Healthcare is a natural arena for the application of machine learning, especially as modern electronic health records (EHRs) provide increasingly large amounts of data to answer clinically meaningful questions. However, clinical data and practice present unique challenges that complicate the use of common methodologies. This article serves as a primer on addressing these challenges and highlights opportunities for members of the machine learning and data science communities to contribute to this growing domain.
Many healthcare decisions involve navigating through a multitude of treatment options in a sequential and iterative manner to find an optimal treatment pathway with the goal of an optimal patient outcome. Such optimization problems may be amenable to reinforcement learning. A reinforcement learning agent could be trained to provide treatment recommendations for physicians, acting as a decision support tool. However, a number of difficulties arise when using RL beyond benchmark environments, such as specifying the reward function, choosing an appropriate state representation and evaluating the learned policy.
Disease phenotyping algorithms process observational clinical data to identify patients with specific diseases. Supervised phenotyping methods require significant quantities of expert-labeled data, while unsupervised methods may learn non-disease phenotypes. To address these limitations, we propose the Semi-Supervised Mixed Membership Model (SS3M) -- a probabilistic graphical model for learning disease phenotypes from clinical data with relatively few labels. We show SS3M can learn interpretable, disease-specific phenotypes which capture the clinical characteristics of the diseases specified by the labels provided.
Deep learning, an area of machine learning, is set to revolutionize patient care. But it is not yet part of standard of care, especially when it comes to individual patient care. In fact, it is unclear to what extent data-driven techniques are being used to support clinical decision making (CDS). Heretofore, there has not been a review of ways in which research in machine learning and other types of data-driven techniques can contribute effectively to clinical care and the types of support they can bring to clinicians. In this paper, we consider ways in which two data driven domains - machine learning and data visualizations - can contribute to the next generation of clinical decision support systems. We review the literature regarding the ways heuristic knowledge, machine learning, and visualization are - and can be - applied to three types of CDS. There has been substantial research into the use of predictive modeling for alerts, however current CDS systems are not utilizing these methods. Approaches that leverage interactive visualizations and machine-learning inferences to organize and review patient data are gaining popularity but are still at the prototype stage and are not yet in use. CDS systems that could benefit from prescriptive machine learning (e.g., treatment recommendations for specific patients) have not yet been developed. We discuss potential reasons for the lack of deployment of data-driven methods in CDS and directions for future research.
Recent years have witnessed widespread adoption of machine learning (ML)/deep learning (DL) techniques due to their superior performance for a variety of healthcare applications ranging from the prediction of cardiac arrest from one-dimensional heart signals to computer-aided diagnosis (CADx) using multi-dimensional medical images. Notwithstanding the impressive performance of ML/DL, there are still lingering doubts regarding the robustness of ML/DL in healthcare settings (which is traditionally considered quite challenging due to the myriad security and privacy issues involved), especially in light of recent results that have shown that ML/DL are vulnerable to adversarial attacks. In this paper, we present an overview of various application areas in healthcare that leverage such techniques from security and privacy point of view and present associated challenges. In addition, we present potential methods to ensure secure and privacy-preserving ML for healthcare applications. Finally, we provide insight into the current research challenges and promising directions for future research.