Effective Representations of Clinical Notes

Clinical notes are a rich source of information about patient state. However, using them to predict clinical events with machine learning models is challenging. They are very high dimensional, sparse and have complex structure. Furthermore, training data is often scarce because it is expensive to obtain reliable labels for many clinical events. These difficulties have traditionally been addressed by manual feature engineering encoding task specific domain knowledge. We explored the use of neural networks and transfer learning to learn representations of clinical notes that are useful for predicting future clinical events of interest, such as all causes mortality, inpatient admissions, and emergency room visits. Our data comprised 2.7 million notes and 115 thousand patients at Stanford Hospital. We used the learned representations, along with commonly used bag of words and topic model representations, as features for predictive models of clinical events. We evaluated the effectiveness of these representations with respect to the performance of the models trained on small datasets. Models using the neural network derived representations performed significantly better than models using the baseline representations with small ($N < 1000$) training datasets. The learned representations offer significant performance gains over commonly used baseline representations for a range of predictive modeling tasks and cohort sizes, offering an effective alternative to task specific feature engineering when plentiful labeled training data is not available

AWE-CM Vectors: Augmenting Word Embeddings with a Clinical Metathesaurus

In recent years, word embeddings have been surprisingly effective at capturing intuitive characteristics of the words they represent. These vectors achieve the best results when training corpora are extremely large, sometimes billions of words. Clinical natural language processing datasets, however, tend to be much smaller. Even the largest publicly-available dataset of medical notes is three orders of magnitude smaller than the dataset of the oft-used "Google News" word vectors. In order to make up for limited training data sizes, we encode expert domain knowledge into our embeddings. Building on a previous extension of word2vec, we show that generalizing the notion of a word's "context" to include arbitrary features creates an avenue for encoding domain knowledge into word embeddings. We show that the word vectors produced by this method outperform their text-only counterparts across the board in correlation with clinical experts

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

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

Text2Node: a Cross-Domain System for Mapping Arbitrary Phrases to a Taxonomy

Electronic health record (EHR) systems are used extensively throughout the healthcare domain. However, data interchangeability between EHR systems is limited due to the use of different coding standards across systems. Existing methods of mapping coding standards based on manual human experts mapping, dictionary mapping, symbolic NLP and classification are unscalable and cannot accommodate large scale EHR datasets. In this work, we present Text2Node, a cross-domain mapping system capable of mapping medical phrases to concepts in a large taxonomy (such as SNOMED CT). The system is designed to generalize from a limited set of training samples and map phrases to elements of the taxonomy that are not covered by training data. As a result, our system is scalable, robust to wording variants between coding systems and can output highly relevant concepts when no exact concept exists in the target taxonomy. Text2Node operates in three main stages: first, the lexicon is mapped to word embeddings; second, the taxonomy is vectorized using node embeddings; and finally, the mapping function is trained to connect the two embedding spaces. We compared multiple algorithms and architectures for each stage of the training, including GloVe and FastText word embeddings, CNN and Bi-LSTM mapping functions, and node2vec for node embeddings. We confirmed the robustness and generalisation properties of Text2Node by mapping ICD-9-CM Diagnosis phrases to SNOMED CT and by zero-shot training at comparable accuracy. This system is a novel methodological contribution to the task of normalizing and linking phrases to a taxonomy, advancing data interchangeability in healthcare. When applied, the system can use electronic health records to generate an embedding that incorporates taxonomical medical knowledge to improve clinical predictive models

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

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

Intelligent Word Embeddings of Free-Text Radiology Reports

Radiology reports are a rich resource for advancing deep learning applications in medicine by leveraging the large volume of data continuously being updated, integrated, and shared. However, there are significant challenges as well, largely due to the ambiguity and subtlety of natural language. We propose a hybrid strategy that combines semantic-dictionary mapping and word2vec modeling for creating dense vector embeddings of free-text radiology reports. Our method leverages the benefits of both semantic-dictionary mapping as well as unsupervised learning. Using the vector representation, we automatically classify the radiology reports into three classes denoting confidence in the diagnosis of intracranial hemorrhage by the interpreting radiologist. We performed experiments with varying hyperparameter settings of the word embeddings and a range of different classifiers. Best performance achieved was a weighted precision of 88% and weighted recall of 90%. Our work offers the potential to leverage unstructured electronic health record data by allowing direct analysis of narrative clinical notes.Comment: AMIA Annual Symposium 201

MiME: Multilevel Medical Embedding of Electronic Health Records for Predictive Healthcare

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 medical codes. We propose Multilevel Medical Embedding (MiME) which learns the multilevel embedding of EHR data while jointly performing auxiliary prediction tasks that rely on this inherent EHR structure without the need for external labels. We conducted two prediction tasks, heart failure prediction and sequential disease prediction, where MiME outperformed baseline methods in diverse evaluation settings. In particular, MiME consistently outperformed all baselines when predicting heart failure on datasets of different volumes, especially demonstrating the greatest performance improvement (15% relative gain in PR-AUC over the best baseline) on the smallest dataset, demonstrating its ability to effectively model the multilevel structure of EHR data.Comment: Accepted at NIPS 201

Unsupervised Low-Dimensional Vector Representations for Words, Phrases and Text that are Transparent, Scalable, and produce Similarity Metrics that are Complementary to Neural Embeddings

Neural embeddings are a popular set of methods for representing words, phrases or text as a low dimensional vector (typically 50-500 dimensions). However, it is difficult to interpret these dimensions in a meaningful manner, and creating neural embeddings requires extensive training and tuning of multiple parameters and hyperparameters. We present here a simple unsupervised method for representing words, phrases or text as a low dimensional vector, in which the meaning and relative importance of dimensions is transparent to inspection. We have created a near-comprehensive vector representation of words, and selected bigrams, trigrams and abbreviations, using the set of titles and abstracts in PubMed as a corpus. This vector is used to create several novel implicit word-word and text-text similarity metrics. The implicit word-word similarity metrics correlate well with human judgement of word pair similarity and relatedness, and outperform or equal all other reported methods on a variety of biomedical benchmarks, including several implementations of neural embeddings trained on PubMed corpora. Our implicit word-word metrics capture different aspects of word-word relatedness than word2vec-based metrics and are only partially correlated (rho = ~0.5-0.8 depending on task and corpus). The vector representations of words, bigrams, trigrams, abbreviations, and PubMed title+abstracts are all publicly available from http://arrowsmith.psych.uic.edu for release under CC-BY-NC license. Several public web query interfaces are also available at the same site, including one which allows the user to specify a given word and view its most closely related terms according to direct co-occurrence as well as different implicit similarity metrics.Comment: 27 pages, 9 tables, and 6 supplemental files which can be accessed at http://arrowsmith.psych.uic.edu/arrowsmith_uic/word_similarity_metrics.html. Rewrote Introduction. This ms. has been submitted to J. Biomed. Informatic