Transfer Learning for Clinical Time Series Analysis using Recurrent Neural Networks

Deep neural networks have shown promising results for various clinical prediction tasks such as diagnosis, mortality prediction, predicting duration of stay in hospital, etc. However, training deep networks -- such as those based on Recurrent Neural Networks (RNNs) -- requires large labeled data, high computational resources, and significant hyperparameter tuning effort. In this work, we investigate as to what extent can transfer learning address these issues when using deep RNNs to model multivariate clinical time series. We consider transferring the knowledge captured in an RNN trained on several source tasks simultaneously using a large labeled dataset to build the model for a target task with limited labeled data. An RNN pre-trained on several tasks provides generic features, which are then used to build simpler linear models for new target tasks without training task-specific RNNs. For evaluation, we train a deep RNN to identify several patient phenotypes on time series from MIMIC-III database, and then use the features extracted using that RNN to build classifiers for identifying previously unseen phenotypes, and also for a seemingly unrelated task of in-hospital mortality. We demonstrate that (i) models trained on features extracted using pre-trained RNN outperform or, in the worst case, perform as well as task-specific RNNs; (ii) the models using features from pre-trained models are more robust to the size of labeled data than task-specific RNNs; and (iii) features extracted using pre-trained RNN are generic enough and perform better than typical statistical hand-crafted features.Comment: Accepted at Machine Learning for Medicine and Healthcare Workshop at ACM KDD 2018 Conferenc

Transfer Learning for Clinical Time Series Analysis using Deep Neural Networks

Deep neural networks have shown promising results for various clinical prediction tasks. However, training deep networks such as those based on Recurrent Neural Networks (RNNs) requires large labeled data, significant hyper-parameter tuning effort and expertise, and high computational resources. In this work, we investigate as to what extent can transfer learning address these issues when using deep RNNs to model multivariate clinical time series. We consider two scenarios for transfer learning using RNNs: i) domain-adaptation, i.e., leveraging a deep RNN - namely, TimeNet - pre-trained for feature extraction on time series from diverse domains, and adapting it for feature extraction and subsequent target tasks in healthcare domain, ii) task-adaptation, i.e., pre-training a deep RNN - namely, HealthNet - on diverse tasks in healthcare domain, and adapting it to new target tasks in the same domain. We evaluate the above approaches on publicly available MIMIC-III benchmark dataset, and demonstrate that (a) computationally-efficient linear models trained using features extracted via pre-trained RNNs outperform or, in the worst case, perform as well as deep RNNs and statistical hand-crafted features based models trained specifically for target task; (b) models obtained by adapting pre-trained models for target tasks are significantly more robust to the size of labeled data compared to task-specific RNNs, while also being computationally efficient. We, therefore, conclude that pre-trained deep models like TimeNet and HealthNet allow leveraging the advantages of deep learning for clinical time series analysis tasks, while also minimize dependence on hand-crafted features, deal robustly with scarce labeled training data scenarios without overfitting, as well as reduce dependence on expertise and resources required to train deep networks from scratch.Comment: Updated version of this work appeared in Journal of Healthcare Informatics Research, Vol. 4, 2020. arXiv admin note: text overlap with arXiv:1807.0170

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

Detection of Paroxysmal Atrial Fibrillation using Attention-based Bidirectional Recurrent Neural Networks

Detection of atrial fibrillation (AF), a type of cardiac arrhythmia, is difficult since many cases of AF are usually clinically silent and undiagnosed. In particular paroxysmal AF is a form of AF that occurs occasionally, and has a higher probability of being undetected. In this work, we present an attention based deep learning framework for detection of paroxysmal AF episodes from a sequence of windows. Time-frequency representation of 30 seconds recording windows, over a 10 minute data segment, are fed sequentially into a deep convolutional neural network for image-based feature extraction, which are then presented to a bidirectional recurrent neural network with an attention layer for AF detection. To demonstrate the effectiveness of the proposed framework for transient AF detection, we use a database of 24 hour Holter Electrocardiogram (ECG) recordings acquired from 2850 patients at the University of Virginia heart station. The algorithm achieves an AUC of 0.94 on the testing set, which exceeds the performance of baseline models. We also demonstrate the cross-domain generalizablity of the approach by adapting the learned model parameters from one recording modality (ECG) to another (photoplethysmogram) with improved AF detection performance. The proposed high accuracy, low false alarm algorithm for detecting paroxysmal AF has potential applications in long-term monitoring using wearable sensors.Comment: Accepted to the 24th ACM SIGKDD International Conference on Knowledge Discovery and Data Mining (KDD 2018), London, UK, 201

Benchmarking Deep Learning Architectures for Predicting Readmission to the ICU and Describing Patients-at-Risk

Objective: To compare different deep learning architectures for predicting the risk of readmission within 30 days of discharge from the intensive care unit (ICU). The interpretability of attention-based models is leveraged to describe patients-at-risk. Methods: Several deep learning architectures making use of attention mechanisms, recurrent layers, neural ordinary differential equations (ODEs), and medical concept embeddings with time-aware attention were trained using publicly available electronic medical record data (MIMIC-III) associated with 45,298 ICU stays for 33,150 patients. Bayesian inference was used to compute the posterior over weights of an attention-based model. Odds ratios associated with an increased risk of readmission were computed for static variables. Diagnoses, procedures, medications, and vital signs were ranked according to the associated risk of readmission. Results: A recurrent neural network, with time dynamics of code embeddings computed by neural ODEs, achieved the highest average precision of 0.331 (AUROC: 0.739, F1-Score: 0.372). Predictive accuracy was comparable across neural network architectures. Groups of patients at risk included those suffering from infectious complications, with chronic or progressive conditions, and for whom standard medical care was not suitable. Conclusions: Attention-based networks may be preferable to recurrent networks if an interpretable model is required, at only marginal cost in predictive accuracy

