Visual Analytics for Performing Complex Tasks with Electronic Health Records

Electronic health record systems (EHRs) facilitate the storage, retrieval, and sharing of patient health data; however, the availability of data does not directly translate to support for tasks that healthcare providers encounter every day. In recent years, healthcare providers employ a large volume of clinical data stored in EHRs to perform various complex data-intensive tasks. The overwhelming volume of clinical data stored in EHRs and a lack of support for the execution of EHR-driven tasks are, but a few problems healthcare providers face while working with EHR-based systems. Thus, there is a demand for computational systems that can facilitate the performance of complex tasks that involve the use and working with the vast amount of data stored in EHRs. Visual analytics (VA) offers great promise in handling such information overload challenges by integrating advanced analytics techniques with interactive visualizations. The user-controlled environment that VA systems provide allows healthcare providers to guide the analytics techniques on analyzing and managing EHR data through interactive visualizations. The goal of this research is to demonstrate how VA systems can be designed systematically to support the performance of complex EHR-driven tasks. In light of this, we present an activity and task analysis framework to analyze EHR-driven tasks in the context of interactive visualization systems. We also conduct a systematic literature review of EHR-based VA systems and identify the primary dimensions of the VA design space to evaluate these systems and identify the gaps. Two novel EHR-based VA systems (SUNRISE and VERONICA) are then designed to bridge the gaps. SUNRISE incorporates frequent itemset mining, extreme gradient boosting, and interactive visualizations to allow users to interactively explore the relationships between laboratory test results and a disease outcome. The other proposed system, VERONICA, uses a representative set of supervised machine learning techniques to find the group of features with the strongest predictive power and make the analytic results accessible through an interactive visual interface. We demonstrate the usefulness of these systems through a usage scenario with acute kidney injury using large provincial healthcare databases from Ontario, Canada, stored at ICES

C-Trend parameters and possibilities of federated learning

Abstract. In this observational study, federated learning, a cutting-edge approach to machine learning, was applied to one of the parameters provided by C-Trend Technology developed by Cerenion Oy. The aim was to compare the performance of federated learning to that of conventional machine learning. Additionally, the potential of federated learning for resolving the privacy concerns that prevent machine learning from realizing its full potential in the medical field was explored. Federated learning was applied to burst-suppression ratio’s machine learning and it was compared to the conventional machine learning of burst-suppression ratio calculated on the same dataset. A suitable aggregation method was developed and used in the updating of the global model. The performance metrics were compared and a descriptive analysis including box plots and histograms was conducted. As anticipated, towards the end of the training, federated learning’s performance was able to approach that of conventional machine learning. The strategy can be regarded to be valid because the performance metric values remained below the set test criterion levels. With this strategy, we will potentially be able to make use of data that would normally be kept confidential and, as we gain access to more data, eventually develop machine learning models that perform better. Federated learning has some great advantages and utilizing it in the context of qEEGs’ machine learning could potentially lead to models, which reach better performance by receiving data from multiple institutions without the difficulties of privacy restrictions. Some possible future directions include an implementation on heterogeneous data and on larger data volume.C-Trend-teknologian parametrit ja federoidun oppimisen mahdollisuudet. Tiivistelmä. Tässä havainnointitutkimuksessa federoitua oppimista, koneoppimisen huippuluokan lähestymistapaa, sovellettiin yhteen Cerenion Oy:n kehittämään C-Trend-teknologian tarjoamaan parametriin. Tavoitteena oli verrata federoidun oppimisen suorituskykyä perinteisen koneoppimisen suorituskykyyn. Lisäksi tutkittiin federoidun oppimisen mahdollisuuksia ratkaista yksityisyyden suojaan liittyviä rajoitteita, jotka estävät koneoppimista hyödyntämästä täyttä potentiaaliaan lääketieteen alalla. Federoitua oppimista sovellettiin purskevaimentumasuhteen koneoppimiseen ja sitä verrattiin purskevaimentumasuhteen laskemiseen, johon käytettiin perinteistä koneoppimista. Kummankin laskentaan käytettiin samaa dataa. Sopiva aggregointimenetelmä kehitettiin, jota käytettiin globaalin mallin päivittämisessä. Suorituskykymittareiden tuloksia verrattiin keskenään ja tehtiin kuvaileva analyysi, johon sisältyi laatikkokuvioita ja histogrammeja. Odotetusti opetuksen loppupuolella federoidun oppimisen suorituskyky pystyi lähestymään perinteisen koneoppimisen suorituskykyä. Menetelmää voidaan pitää pätevänä, koska suorituskykymittarin arvot pysyivät alle asetettujen testikriteerien tasojen. Tämän menetelmän avulla voimme ehkä hyödyntää dataa, joka normaalisti pidettäisiin salassa, ja kun saamme lisää dataa käyttöömme, voimme lopulta kehittää koneoppimismalleja, jotka saavuttavat paremman suorituskyvyn. Federoidulla oppimisella on joitakin suuria etuja, ja sen hyödyntäminen qEEG:n koneoppimisen yhteydessä voisi mahdollisesti johtaa malleihin, jotka saavuttavat paremman suorituskyvyn saamalla tietoja useista eri lähteistä ilman yksityisyyden suojaan liittyviä rajoituksia. Joitakin mahdollisia tulevia suuntauksia ovat muun muassa heterogeenisen datan ja suurempien tietomäärien käyttö

Predictive modelling for health and health-care utilisation : an observational study for Australians aged 45 and up

