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Register a new userLearning from development of a third-party patient-oriented application using Australian national personal health records system
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Added by
Niranjan Bidargaddi
Publication date
2017
fields
Informatics Engineering
and research's language is
English
Authors
Niranjan Bidargaddi
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No Arabic abstract
Large-scale national level Personal Health Record (PHR) has been implemented in Australia. However, usability, data quality and poor functionalities have resulted in low utility affecting enrollment and participation rates by both patients and clinicians alike. Development of new applications deriving secondary utility of data can enhance use of PHRs but there is limited understanding on processes involved in development of third-party applications with nationally run PHRs. This paper prsents an analysis of processes and regulatory requirements for developing applications of data from My Health Record, Australian nationally run PHR and subsequently implementation of a patient oriented software application using data sourced from My Health Record.
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Secure and privacy-preserving management of Personal Health Records (PHRs) has proved to be a major challenge in modern healthcare. Current solutions generally do not offer patients a choice in where the data is actually stored and also rely on at least one fully trusted element that patients must also trust with their data. In this work, we present the Health Access Broker (HAB), a patient-controlled service for secure PHR sharing that (a) does not impose a specific storage location (uniquely for a PHR system), and (b) does not assume any of its components to be fully secure against adversarial threats. Instead, HAB introduces a novel auditing and intrusion-detection mechanism where its workflow is securely logged and continuously inspected to provide auditability of data access and quickly detect any intrusions.
Patient representation learning refers to learning a dense mathematical representation of a patient that encodes meaningful information from Electronic Health Records (EHRs). This is generally performed using advanced deep learning methods. This study presents a systematic review of this field and provides both qualitative and quantitative analyses from a methodological perspective. We identified studies developing patient representations from EHRs with deep learning methods from MEDLINE, EMBASE, Scopus, the Association for Computing Machinery (ACM) Digital Library, and Institute of Electrical and Electronics Engineers (IEEE) Xplore Digital Library. After screening 363 articles, 49 papers were included for a comprehensive data collection. We noticed a typical workflow starting with feeding raw data, applying deep learning models, and ending with clinical outcome predictions as evaluations of the learned representations. Specifically, learning representations from structured EHR data was dominant (37 out of 49 studies). Recurrent Neural Networks were widely applied as the deep learning architecture (LSTM: 13 studies, GRU: 11 studies). Disease prediction was the most common application and evaluation (31 studies). Benchmark datasets were mostly unavailable (28 studies) due to privacy concerns of EHR data, and code availability was assured in 20 studies. We show the importance and feasibility of learning comprehensive representations of patient EHR data through a systematic review. Advances in patient representation learning techniques will be essential for powering patient-level EHR analyses. Future work will still be devoted to leveraging the richness and potential of available EHR data. Knowledge distillation and advanced learning techniques will be exploited to assist the capability of learning patient representation further.
Predictive modeling with electronic health record (EHR) data is anticipated to drive personalized medicine and improve healthcare quality. Constructing predictive statistical models typically requires extraction of curated predictor variables from normalized EHR data, a labor-intensive process that discards the vast majority of information in each patients record. We propose a representation of patients entire, raw EHR records based on the Fast Healthcare Interoperability Resources (FHIR) format. We demonstrate that deep learning methods using this representation are capable of accurately predicting multiple medical events from multiple centers without site-specific data harmonization. We validated our approach using de-identified EHR data from two U.S. academic medical centers with 216,221 adult patients hospitalized for at least 24 hours. In the sequential format we propose, this volume of EHR data unrolled into a total of 46,864,534,945 data points, including clinical notes. Deep learning models achieved high accuracy for tasks such as predicting in-hospital mortality (AUROC across sites 0.93-0.94), 30-day unplanned readmission (AUROC 0.75-0.76), prolonged length of stay (AUROC 0.85-0.86), and all of a patients final discharge diagnoses (frequency-weighted AUROC 0.90). These models outperformed state-of-the-art traditional predictive models in all cases. We also present a case-study of a neural-network attribution system, which illustrates how clinicians can gain some transparency into the predictions. We believe that this approach can be used to create accurate and scalable predictions for a variety of clinical scenarios, complete with explanations that directly highlight evidence in the patients chart.
Health is a very important prerequisite in peoples well-being and happiness. Several studies were more focused on presenting the occurrence on specific disease like forecasting the number of dengue and malaria cases. This paper utilized the time series data for trend analysis and data forecasting using ARIMA model to visualize the trends of health data on the ten leading causes of deaths, leading cause of morbidity and leading cause of infants deaths particularly in the Philippines presented in a tabular data. Figures for each disease trend are presented individually with the use of the GRETL software. Forecasting results of the leading causes of death showed that Diseases of the heart, vascular system, accidents, Chronic lower respiratory diseases and Chronic Tuberculosis (all forms) showed a slight changed of the forecasted data, Malignant neoplasms showed unstable behavior of the forecasted data, and Pneumonia, diabetes mellitus, Nephritis, nephrotic syndrome and nephrosis and certain conditions originating in perinatal showed a decreasing patterns based on the forecasted data.
In recent years, we have witnessed an increased interest in temporal modeling of patient records from large scale Electronic Health Records (EHR). While simpler RNN models have been used for such problems, memory networks, which in other domains were found to generalize well, are underutilized. Traditional memory networks involve diffused and non-linear operations where influence of past events on outputs are not readily quantifiable. We posit that this lack of interpretability makes such networks not applicable for EHR analysis. While networks with explicit memory have been proposed recently, the discontinuities imposed by the discrete operations make such networks harder to train and require more supervision. The problem is further exacerbated in the limited data setting of EHR studies. In this paper, we propose a novel memory architecture that is more interpretable than traditional memory networks while being easier to train than explicit memory banks. Inspired by well-known models of human cognition, we propose partitioning the external memory space into (a) a primary explicit memory block to store exact replicas of recent events to support interpretations, followed by (b) a secondary blurred memory block that accumulates salient aspects of past events dropped from the explicit block as higher level abstractions and allow training with less supervision by stabilize the gradients. We apply the model for 3 learning problems on ICU records from the MIMIC III database spanning millions of data points. Our model performs comparably to the state-of the art while also, crucially, enabling ready interpretation of the results.
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