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

A Survey on Deep Learning for Neuroimaging-based Brain Disorder Analysis

Deep learning has been recently used for the analysis of neuroimages, such as structural magnetic resonance imaging (MRI), functional MRI, and positron emission tomography (PET), and has achieved significant performance improvements over traditional machine learning in computer-aided diagnosis of brain disorders. This paper reviews the applications of deep learning methods for neuroimaging-based brain disorder analysis. We first provide a comprehensive overview of deep learning techniques and popular network architectures, by introducing various types of deep neural networks and recent developments. We then review deep learning methods for computer-aided analysis of four typical brain disorders, including Alzheimer's disease, Parkinson's disease, Autism spectrum disorder, and Schizophrenia, where the first two diseases are neurodegenerative disorders and the last two are neurodevelopmental and psychiatric disorders, respectively. More importantly, we discuss the limitations of existing studies and present possible future directions.Comment: 30 pages, 7 figure

Doctor AI: Predicting Clinical Events via Recurrent Neural Networks

Leveraging large historical data in electronic health record (EHR), we developed Doctor AI, a generic predictive model that covers observed medical conditions and medication uses. Doctor AI is a temporal model using recurrent neural networks (RNN) and was developed and applied to longitudinal time stamped EHR data from 260K patients over 8 years. Encounter records (e.g. diagnosis codes, medication codes or procedure codes) were input to RNN to predict (all) the diagnosis and medication categories for a subsequent visit. Doctor AI assesses the history of patients to make multilabel predictions (one label for each diagnosis or medication category). Based on separate blind test set evaluation, Doctor AI can perform differential diagnosis with up to 79% recall@30, significantly higher than several baselines. Moreover, we demonstrate great generalizability of Doctor AI by adapting the resulting models from one institution to another without losing substantial accuracy.Comment: Presented at 2016 Machine Learning and Healthcare Conference (MLHC 2016), Los Angeles, C

ConvTimeNet: A Pre-trained Deep Convolutional Neural Network for Time Series Classification

Training deep neural networks often requires careful hyper-parameter tuning and significant computational resources. In this paper, we propose ConvTimeNet (CTN): an off-the-shelf deep convolutional neural network (CNN) trained on diverse univariate time series classification (TSC) source tasks. Once trained, CTN can be easily adapted to new TSC target tasks via a small amount of fine-tuning using labeled instances from the target tasks. We note that the length of convolutional filters is a key aspect when building a pre-trained model that can generalize to time series of different lengths across datasets. To achieve this, we incorporate filters of multiple lengths in all convolutional layers of CTN to capture temporal features at multiple time scales. We consider all 65 datasets with time series of lengths up to 512 points from the UCR TSC Benchmark for training and testing transferability of CTN: We train CTN on a randomly chosen subset of 24 datasets using a multi-head approach with a different softmax layer for each training dataset, and study generalizability and transferability of the learned filters on the remaining 41 TSC datasets. We observe significant gains in classification accuracy as well as computational efficiency when using pre-trained CTN as a starting point for subsequent task-specific fine-tuning compared to existing state-of-the-art TSC approaches. We also provide qualitative insights into the working of CTN by: i) analyzing the activations and filters of first convolution layer suggesting the filters in CTN are generically useful, ii) analyzing the impact of the design decision to incorporate multiple length decisions, and iii) finding regions of time series that affect the final classification decision via occlusion sensitivity analysis.Comment: Accepted at IJCNN 201

An Empirical Evaluation of Deep Learning for ICD-9 Code Assignment using MIMIC-III Clinical Notes

Background and Objective: Code assignment is of paramount importance in many levels in modern hospitals, from ensuring accurate billing process to creating a valid record of patient care history. However, the coding process is tedious and subjective, and it requires medical coders with extensive training. This study aims to evaluate the performance of deep-learning-based systems to automatically map clinical notes to ICD-9 medical codes. Methods: The evaluations of this research are focused on end-to-end learning methods without manually defined rules. Traditional machine learning algorithms, as well as state-of-the-art deep learning methods such as Recurrent Neural Networks and Convolution Neural Networks, were applied to the Medical Information Mart for Intensive Care (MIMIC-III) dataset. An extensive number of experiments was applied to different settings of the tested algorithm. Results: Findings showed that the deep learning-based methods outperformed other conventional machine learning methods. From our assessment, the best models could predict the top 10 ICD-9 codes with 0.6957 F1 and 0.8967 accuracy and could estimate the top 10 ICD-9 categories with 0.7233 F1 and 0.8588 accuracy. Our implementation also outperformed existing work under certain evaluation metrics. Conclusion: A set of standard metrics was utilized in assessing the performance of ICD-9 code assignment on MIMIC-III dataset. All the developed evaluation tools and resources are available online, which can be used as a baseline for further research