Electronic health records (EHRs) have been heavily used in modern healthcare systems for recording patients' admission information to health facilities. Many data-driven approaches employ temporal features in EHR for predicting specific diseases, readmission times, and diagnoses of patients. However, most existing predictive models cannot fully utilize EHR data, due to an inherent lack of labels in supervised training for some temporal events. Moreover, it is hard for the existing methods to simultaneously provide generic and personalized interpretability. To address these challenges, we propose Sherbet, a self-supervised graph learning framework with hyperbolic embeddings for temporal health event prediction. We first propose a hyperbolic embedding method with information flow to pretrain medical code representations in a hierarchical structure. We incorporate these pretrained representations into a graph neural network (GNN) to detect disease complications and design a multilevel attention method to compute the contributions of particular diseases and admissions, thus enhancing personalized interpretability. We present a new hierarchy-enhanced historical prediction proxy task in our self-supervised learning framework to fully utilize EHR data and exploit medical domain knowledge. We conduct a comprehensive set of experiments on widely used publicly available EHR datasets to verify the effectiveness of our model. Our results demonstrate the proposed model's strengths in both predictive tasks and interpretable abilities.
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Collaborative Graph Learning with Auxiliary Text for Temporal Event Prediction in Healthcare
Accurate and explainable health event predictions are becoming crucial for healthcare providers to develop care plans for patients. The availability of electronic health records (EHR) has enabled machine learning advances in providing these predictions. However, many deep-learning-based methods are not satisfactory in solving several key challenges: 1) effectively utilizing disease domain knowledge; 2) collaboratively learning representations of patients and diseases; and 3) incorporating unstructured features. To address these issues, we propose a collaborative graph learning model to explore patient-disease interactions and medical domain knowledge. Our solution is able to capture structural features of both patients and diseases. The proposed model also utilizes unstructured text data by employing an attention manipulating strategy and then integrates attentive text features into a sequential learning process. We conduct extensive experiments on two important healthcare problems to show the competitive prediction performance of the proposed method compared with various state-of-the-art models. We also confirm the effectiveness of learned representations and model interpretability by a set of ablation and case studies.
more » « less- Award ID(s):
- 1948432
- NSF-PAR ID:
- 10318644
- Date Published:
- Journal Name:
- Proceedings of the Thirtieth International Joint Conference on Artificial Intelligence
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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Abstract Objective Early identification of chronic diseases is a pillar of precision medicine as it can lead to improved outcomes, reduction of disease burden, and lower healthcare costs. Predictions of a patient’s health trajectory have been improved through the application of machine learning approaches to electronic health records (EHRs). However, these methods have traditionally relied on “black box” algorithms that can process large amounts of data but are unable to incorporate domain knowledge, thus limiting their predictive and explanatory power. Here, we present a method for incorporating domain knowledge into clinical classifications by embedding individual patient data into a biomedical knowledge graph.
Materials and Methods A modified version of the Page rank algorithm was implemented to embed millions of deidentified EHRs into a biomedical knowledge graph (SPOKE). This resulted in high-dimensional, knowledge-guided patient health signatures (ie, SPOKEsigs) that were subsequently used as features in a random forest environment to classify patients at risk of developing a chronic disease.
Results Our model predicted disease status of 5752 subjects 3 years before being diagnosed with multiple sclerosis (MS) (AUC = 0.83). SPOKEsigs outperformed predictions using EHRs alone, and the biological drivers of the classifiers provided insight into the underpinnings of prodromal MS.
Conclusion Using data from EHR as input, SPOKEsigs describe patients at both the clinical and biological levels. We provide a clinical use case for detecting MS up to 5 years prior to their documented diagnosis in the clinic and illustrate the biological features that distinguish the prodromal MS state.
