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Clinical information modeling processes for semantic interoperability of electronic health records: systematic review and inductive analysis

This is a pre-copyedited, author-produced PDF of an article accepted for publication in Journal of the American Medical Informatics Association following peer review. The version of record is available online at: http://dx.doi.org/10.1093/jamia/ocv008[EN] [Objective] This systematic review aims to identify and compare the existing processes and methodologies that have been published in the literature for defining clinical information models (CIMs) that support the semantic interoperability of electronic health record (EHR) systems. [Material and Methods] Following the preferred reporting items for systematic reviews and meta-analyses systematic review methodology, the authors reviewed published papers between 2000 and 2013 that covered that semantic interoperability of EHRs, found by searching the PubMed, IEEE Xplore, and ScienceDirect databases. Additionally, after selection of a final group of articles, an inductive content analysis was done to summarize the steps and methodologies followed in order to build CIMs described in those articles. [Results] Three hundred and seventy-eight articles were screened and thirty six were selected for full review. The articles selected for full review were analyzed to extract relevant information for the analysis and characterized according to the steps the authors had followed for clinical information modeling. [Discussion] Most of the reviewed papers lack a detailed description of the modeling methodologies used to create CIMs. A representative example is the lack of description related to the definition of terminology bindings and the publication of the generated models. However, this systematic review confirms that most clinical information modeling activities follow very similar steps for the definition of CIMs. Having a robust and shared methodology could improve their correctness, reliability, and quality. [Conclusion] Independently of implementation technologies and standards, it is possible to find common patterns in methods for developing CIMs, suggesting the viability of defining a unified good practice methodology to be used by any clinical information modeler.This research has been partially funded by the Instituto de Salud Carlos III (Platform for Innovation in Medical Technologies and Health), grant PT13/0006/0036 and the Spanish Ministry of Economy and Competitiveness, grants TIN2010-21388-C02-01 and PTQ-12-05620.Moreno-Conde, A.; Moner Cano, D.; Da Cruz, WD.; Santos, MR.; Maldonado Segura, JA.; Robles Viejo, M.; Kalra, D. (2015). 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Secure and Trustworthy Artificial Intelligence-Extended Reality (AI-XR) for Metaverses

Metaverse is expected to emerge as a new paradigm for the next-generation Internet, providing fully immersive and personalised experiences to socialize, work, and play in self-sustaining and hyper-spatio-temporal virtual world(s). The advancements in different technologies like augmented reality, virtual reality, extended reality (XR), artificial intelligence (AI), and 5G/6G communication will be the key enablers behind the realization of AI-XR metaverse applications. While AI itself has many potential applications in the aforementioned technologies (e.g., avatar generation, network optimization, etc.), ensuring the security of AI in critical applications like AI-XR metaverse applications is profoundly crucial to avoid undesirable actions that could undermine users' privacy and safety, consequently putting their lives in danger. To this end, we attempt to analyze the security, privacy, and trustworthiness aspects associated with the use of various AI techniques in AI-XR metaverse applications. Specifically, we discuss numerous such challenges and present a taxonomy of potential solutions that could be leveraged to develop secure, private, robust, and trustworthy AI-XR applications. To highlight the real implications of AI-associated adversarial threats, we designed a metaverse-specific case study and analyzed it through the adversarial lens. Finally, we elaborate upon various open issues that require further research interest from the community.Comment: 24 pages, 11 figure

Practical and Ethical Challenges of Large Language Models in Education: A Systematic Scoping Review

Educational technology innovations leveraging large language models (LLMs) have shown the potential to automate the laborious process of generating and analysing textual content. While various innovations have been developed to automate a range of educational tasks (e.g., question generation, feedback provision, and essay grading), there are concerns regarding the practicality and ethicality of these innovations. Such concerns may hinder future research and the adoption of LLMs-based innovations in authentic educational contexts. To address this, we conducted a systematic scoping review of 118 peer-reviewed papers published since 2017 to pinpoint the current state of research on using LLMs to automate and support educational tasks. The findings revealed 53 use cases for LLMs in automating education tasks, categorised into nine main categories: profiling/labelling, detection, grading, teaching support, prediction, knowledge representation, feedback, content generation, and recommendation. Additionally, we also identified several practical and ethical challenges, including low technological readiness, lack of replicability and transparency, and insufficient privacy and beneficence considerations. The findings were summarised into three recommendations for future studies, including updating existing innovations with state-of-the-art models (e.g., GPT-3/4), embracing the initiative of open-sourcing models/systems, and adopting a human-centred approach throughout the developmental process. As the intersection of AI and education is continuously evolving, the findings of this study can serve as an essential reference point for researchers, allowing them to leverage the strengths, learn from the limitations, and uncover potential research opportunities enabled by ChatGPT and other generative AI models