The burden of chronic disease is growing at a fast pace, leading to poor quality of life and high healthcare expenditures in a large portion of the Australian population. Much of the burden is borne by hospitals, and therefore there is an ever-increasing interest in preventative interventions that can keep people out of hospitals and healthier for longer periods. There is a wide range of potential interventions that may be able to achieve this goal, and policy makers need to decide which one should be funded and implemented. This task is difficult for two reasons: first it is often not clear what is the short-term effectiveness of an intervention, and how it varies in specific sub-populations, and second it is also not clear what the long-term intended and unintended consequences might be. In this thesis I make contributions to address both these difficulties. On the short-term side I focus on the use of physical activity to prevent the development of chronic disease and to reduce hospital costs. Increasing physical activity has been long heralded as a way to achieve these goals but evidence of its effectiveness has been elusive. In this thesis I provide data driven evidence to justify policies that encourage higher levels of physical activity (PA) in middle age and older Australian population. I use data from the “45 and up” and the Social, Economic and Environmental Factors (SEEF) study, linked with the Admitted Patient Data Collection (APDC), to identify and study the cost and health trajectories of individuals with different levels of physical activity. The results show a clear statistically significant association between PA and lower hospitalisation cost, as well as between PA and reduced risk of heart disease, diabetes and stroke. On the long-term side of the analysis, I placed this thesis in the context of a larger program of work performed at Western Sydney University that aims to build a microsimulation model for the analysis of health policy interventions. In this framework I studied predictive models that use survey and/or administrative data to predict hospital costs and resource utilisation. I placed particular emphasis on the application of methods borrowed from Natural Language Processing to understand how to use the thousands of diagnosis and procedure codes found in administrative data as input to predictive models. The methods developed in this thesis go beyond the application to hospital data and can be used in any predictive model that relies on complex coding of healthcare information

International healthcare accreditation : an analysis of clinical quality and patient experience in the UAE

A mixed method research design was used to answer the question; ‘does accreditation have an impact on hospital quality, clinical measures and patient experience?’ The thesis contains three study components: 1) A case study determining the predictors of patient experience; 2) a cross-sectional study examining the relationship of hospital accreditation and patient experience and 3) A four year time series analysis of the impact of accreditation on hospital quality using 27 quality measures. A case study analysis of patient experience, using a piloted, validated and reliable survey tool, was conducted in Al Noor Hospital. The survey was administered via face-to-face interviews to 391 patients. Patient demographic variables, stay characteristics and patient experience constructs were tested against five patient experience outcome measures using regression analysis. The predictors of positive patient experience were the patient demographics (age, nationality, and health status), hospital stay characteristics (length of stay and hospital treatment outcome) and patient experience constructs (care from nurses, care from doctors, cleanliness, pain management and quality of food). Recommendations were made on how hospital managers can improve patient experience using these modifiable factors. The cross-sectional study found that accredited hospitals had significantly higher inpatient experience scores than non-accredited hospitals. The hospital level variables, other than patient volume, had no correlations with patient experience. The interrupted time series analysis demonstrated that although accreditation improved the quality performance of the hospital with a residual benefit of 20 percentage points above the baseline level, this improvement was not sustained over the 3-year accreditation cycle. The accreditation life cycle theory was developed as an explanatory framework for the pattern of performance during the accreditation cycle. This theory was consequently supported by empirical evidence. Recommendations were made for improvement of the accreditation process. The Life Cycle Model and time series analysis were proposed as strategic tools for healthcare managers to recognise and prevent the negative trends of the accreditation life cycle in order to sustain improvements gained from accreditation. The findings of the three research components were triangulated to form a theory on the impact of accreditation on clinical quality measures and patient experience. This thesis is important from a research perspective, as healthcare accreditation, although commonly used to improve quality, is still under researched and under theorised. This is the first investigation of accreditation to use interrupted time series analysis, the first analysis on patient experience and hospital accreditation and also the first study on patient experience in the Middle East. Thus it adds to the evidence base of accreditation and patient experience but also has policy and management implications

Visual Analytics of Electronic Health Records with a focus on Acute Kidney Injury

The increasing use of electronic platforms in healthcare has resulted in the generation of unprecedented amounts of data in recent years. The amount of data available to clinical researchers, physicians, and healthcare administrators continues to grow, which creates an untapped resource with the ability to improve the healthcare system drastically. Despite the enthusiasm for adopting electronic health records (EHRs), some recent studies have shown that EHR-based systems hardly improve the ability of healthcare providers to make better decisions. One reason for this inefficacy is that these systems do not allow for human-data interaction in a manner that fits and supports the needs of healthcare providers. Another reason is the information overload, which makes healthcare providers often misunderstand, misinterpret, ignore, or overlook vital data. The emergence of a type of computational system known as visual analytics (VA), has the potential to reduce the complexity of EHR data by combining advanced analytics techniques with interactive visualizations to analyze, synthesize, and facilitate high-level activities while allowing users to get more involved in a discourse with the data. The purpose of this research is to demonstrate the use of sophisticated visual analytics systems to solve various EHR-related research problems. This dissertation includes a framework by which we identify gaps in existing EHR-based systems and conceptualize the data-driven activities and tasks of our proposed systems. Two novel VA systems (VISA_M3R3 and VALENCIA) and two studies are designed to bridge the gaps. VISA_M3R3 incorporates multiple regression, frequent itemset mining, and interactive visualization to assist users in the identification of nephrotoxic medications. Another proposed system, VALENCIA, brings a wide range of dimension reduction and cluster analysis techniques to analyze high-dimensional EHRs, integrate them seamlessly, and make them accessible through interactive visualizations. The studies are conducted to develop prediction models to classify patients who are at risk of developing acute kidney injury (AKI) and identify AKI-associated medication and medication combinations using EHRs. Through healthcare administrative datasets stored at the ICES-KDT (Kidney Dialysis and Transplantation program), London, Ontario, we have demonstrated how our proposed systems and prediction models can be used to solve real-world problems