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Abstract Background Natural language processing (NLP) tasks in the health domain often deal with limited amount of labeled data due to high annotation costs and naturally rare observations. To compensate for the lack of training data, health NLP researchers often have to leverage knowledge and resources external to a task at hand. Recently, pretrained large-scale language models such as the Bidirectional Encoder Representations from Transformers (BERT) have been proven to be a powerful way of learning rich linguistic knowledge from massive unlabeled text and transferring that knowledge to downstream tasks. However, previous downstream tasks often used training data at such a large scale that is unlikely to obtain in the health domain. In this work, we aim to study whether BERT can still benefit downstream tasks when training data are relatively small in the context of health NLP.
Method We conducted a learning curve analysis to study the behavior of BERT and baseline models as training data size increases. We observed the classification performance of these models on two disease diagnosis data sets, where some diseases are naturally rare and have very limited observations (fewer than 2 out of 10,000). The baselines included commonly used text classification models such as sparse and dense bag-of-words models, long short-term memory networks, and their variants that leveraged external knowledge. To obtain learning curves, we incremented the amount of training examples per disease from small to large, and measured the classification performance in macro-averaged
$$F_{1}$$ Results On the task of classifying all diseases, the learning curves of BERT were consistently above all baselines, significantly outperforming them across the spectrum of training data sizes. But under extreme situations where only one or two training documents per disease were available, BERT was outperformed by linear classifiers with carefully engineered bag-of-words features.
Conclusion As long as the amount of training documents is not extremely few, fine-tuning a pretrained BERT model is a highly effective approach to health NLP tasks like disease classification. However, in extreme cases where each class has only one or two training documents and no more will be available, simple linear models using bag-of-words features shall be considered.
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With the wide application of electronic health records (EHR) in healthcare facilities, health event prediction with deep learning has gained more and more attention. A common feature of EHR data used for deep-learning-based predictions is historical diagnoses. Existing work mainly regards a diagnosis as an independent disease and does not consider clinical relations among diseases in a visit. Many machine learning approaches assume disease representations are static in different visits of a patient. However, in real practice, multiple diseases that are frequently diagnosed at the same time reflect hidden patterns that are conducive to prognosis. Moreover, the development of a disease is not static since some diseases can emerge or disappear and show various symptoms in different visits of a patient. To effectively utilize this combinational disease information and explore the dynamics of diseases, we propose a novel context-aware learning framework using transition functions on dynamic disease graphs. Specifically, we construct a global disease co-occurrence graph with multiple node properties for disease combinations. We design dynamic subgraphs for each patient's visit to leverage global and local contexts. We further define three diagnosis roles in each visit based on the variation of node properties to model disease transition processes. Experimental results on two real-world EHR datasets show that the proposed model outperforms state of the art in predicting health events.more » « less
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Off-label drug use refers to using marketed drugs for indications that are not listed in their FDA labeling information. Such uses are very common and sometimes inevitable in clinical practice. To some extent, off-label drug uses provide a pathway for clinical innovation, however, they could cause serious adverse effects due to lacking scientific research and tests. Since identifying the off-label uses can provide a clue to the stakeholders including healthcare providers, patients, and medication manufacturers to further the investigation on drug efficacy and safety, it raises the demand for a systematic way to detect off-label uses. Given data contributed by health consumers in online health communities (OHCs), we developed an automated approach to detect off-label drug uses based on heterogeneous network mining. We constructed a heterogeneous healthcare network with medical entities (e.g. disease, drug, adverse drug reaction) mined from the text corpus, which involved 50 diseases, 1,297 drugs, and 185 ADRs, and determined 13 meta paths between the drugs and diseases. We developed three metrics to represent the meta-path-based topological features. With the network features, we trained the binary classifiers built on Random Forest algorithm to recognize the known drug-disease associations. The best classification model that used lift to measure path weights obtained F1-score of 0.87, based on which, we identified 1,009 candidates of off-label drug uses and examined their potential by searching evidence from PubMed and FAERS.more » « less
- Free Publicly Accessible Full Text
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Accepted Manuscript1.0
- Conference Paper:
- https://doi.org/10.24963/ijcai.2021/486
