Multi-layer Representation Learning for Medical Concepts

Learning efficient representations for concepts has been proven to be an important basis for many applications such as machine translation or document classification. Proper representations of medical concepts such as diagnosis, medication, procedure codes and visits will have broad applications in healthcare analytics. However, in Electronic Health Records (EHR) the visit sequences of patients include multiple concepts (diagnosis, procedure, and medication codes) per visit. This structure provides two types of relational information, namely sequential order of visits and co-occurrence of the codes within each visit. In this work, we propose Med2Vec, which not only learns distributed representations for both medical codes and visits from a large EHR dataset with over 3 million visits, but also allows us to interpret the learned representations confirmed positively by clinical experts. In the experiments, Med2Vec displays significant improvement in key medical applications compared to popular baselines such as Skip-gram, GloVe and stacked autoencoder, while providing clinically meaningful interpretation

Knowledge Transfer with Medical Language Embeddings

Identifying relationships between concepts is a key aspect of scientific knowledge synthesis. Finding these links often requires a researcher to laboriously search through scien- tific papers and databases, as the size of these resources grows ever larger. In this paper we describe how distributional semantics can be used to unify structured knowledge graphs with unstructured text to predict new relationships between medical concepts, using a probabilistic generative model. Our approach is also designed to ameliorate data sparsity and scarcity issues in the medical domain, which make language modelling more challenging. Specifically, we integrate the medical relational database (SemMedDB) with text from electronic health records (EHRs) to perform knowledge graph completion. We further demonstrate the ability of our model to predict relationships between tokens not appearing in the relational database.Comment: 6 pages, 2 figures, to appear at SDM-DMMH 201

Deep EHR: A Survey of Recent Advances in Deep Learning Techniques for Electronic Health Record (EHR) Analysis

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, and clinical applications. We also identify shortcomings of current techniques and discuss avenues of future research for EHR-based deep learning.Comment: Accepted for publication with Journal of Biomedical and Health Informatics: http://ieeexplore.ieee.org/abstract/document/8086133

Medical Concept Representation Learning from Electronic Health Records and its Application on Heart Failure Prediction

Objective: To transform heterogeneous clinical data from electronic health records into clinically meaningful constructed features using data driven method that rely, in part, on temporal relations among data. Materials and Methods: The clinically meaningful representations of medical concepts and patients are the key for health analytic applications. Most of existing approaches directly construct features mapped to raw data (e.g., ICD or CPT codes), or utilize some ontology mapping such as SNOMED codes. However, none of the existing approaches leverage EHR data directly for learning such concept representation. We propose a new way to represent heterogeneous medical concepts (e.g., diagnoses, medications and procedures) based on co-occurrence patterns in longitudinal electronic health records. The intuition behind the method is to map medical concepts that are co-occuring closely in time to similar concept vectors so that their distance will be small. We also derive a simple method to construct patient vectors from the related medical concept vectors. Results: For qualitative evaluation, we study similar medical concepts across diagnosis, medication and procedure. In quantitative evaluation, our proposed representation significantly improves the predictive modeling performance for onset of heart failure (HF), where classification methods (e.g. logistic regression, neural network, support vector machine and K-nearest neighbors) achieve up to 23% improvement in area under the ROC curve (AUC) using this proposed representation. Conclusion: We proposed an effective method for patient and medical concept representation learning. The resulting representation can map relevant concepts together and also improves predictive modeling performance.Comment: 45 page

Unsupervised Extraction of Phenotypes from Cancer Clinical Notes for Association Studies

The recent adoption of Electronic Health Records (EHRs) by health care providers has introduced an important source of data that provides detailed and highly specific insights into patient phenotypes over large cohorts. These datasets, in combination with machine learning and statistical approaches, generate new opportunities for research and clinical care. However, many methods require the patient representations to be in structured formats, while the information in the EHR is often locked in unstructured texts designed for human readability. In this work, we develop the methodology to automatically extract clinical features from clinical narratives from large EHR corpora without the need for prior knowledge. We consider medical terms and sentences appearing in clinical narratives as atomic information units. We propose an efficient clustering strategy suitable for the analysis of large text corpora and to utilize the clusters to represent information about the patient compactly. To demonstrate the utility of our approach, we perform an association study of clinical features with somatic mutation profiles from 4,007 cancer patients and their tumors. We apply the proposed algorithm to a dataset consisting of about 65 thousand documents with a total of about 3.2 million sentences. We identify 341 significant statistical associations between the presence of somatic mutations and clinical features. We annotated these associations according to their novelty, and report several known associations. We also propose 32 testable hypotheses where the underlying biological mechanism does not appear to be known but plausible. These results illustrate that the automated discovery of clinical features is possible and the joint analysis of clinical and genetic datasets can generate appealing new hypotheses

Boosting Deep Learning Risk Prediction with Generative Adversarial Networks for Electronic Health Records

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 namely ehrGAN, which can provide plausible labeled EHR data by mimicking real patient records, to augment the training dataset in a semi-supervised learning manner. We use this generative model together with a convolutional neural network (CNN) based prediction model to improve the onset prediction performance. Experiments on two real healthcare datasets demonstrate that our proposed framework produces realistic data samples and achieves significant improvements on classification tasks with the generated data over several stat-of-the-art baselines.Comment: To appear in ICDM 2017. This is the full version of paper with 8 page

ClinicalBERT: Modeling Clinical Notes and Predicting Hospital Readmission

Clinical notes contain information about patients that goes beyond structured data like lab values and medications. However, clinical notes have been underused relative to structured data, because notes are high-dimensional and sparse. This work develops and evaluates representations of clinical notes using bidirectional transformers (ClinicalBERT). ClinicalBERT uncovers high-quality relationships between medical concepts as judged by humans. ClinicalBert outperforms baselines on 30-day hospital readmission prediction using both discharge summaries and the first few days of notes in the intensive care unit. Code and model parameters are available.Comment: CHIL 2020 Worksho

Learning Hierarchical Representations of Electronic Health Records for Clinical Outcome Prediction

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 sequences, to adaptively distinguish between short-range and long-range events, and accurately capture coretemporal dependencies. Experimental results on real clinical data show that our model greatly improves over previous state-of-the-art models, achieving AUC scores of 0.94 and 0.90 for predicting death and ICU admission respectively, Our model also successfully identifies important events for different clinical outcome prediction tasksComment: 10 pages, 2 figures, accepted by AMIA annual symposiu

Inpatient2Vec: Medical Representation Learning for Inpatients

Representation learning (RL) plays an important role in extracting proper representations from complex medical data for various analyzing tasks, such as patient grouping, clinical endpoint prediction and medication recommendation. Medical data can be divided into two typical categories, outpatient and inpatient, that have different data characteristics. However, few of existing RL methods are specially designed for inpatients data, which have strong temporal relations and consistent diagnosis. In addition, for unordered medical activity set, existing medical RL methods utilize a simple pooling strategy, which would result in indistinguishable contributions among the activities for learning. In this work, weproposeInpatient2Vec, anovelmodel for learning three kinds of representations for inpatient, including medical activity, hospital day and diagnosis. A multi-layer self-attention mechanism with two training tasks is designed to capture the inpatient data characteristics and process the unordered set. Using a real-world dataset, we demonstrate that the proposed approach outperforms the competitive baselines on semantic similarity measurement and clinical events prediction tasks

Bidirectional Recurrent Neural Networks for Medical Event Detection in Electronic Health Records

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.Comment: In proceedings of NAACL HLT 201