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Register a new userSupervised multi-specialist topic model with applications on large-scale electronic health record data
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Motivation: Electronic health record (EHR) data provides a new venue to elucidate disease comorbidities and latent phenotypes for precision medicine. To fully exploit its potential, a realistic data generative process of the EHR data needs to be modelled. We present MixEHR-S to jointly infer specialist-disease topics from the EHR data. As the key contribution, we model the specialist assignments and ICD-coded diagnoses as the latent topics based on patients underlying disease topic mixture in a novel unified supervised hierarchical Bayesian topic model. For efficient inference, we developed a closed-form collapsed variational inference algorithm to learn the model distributions of MixEHR-S. We applied MixEHR-S to two independent large-scale EHR databases in Quebec with three targeted applications: (1) Congenital Heart Disease (CHD) diagnostic prediction among 154,775 patients; (2) Chronic obstructive pulmonary disease (COPD) diagnostic prediction among 73,791 patients; (3) future insulin treatment prediction among 78,712 patients diagnosed with diabetes as a mean to assess the disease exacerbation. In all three applications, MixEHR-S conferred clinically meaningful latent topics among the most predictive latent topics and achieved superior target prediction accuracy compared to the existing methods, providing opportunities for prioritizing high-risk patients for healthcare services. MixEHR-S source code and scripts of the experiments are freely available at https://github.com/li-lab-mcgill/mixehrS
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Non-negative tensor factorization has been shown a practical solution to automatically discover phenotypes from the electronic health records (EHR) with minimal human supervision. Such methods generally require an input tensor describing the inter-modal interactions to be pre-established; however, the correspondence between different modalities (e.g., correspondence between medications and diagnoses) can often be missing in practice. Although heuristic methods can be applied to estimate them, they inevitably introduce errors, and leads to sub-optimal phenotype quality. This is particularly important for patients with complex health conditions (e.g., in critical care) as multiple diagnoses and medications are simultaneously present in the records. To alleviate this problem and discover phenotypes from EHR with unobserved inter-modal correspondence, we propose the collective hidden interaction tensor factorization (cHITF) to infer the correspondence between multiple modalities jointly with the phenotype discovery. We assume that the observed matrix for each modality is marginalization of the unobserved inter-modal correspondence, which are reconstructed by maximizing the likelihood of the observed matrices. Extensive experiments conducted on the real-world MIMIC-III dataset demonstrate that cHITF effectively infers clinically meaningful inter-modal correspondence, discovers phenotypes that are more clinically relevant and diverse, and achieves better predictive performance compared with a number of state-of-the-art computational phenotyping models.
Electronic Health Record (EHR) data has been of tremendous utility in Artificial Intelligence (AI) for healthcare such as predicting future clinical events. These tasks, however, often come with many challenges when using classical machine learning models due to a myriad of factors including class imbalance and data heterogeneity (i.e., the complex intra-class variances). To address some of these research gaps, this paper leverages the exciting contrastive learning framework and proposes a novel contrastive regularized clinical classification model. The contrastive loss is found to substantially augment EHR-based prediction: it effectively characterizes the similar/dissimilar patterns (by its push-and-pull form), meanwhile mitigating the highly skewed class distribution by learning more balanced feature spaces (as also echoed by recent findings). In particular, when naively exporting the contrastive learning to the EHR data, one hurdle is in generating positive samples, since EHR data is not as amendable to data augmentation as image data. To this end, we have introduced two unique positive sampling strategies specifically tailored for EHR data: a feature-based positive sampling that exploits the feature space neighborhood structure to reinforce the feature learning; and an attribute-based positive sampling that incorporates pre-generated patient similarity metrics to define the sample proximity. Both sampling approaches are designed with an awareness of unique high intra-class variance in EHR data. Our overall framework yields highly competitive experimental results in predicting the mortality risk on real-world COVID-19 EHR data with a total of 5,712 patients admitted to a large, urban health system. Specifically, our method reaches a high AUROC prediction score of 0.959, which outperforms other baselines and alternatives: cross-entropy(0.873) and focal loss(0.931).
The incidence of Acute Kidney Injury (AKI) commonly happens in the Intensive Care Unit (ICU) patients, especially in the adults, which is an independent risk factor affecting short-term and long-term mortality. Though researchers in recent years highlight the early prediction of AKI, the performance of existing models are not precise enough. The objective of this research is to precisely predict AKI by means of Convolutional Neural Network on Electronic Health Record (EHR) data. The data sets used in this research are two public Electronic Health Record (EHR) databases: MIMIC-III and eICU database. In this study, we take several Convolutional Neural Network models to train and test our AKI predictor, which can precisely predict whether a certain patient will suffer from AKI after admission in ICU according to the last measurements of the 16 blood gas and demographic features. The research is based on Kidney Disease Improving Global Outcomes (KDIGO) criteria for AKI definition. Our work greatly improves the AKI prediction precision, and the best AUROC is up to 0.988 on MIMIC-III data set and 0.936 on eICU data set, both of which outperform the state-of-art predictors. And the dimension of the input vector used in this predictor is much fewer than that used in other existing researches. Compared with the existing AKI predictors, the predictor in this work greatly improves the precision of early prediction of AKI by using the Convolutional Neural Network architecture and a more concise input vector. Early and precise prediction of AKI will bring much benefit to the decision of treatment, so it is believed that our work is a very helpful clinical application.
Advancements in machine learning algorithms have had a beneficial impact on representation learning, classification, and prediction models built using electronic health record (EHR) data. Effort has been put both on increasing models overall performance as well as improving their interpretability, particularly regarding the decision-making process. In this study, we present a temporal deep learning model to perform bidirectional representation learning on EHR sequences with a transformer architecture to predict future diagnosis of depression. This model is able to aggregate five heterogenous and high-dimensional data sources from the EHR and process them in a temporal manner for chronic disease prediction at various prediction windows. We applied the current trend of pretraining and fine-tuning on EHR data to outperform the current state-of-the-art in chronic disease prediction, and to demonstrate the underlying relation between EHR codes in the sequence. The model generated the highest increases of precision-recall area under the curve (PRAUC) from 0.70 to 0.76 in depression prediction compared to the best baseline model. Furthermore, the self-attention weights in each sequence quantitatively demonstrated the inner relationship between various codes, which improved the models interpretability. These results demonstrate the models ability to utilize heterogeneous EHR data to predict depression while achieving high accuracy and interpretability, which may facilitate constructing clinical decision support systems in the future for chronic disease screening and early detection.
There is currently an unprecedented demand for large-scale temporal data analysis due to the explosive growth of data. Dynamic topic modeling has been widely used in social and data sciences with the goal of learning latent topics that emerge, evolve, and fade over time. Previous work on dynamic topic modeling primarily employ the method of nonnegative matrix factorization (NMF), where slices of the data tensor are each factorized into the product of lower-dimensional nonnegative matrices. With this approach, however, information contained in the temporal dimension of the data is often neglected or underutilized. To overcome this issue, we propose instead adopting the method of nonnegative CANDECOMP/PARAPAC (CP) tensor decomposition (NNCPD), where the data tensor is directly decomposed into a minimal sum of outer products of nonnegative vectors, thereby preserving the temporal information. The viability of NNCPD is demonstrated through application to both synthetic and real data, where significantly improved results are obtained compared to those of typical NMF-based methods. The advantages of NNCPD over such approaches are studied and discussed. To the best of our knowledge, this is the first time that NNCPD has been utilized for the purpose of dynamic topic modeling, and our findings will be transformative for both applications and further developments.
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