Explanation-Based Auditing

To comply with emerging privacy laws and regulations, it has become common for applications like electronic health records systems (EHRs) to collect access logs, which record each time a user (e.g., a hospital employee) accesses a piece of sensitive data (e.g., a patient record). Using the access log, it is easy to answer simple queries (e.g., Who accessed Alice's medical record?), but this often does not provide enough information. In addition to learning who accessed their medical records, patients will likely want to understand why each access occurred. In this paper, we introduce the problem of generating explanations for individual records in an access log. The problem is motivated by user-centric auditing applications, and it also provides a novel approach to misuse detection. We develop a framework for modeling explanations which is based on a fundamental observation: For certain classes of databases, including EHRs, the reason for most data accesses can be inferred from data stored elsewhere in the database. For example, if Alice has an appointment with Dr. Dave, this information is stored in the database, and it explains why Dr. Dave looked at Alice's record. Large numbers of data accesses can be explained using general forms called explanation templates. Rather than requiring an administrator to manually specify explanation templates, we propose a set of algorithms for automatically discovering frequent templates from the database (i.e., those that explain a large number of accesses). We also propose techniques for inferring collaborative user groups, which can be used to enhance the quality of the discovered explanations. Finally, we have evaluated our proposed techniques using an access log and data from the University of Michigan Health System. Our results demonstrate that in practice we can provide explanations for over 94% of data accesses in the log.Comment: VLDB201

PathwAI Systems in Healthcare – a Framework for Coupling AI and Pathway-based Health Information Systems

Pathway-based Health Information Systems (HIS) enable planning, execution and improvement of standardized care processes. Adaptive behavior and learning effects are taken to a new level by advances in Artificial Intelligence (AI). Yet, design support to unlock synergies from coupling pathway-based HIS with AI is lacking. This Umbrella Review identifies applied purposes of AI in healthcare, describes the relation to pathway-based HIS, and derives a PathwAI Framework as design support for future research and development activities. Previous findings already provide a large base of approaches to realize personalized care pathways and improve coordination and business operations. Furthermore, potentials for designing learning health systems at micro, meso, and macro levels are formulated, but there is still greater opportunity for future research and design. Pathway-based HIS in this context can not only provide interpretable and interoperable data input, but can be conceptual as well as operational receivers of artificially generated knowledge

Clinical information extraction for preterm birth risk prediction

This paper contributes to the pursuit of leveraging unstructured medical notes to structured clinical decision making. In particular, we present a pipeline for clinical information extraction from medical notes related to preterm birth, and discuss the main challenges as well as its potential for clinical practice. A large collection of medical notes, created by staff during hospitalizations of patients who were at risk of delivering preterm, was gathered and analyzed. Based on an annotated collection of notes, we trained and evaluated information extraction components to discover clinical entities such as symptoms, events, anatomical sites and procedures, as well as attributes linked to these clinical entities. In a retrospective study, we show that these are highly informative for clinical decision support models that are trained to predict whether delivery is likely to occur within specific time windows, in combination with structured information from electronic health records

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

Big data analytics for preventive medicine

© 2019, Springer-Verlag London Ltd., part of Springer Nature. Medical data is one of the most rewarding and yet most complicated data to analyze. How can healthcare providers use modern data analytics tools and technologies to analyze and create value from complex data? Data analytics, with its promise to efficiently discover valuable pattern by analyzing large amount of unstructured, heterogeneous, non-standard and incomplete healthcare data. It does not only forecast but also helps in decision making and is increasingly noticed as breakthrough in ongoing advancement with the goal is to improve the quality of patient care and reduces the healthcare cost. The aim of this study is to provide a comprehensive and structured overview of extensive research on the advancement of data analytics methods for disease prevention. This review first introduces disease prevention and its challenges followed by traditional prevention methodologies. We summarize state-of-the-art data analytics algorithms used for classification of disease, clustering (unusually high incidence of a particular disease), anomalies detection (detection of disease) and association as well as their respective advantages, drawbacks and guidelines for selection of specific model followed by discussion on recent development and successful application of disease prevention methods. The article concludes with open research challenges and recommendations

Design considerations for a hierarchical semantic compositional framework for medical natural language understanding

Medical natural language processing (NLP) systems are a key enabling technology for transforming Big Data from clinical report repositories to information used to support disease models and validate intervention methods. However, current medical NLP systems fall considerably short when faced with the task of logically interpreting clinical text. In this paper, we describe a framework inspired by mechanisms of human cognition in an attempt to jump the NLP performance curve. The design centers about a hierarchical semantic compositional model (HSCM) which provides an internal substrate for guiding the interpretation process. The paper describes insights from four key cognitive aspects including semantic memory, semantic composition, semantic activation, and hierarchical predictive coding. We discuss the design of a generative semantic model and an associated semantic parser used to transform a free-text sentence into a logical representation of its meaning. The paper discusses supportive and antagonistic arguments for the key features of the architecture as a long-term foundational framework