Establishing Data Provenance for Responsible Artificial Intelligence Systems

Data provenance, a record that describes the origins and processing of data, offers new promises in the increasingly important role of artificial intelligence (AI)-based systems in guiding human decision making. To avoid disastrous outcomes that can result from bias-laden AI systems, responsible AI builds on four important characteristics: fairness, accountability, transparency, and explainability. To stimulate further research on data provenance that enables responsible AI, this study outlines existing biases and discusses possible implementations of data provenance to mitigate them. We first review biases stemming from the data’s origins and pre-processing. We then discuss the current state of practice, the challenges it presents, and corresponding recommendations to address them. We present a summary highlighting how our recommendations can help establish data provenance and thereby mitigate biases stemming from the data’s origins and pre-processing to realize responsible AI-based systems. We conclude with a research agenda suggesting further research avenues

FLAGS : a methodology for adaptive anomaly detection and root cause analysis on sensor data streams by fusing expert knowledge with machine learning

Anomalies and faults can be detected, and their causes verified, using both data-driven and knowledge-driven techniques. Data-driven techniques can adapt their internal functioning based on the raw input data but fail to explain the manifestation of any detection. Knowledge-driven techniques inherently deliver the cause of the faults that were detected but require too much human effort to set up. In this paper, we introduce FLAGS, the Fused-AI interpretabLe Anomaly Generation System, and combine both techniques in one methodology to overcome their limitations and optimize them based on limited user feedback. Semantic knowledge is incorporated in a machine learning technique to enhance expressivity. At the same time, feedback about the faults and anomalies that occurred is provided as input to increase adaptiveness using semantic rule mining methods. This new methodology is evaluated on a predictive maintenance case for trains. We show that our method reduces their downtime and provides more insight into frequently occurring problems. (C) 2020 The Authors. Published by Elsevier B.V

A Learning Health System for Radiation Oncology

The proposed research aims to address the challenges faced by clinical data science researchers in radiation oncology accessing, integrating, and analyzing heterogeneous data from various sources. The research presents a scalable intelligent infrastructure, called the Health Information Gateway and Exchange (HINGE), which captures and structures data from multiple sources into a knowledge base with semantically interlinked entities. This infrastructure enables researchers to mine novel associations and gather relevant knowledge for personalized clinical outcomes. The dissertation discusses the design framework and implementation of HINGE, which abstracts structured data from treatment planning systems, treatment management systems, and electronic health records. It utilizes disease-specific smart templates for capturing clinical information in a discrete manner. HINGE performs data extraction, aggregation, and quality and outcome assessment functions automatically, connecting seamlessly with local IT/medical infrastructure. Furthermore, the research presents a knowledge graph-based approach to map radiotherapy data to an ontology-based data repository using FAIR (Findable, Accessible, Interoperable, Reusable) concepts. This approach ensures that the data is easily discoverable and accessible for clinical decision support systems. The dissertation explores the ETL (Extract, Transform, Load) process, data model frameworks, ontologies, and provides a real-world clinical use case for this data mapping. To improve the efficiency of retrieving information from large clinical datasets, a search engine based on ontology-based keyword searching and synonym-based term matching tool was developed. The hierarchical nature of ontologies is leveraged to retrieve patient records based on parent and children classes. Additionally, patient similarity analysis is conducted using vector embedding models (Word2Vec, Doc2Vec, GloVe, and FastText) to identify similar patients based on text corpus creation methods. Results from the analysis using these models are presented. The implementation of a learning health system for predicting radiation pneumonitis following stereotactic body radiotherapy is also discussed. 3D convolutional neural networks (CNNs) are utilized with radiographic and dosimetric datasets to predict the likelihood of radiation pneumonitis. DenseNet-121 and ResNet-50 models are employed for this study, along with integrated gradient techniques to identify salient regions within the input 3D image dataset. The predictive performance of the 3D CNN models is evaluated based on clinical outcomes. Overall, the proposed Learning Health System provides a comprehensive solution for capturing, integrating, and analyzing heterogeneous data in a knowledge base. It offers researchers the ability to extract valuable insights and associations from diverse sources, ultimately leading to improved clinical outcomes. This work can serve as a model for implementing LHS in other medical specialties, advancing personalized and data-driven medicine

