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1. EHR Security and Privacy Aspects: A Systematic Review

   Banerjee, Sourav; Barik, Sudip; Das, Debashis; Ghosh, Uttam (October 2023, Springer Nature Switzerland)

   Electronic Health Records (EHRs) have become increasingly popular in recent years, providing a convenient way to store, manage and share relevant information among healthcare providers. However, as EHRs contain sensitive personal information, ensuring their security and privacy is most important. This paper reviews the key aspects of EHR security and privacy, including authentication, access control, data encryption, auditing, and risk management. Additionally, the paper dis- cusses the legal and ethical issues surrounding EHRs, such as patient consent, data ownership, and breaches of confidentiality. Effective implementation of security and privacy measures in EHR systems requires a multi-disciplinary approach involving healthcare providers, IT specialists, and regulatory bodies. Ultimately, the goal is to come upon a balance between protecting patient privacy and ensuring timely access to critical medical information for feature healthcare delivery. 

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2. Privacy-Preserving Tensor Factorization for Collaborative Health Data Analysis

   https://doi.org/10.1145/3357384.3357878  

   Ma, Jing; Zhang, Qiuchen; Lou, Jian; Ho, Joyce C.; Xiong, Li; Jiang, Xiaoqian (November 2019, Proceedings of the 28th ACM International Conference on Information and Knowledge Management)

   Tensor factorization has been demonstrated as an efficient approach for computational phenotyping, where massive electronic health records (EHRs) are converted to concise and meaningful clinical concepts. While distributing the tensor factorization tasks to local sites can avoid direct data sharing, it still requires the exchange of intermediary results which could reveal sensitive patient information. Therefore, the challenge is how to jointly decompose the tensor under rigorous and principled privacy constraints, while still support the model's interpretability. We propose DPFact, a privacy-preserving collaborative tensor factorization method for computational phenotyping using EHR. It embeds advanced privacy-preserving mechanisms with collaborative learning. Hospitals can keep their EHR database private but also collaboratively learn meaningful clinical concepts by sharing differentially private intermediary results. Moreover, DPFact solves the heterogeneous patient population using a structured sparsity term. In our framework, each hospital decomposes its local tensors and sends the updated intermediary results with output perturbation every several iterations to a semi-trusted server which generates the phenotypes. The evaluation on both real-world and synthetic datasets demonstrated that under strict privacy constraints, our method is more accurate and communication-efficient than state-of-the-art baseline methods. 

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3. Generating Connected Synthetic Electronic Health Records and Social Media Data for Modeling and Simulation

   Tall, Anne M.; Zou, Cliff C.; Wang, Jun (December 2020, Interservice/Industry Training, Simulation and Education Conference (I/ITSEC))

   null (Ed.)

   Research and experimentation using big data sets, specifically large sets of electronic health records (EHR) and social media data, is demonstrating the potential to understand the spread of diseases and a variety of other issues. Applications of advanced algorithms, machine learning, and artificial intelligence indicate a potential for rapidly advancing improvements in public health. For example, several reports indicate that social media data can be used to predict disease outbreak and spread (Brown, 2015). Since real-world EHR data has complicated security and privacy issues preventing it from being widely used by researchers, there is a real need to synthetically generate EHR data that is realistic and representative. Current EHR generators, such as Syntheaä (Walonoski et al., 2018) only simulate and generate pure medical-related data. However, adding patients’ social media data with their simulated EHR data would make combined data more comprehensive and realistic for healthcare research. This paper presents a patients’ social media data generator that extends an EHR data generator. By adding coherent social media data to EHR data, a variety of issues can be examined for emerging interests, such as where a contagious patient may have been and others with whom they may have been in contact. Social media data, specifically Twitter data, is generated with phrases indicating the onset of symptoms corresponding to the synthetically generated EHR reports of simulated patients. This enables creation of an open data set that is scalable up to a big-data size, and is not subject to the security, privacy concerns, and restrictions of real healthcare data sets. This capability is important to the modeling and simulation community, such as scientists and epidemiologists who are developing algorithms to analyze the spread of diseases. It enables testing a variety of analytics without revealing real-world private patient information. 

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4. MCRAGE: Synthetic Healthcare Data for Fairness

   https://doi.org/10.1137/23S1611282  

   Fikes, Caleb; Behal, Keira; Chen, Jiayi; Xiao, Sophia (January 2024, SIAM Undergraduate Research Online)

   In the field of healthcare, electronic health records (EHR) serve as crucial training data for developing machine learning models for diagnosis, treatment, and the management of healthcare resources. However, medical datasets are often imbalanced in terms of sensitive attributes such as race/ethnicity, gender, and age. Machine learning models trained on class-imbalanced EHR datasets perform significantly worse in deployment for individuals of the minority classes compared to those from majority classes, which may lead to inequitable healthcare outcomes for minority groups. To address this challenge, we propose Minority Class Rebalancing through Augmentation by Generative modeling (MCRAGE), a novel approach to augment imbalanced datasets using samples generated by a deep generative model. The MCRAGE process involves training a Conditional Denoising Diffusion Probabilistic Model (CDDPM) capable of generating high-quality synthetic EHR samples from underrepresented classes. We use this synthetic data to augment the existing imbalanced dataset, resulting in a more balanced distribution across all classes, which can be used to train less biased downstream models. We measure the performance of MCRAGE versus alternative approaches using Accuracy, F1 score and AUROC of these downstream models. We provide theoretical justification for our method in terms of recent convergence results for DDPMs. 

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5. Self-Supervised Graph Learning With Hyperbolic Embedding for Temporal Health Event Prediction

   https://doi.org/10.1109/TCYB.2021.3109881  

   Lu, Chang; Reddy, Chandan K.; Ning, Yue (September 2021, IEEE Transactions on Cybernetics)

   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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