Predicting Risk-of-Readmission for Congestive Heart Failure Patients: A Multi-Layer Approach

Mitigating risk-of-readmission of Congestive Heart Failure (CHF) patients within 30 days of discharge is important because such readmissions are not only expensive but also critical indicator of provider care and quality of treatment. Accurately predicting the risk-of-readmission may allow hospitals to identify high-risk patients and eventually improve quality of care by identifying factors that contribute to such readmissions in many scenarios. In this paper, we investigate the problem of predicting risk-of-readmission as a supervised learning problem, using a multi-layer classification approach. Earlier contributions inadequately attempted to assess a risk value for 30 day readmission by building a direct predictive model as opposed to our approach. We first split the problem into various stages, (a) at risk in general (b) risk within 60 days (c) risk within 30 days, and then build suitable classifiers for each stage, thereby increasing the ability to accurately predict the risk using multiple layers of decision. The advantage of our approach is that we can use different classification models for the subtasks that are more suited for the respective problems. Moreover, each of the subtasks can be solved using different features and training data leading to a highly confident diagnosis or risk compared to a one-shot single layer approach. An experimental evaluation on actual hospital patient record data from Multicare Health Systems shows that our model is significantly better at predicting risk-of-readmission of CHF patients within 30 days after discharge compared to prior attempts

Simultaneous Modeling of Multiple Complications for Risk Profiling in Diabetes Care

Type 2 diabetes mellitus (T2DM) is a chronic disease that often results in multiple complications. Risk prediction and profiling of T2DM complications is critical for healthcare professionals to design personalized treatment plans for patients in diabetes care for improved outcomes. In this paper, we study the risk of developing complications after the initial T2DM diagnosis from longitudinal patient records. We propose a novel multi-task learning approach to simultaneously model multiple complications where each task corresponds to the risk modeling of one complication. Specifically, the proposed method strategically captures the relationships (1) between the risks of multiple T2DM complications, (2) between the different risk factors, and (3) between the risk factor selection patterns. The method uses coefficient shrinkage to identify an informative subset of risk factors from high-dimensional data, and uses a hierarchical Bayesian framework to allow domain knowledge to be incorporated as priors. The proposed method is favorable for healthcare applications because in additional to improved prediction performance, relationships among the different risks and risk factors are also identified. Extensive experimental results on a large electronic medical claims database show that the proposed method outperforms state-of-the-art models by a significant margin. Furthermore, we show that the risk associations learned and the risk factors identified lead to meaningful clinical insights

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

RetainVis: Visual Analytics with Interpretable and Interactive Recurrent Neural Networks on Electronic Medical Records

We have recently seen many successful applications of recurrent neural networks (RNNs) on electronic medical records (EMRs), which contain histories of patients' diagnoses, medications, and other various events, in order to predict the current and future states of patients. Despite the strong performance of RNNs, it is often challenging for users to understand why the model makes a particular prediction. Such black-box nature of RNNs can impede its wide adoption in clinical practice. Furthermore, we have no established methods to interactively leverage users' domain expertise and prior knowledge as inputs for steering the model. Therefore, our design study aims to provide a visual analytics solution to increase interpretability and interactivity of RNNs via a joint effort of medical experts, artificial intelligence scientists, and visual analytics researchers. Following the iterative design process between the experts, we design, implement, and evaluate a visual analytics tool called RetainVis, which couples a newly improved, interpretable and interactive RNN-based model called RetainEX and visualizations for users' exploration of EMR data in the context of prediction tasks. Our study shows the effective use of RetainVis for gaining insights into how individual medical codes contribute to making risk predictions, using EMRs of patients with heart failure and cataract symptoms. Our study also demonstrates how we made substantial changes to the state-of-the-art RNN model called RETAIN in order to make use of temporal information and increase interactivity. This study will provide a useful guideline for researchers that aim to design an interpretable and interactive visual analytics tool for RNNs.Comment: Accepted at IEEE VIS 2018. To appear in IEEE Transactions on Visualization and Computer Graphics in January 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

Joint Modeling of Event Sequence and Time Series with Attentional Twin Recurrent Neural Networks

A variety of real-world processes (over networks) produce sequences of data whose complex temporal dynamics need to be studied. More especially, the event timestamps can carry important information about the underlying network dynamics, which otherwise are not available from the time-series evenly sampled from continuous signals. Moreover, in most complex processes, event sequences and evenly-sampled times series data can interact with each other, which renders joint modeling of those two sources of data necessary. To tackle the above problems, in this paper, we utilize the rich framework of (temporal) point processes to model event data and timely update its intensity function by the synergic twin Recurrent Neural Networks (RNNs). In the proposed architecture, the intensity function is synergistically modulated by one RNN with asynchronous events as input and another RNN with time series as input. Furthermore, to enhance the interpretability of the model, the attention mechanism for the neural point process is introduced. The whole model with event type and timestamp prediction output layers can be trained end-to-end and allows a black-box treatment for modeling the intensity. We substantiate the superiority of our model in synthetic data and three real-world benchmark datasets.Comment: 14 page

A Comparative Study for Predicting Heart Diseases Using Data Mining Classification Methods

Improving the precision of heart diseases detection has been investigated by many researchers in the literature. Such improvement induced by the overwhelming health care expenditures and erroneous diagnosis. As a result, various methodologies have been proposed to analyze the disease factors aiming to decrease the physicians practice variation and reduce medical costs and errors. In this paper, our main motivation is to develop an effective intelligent medical decision support system based on data mining techniques. In this context, five data mining classifying algorithms, with large datasets, have been utilized to assess and analyze the risk factors statistically related to heart diseases in order to compare the performance of the implemented classifiers (e.g., Na\"ive Bayes, Decision Tree, Discriminant, Random Forest, and Support Vector Machine). To underscore the practical viability of our approach, the selected classifiers have been implemented using MATLAB tool with two datasets. Results of the conducted experiments showed that all classification algorithms are predictive and can give relatively correct answer. However, the decision tree outperforms other classifiers with an accuracy rate of 99.0% followed by Random forest. That is the case because both of them have relatively same mechanism but the Random forest can build ensemble of decision tree. Although ensemble learning has been proved to produce superior results, but in our case the decision tree has outperformed its ensemble version

Interpretable Neural Networks for Predicting Mortality Risk using Multi-modal Electronic Health Records

We present an interpretable neural network for predicting an important clinical outcome (1-year mortality) from multi-modal Electronic Health Record (EHR) data. Our approach builds on prior multi-modal machine learning models by now enabling visualization of how individual factors contribute to the overall outcome risk, assuming other factors remain constant, which was previously impossible. We demonstrate the value of this approach using a large multi-modal clinical dataset including both EHR data and 31,278 echocardiographic videos of the heart from 26,793 patients. We generated separate models for (i) clinical data only (CD) (e.g. age, sex, diagnoses and laboratory values), (ii) numeric variables derived from the videos, which we call echocardiography-derived measures (EDM), and (iii) CD+EDM+raw videos (pixel data). The interpretable multi-modal model maintained performance compared to non-interpretable models (Random Forest, XGBoost), and also performed significantly better than a model using a single modality (average AUC=0.82). Clinically relevant insights and multi-modal variable importance rankings were also facilitated by the new model, which have previously been impossible.Comment: Submitted to IEEE JBH

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

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