A Review on Explainable Artificial Intelligence for Healthcare: Why, How, and When?

Artificial intelligence (AI) models are increasingly finding applications in the field of medicine. Concerns have been raised about the explainability of the decisions that are made by these AI models. In this article, we give a systematic analysis of explainable artificial intelligence (XAI), with a primary focus on models that are currently being used in the field of healthcare. The literature search is conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) standards for relevant work published from 1 January 2012 to 02 February 2022. The review analyzes the prevailing trends in XAI and lays out the major directions in which research is headed. We investigate the why, how, and when of the uses of these XAI models and their implications. We present a comprehensive examination of XAI methodologies as well as an explanation of how a trustworthy AI can be derived from describing AI models for healthcare fields. The discussion of this work will contribute to the formalization of the XAI field.Comment: 15 pages, 3 figures, accepted for publication in the IEEE Transactions on Artificial Intelligenc

Counterfactuals and Causability in Explainable Artificial Intelligence: Theory, Algorithms, and Applications

There has been a growing interest in model-agnostic methods that can make deep learning models more transparent and explainable to a user. Some researchers recently argued that for a machine to achieve a certain degree of human-level explainability, this machine needs to provide human causally understandable explanations, also known as causability. A specific class of algorithms that have the potential to provide causability are counterfactuals. This paper presents an in-depth systematic review of the diverse existing body of literature on counterfactuals and causability for explainable artificial intelligence. We performed an LDA topic modelling analysis under a PRISMA framework to find the most relevant literature articles. This analysis resulted in a novel taxonomy that considers the grounding theories of the surveyed algorithms, together with their underlying properties and applications in real-world data. This research suggests that current model-agnostic counterfactual algorithms for explainable AI are not grounded on a causal theoretical formalism and, consequently, cannot promote causability to a human decision-maker. Our findings suggest that the explanations derived from major algorithms in the literature provide spurious correlations rather than cause/effects relationships, leading to sub-optimal, erroneous or even biased explanations. This paper also advances the literature with new directions and challenges on promoting causability in model-agnostic approaches for explainable artificial intelligence

Artificial intelligence in cancer imaging: Clinical challenges and applications

Judgement, as one of the core tenets of medicine, relies upon the integration of multilayered data with nuanced decision making. Cancer offers a unique context for medical decisions given not only its variegated forms with evolution of disease but also the need to take into account the individual condition of patients, their ability to receive treatment, and their responses to treatment. Challenges remain in the accurate detection, characterization, and monitoring of cancers despite improved technologies. Radiographic assessment of disease most commonly relies upon visual evaluations, the interpretations of which may be augmented by advanced computational analyses. In particular, artificial intelligence (AI) promises to make great strides in the qualitative interpretation of cancer imaging by expert clinicians, including volumetric delineation of tumors over time, extrapolation of the tumor genotype and biological course from its radiographic phenotype, prediction of clinical outcome, and assessment of the impact of disease and treatment on adjacent organs. AI may automate processes in the initial interpretation of images and shift the clinical workflow of radiographic detection, management decisions on whether or not to administer an intervention, and subsequent observation to a yet to be envisioned paradigm. Here, the authors review the current state of AI as applied to medical imaging of cancer and describe advances in 4 tumor types (lung, brain, breast, and prostate) to illustrate how common clinical problems are being addressed. Although most studies evaluating AI applications in oncology to date have not been vigorously validated for reproducibility and generalizability, the results do highlight increasingly concerted efforts in pushing AI technology to clinical use and to impact future directions in cancer care