLogic to test different scenarios of scheduling methods, and to identify how these scenarios could impact clinic access performance. This research potentially improves well-being of and care quality and timeliness for uninsured, underinsured, and underserved patients, and it helps clinics predict appointment no-shows and ensures scheduling systems are capable of properly meeting the populations’ care needs.2021-12-2

Focal Spot, Winter 2008/2009

https://digitalcommons.wustl.edu/focal_spot_archives/1110/thumbnail.jp

Ensemble Machine Learning to Predict Family Consent for Organ Donation

There is ever increasing disparity between number of organs needed for transplantation and numbers available for donation to save lives. As a result, thousands of people die every year waiting for organs. Therefore, it is now more important than ever before to take serious actions to decrease this disparity. One way to bridge gap between organ demand and supply is to increase family consent for organ donation. This research studied the factors associated with family consent. Machine Learning approach had been used in very few literature to understand factors related to family consent. This study uses six Ensemble Machine Learning models to accurately predict family consent outcome (yes/no). All family approaches data between January 2016 and March 2018 from an Organ Procurement Organization (OPO) based in New York city is used to build the family consent prediction model. The experimental results reveals that eXtreme Gradient Boosting (XGB) Machine Learning model performs better than other ensemble models with AUC of 0.8946 and accuracy of 81.7% after normalizing features and using LDA for dimension reduction and then tuning parameters using grid search method. 24 out of 29 features are identied as important features by XGB model. The model is used to calculate probability of consent before approaching family as the values for dierent features are available real-time after patient is referred to OPO for medical evaluation and suitability. The experimental result shows that the accuracy of the model increases from 77.6% to 91.5% as value for factors are added real-time. This model is also used for selecting the best sta for a particular case to approach family based on their past experience. Sta work schedule is incorporated with the model to select the top three sta based on likelihood of getting consent from family for organ donation. This recommendation system can be used as a potential sta dispatch model for OPO to further improve the consent from family for organ donation and save more lives by customizing the sta deployment procedure based on the characteristics of donor referral

A Hybrid Modelling Framework for Real-time Decision-support for Urgent and Emergency Healthcare

In healthcare, opportunities to use real-time data to support quick and effective decision-making are expanding rapidly, as data increases in volume, velocity and variety. In parallel, the need for short-term decision-support to improve system resilience is increasingly relevant, with the recent COVID-19 crisis underlining the pressure that our healthcare services are under to deliver safe, effective, quality care in the face of rapidly-shifting parameters. A real-time hybrid model (HM) which combines real-time data, predictions, and simulation, has the potential to support short-term decision-making in healthcare. Considering decision-making as a consequence of situation awareness focuses the HM on what information is needed where, when, how, and by whom with a view toward sustained implementation. However the articulation between real-time decision-support tools and a sociotechnical approach to their development and implementation is currently lacking in the literature. Having identified the need for a conceptual framework to support the development of real-time HMs for short-term decision-support, this research proposed and tested the Integrated Hybrid Analytics Framework (IHAF) through an examination of the stages of a Design Science methodology and insights from the literature examining decision-making in dynamic, sociotechnical systems, data analytics, and simulation. Informed by IHAF, a HM was developed using real-time Emergency Department data, time-series forecasting, and discrete-event simulation. The application started with patient questionnaires to support problem definition and to act as a formative evaluation, and was subsequently evaluated using staff interviews. Evaluation of the application found multiple examples where the objectives of people or sub-systems are not aligned, resulting in inefficiencies and other quality problems, which are characteristic of complex adaptive sociotechnical systems. Synthesis of the literature, the formative evaluation, and the final evaluation found significant themes which can act as antecedents or evaluation criteria for future real-time HM studies in sociotechnical systems, in particular in healthcare. The generic utility of IHAF is emphasised for supporting future applications in similar domains