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Reinforcement Learning for Intelligent Healthcare Systems: A Comprehensive Survey Artificial Intelligence

The rapid increase in the percentage of chronic disease patients along with the recent pandemic pose immediate threats on healthcare expenditure and elevate causes of death. This calls for transforming healthcare systems away from one-on-one patient treatment into intelligent health systems, to improve services, access and scalability, while reducing costs. Reinforcement Learning (RL) has witnessed an intrinsic breakthrough in solving a variety of complex problems for diverse applications and services. Thus, we conduct in this paper a comprehensive survey of the recent models and techniques of RL that have been developed/used for supporting Intelligent-healthcare (I-health) systems. This paper can guide the readers to deeply understand the state-of-the-art regarding the use of RL in the context of I-health. Specifically, we first present an overview for the I-health systems challenges, architecture, and how RL can benefit these systems. We then review the background and mathematical modeling of different RL, Deep RL (DRL), and multi-agent RL models. After that, we provide a deep literature review for the applications of RL in I-health systems. In particular, three main areas have been tackled, i.e., edge intelligence, smart core network, and dynamic treatment regimes. Finally, we highlight emerging challenges and outline future research directions in driving the future success of RL in I-health systems, which opens the door for exploring some interesting and unsolved problems.

Challenges for Reinforcement Learning in Healthcare Artificial Intelligence

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.

Deep Reinforcement Learning for Clinical Decision Support: A Brief Survey Machine Learning

Owe to the recent advancements in Artificial Intelligence especially deep learning, many data-driven decision support systems have been implemented to facilitate medical doctors in delivering personalized care. We focus on the deep reinforcement learning (DRL) models in this paper. DRL models have demonstrated human-level or even superior performance in the tasks of computer vision and game playings, such as Go and Atari game. However, the adoption of deep reinforcement learning techniques in clinical decision optimization is still rare. We here present the first survey that summarizes reinforcement learning algorithms with Deep Neural Networks (DNN) on clinical decision support. We also discuss some case studies, where different DRL algorithms were applied to address various clinical challenges. We further compare and contrast the advantages and limitations of various DRL algorithms and present a preliminary guide on how to choose the appropriate DRL algorithm for particular clinical applications.

Deep Reinforcement Learning for Dynamic Treatment Regimes on Medical Registry Data Machine Learning

This paper presents the first deep reinforcement learning (DRL) framework to estimate the optimal Dynamic Treatment Regimes from observational medical data. This framework is more flexible and adaptive for high dimensional action and state spaces than existing reinforcement learning methods to model real-life complexity in heterogeneous disease progression and treatment choices, with the goal of providing doctor and patients the data-driven personalized decision recommendations. The proposed DRL framework comprises (i) a supervised learning step to predict the most possible expert actions, and (ii) a deep reinforcement learning step to estimate the long-term value function of Dynamic Treatment Regimes. Both steps depend on deep neural networks. As a key motivational example, we have implemented the proposed framework on a data set from the Center for International Bone Marrow Transplant Research (CIBMTR) registry database, focusing on the sequence of prevention and treatments for acute and chronic graft versus host disease after transplantation. In the experimental results, we have demonstrated promising accuracy in predicting human experts' decisions, as well as the high expected reward function in the DRL-based dynamic treatment regimes.

Is Deep Reinforcement Learning Ready for Practical Applications in Healthcare? A Sensitivity Analysis of Duel-DDQN for Hemodynamic Management in Sepsis Patients Machine Learning

The potential of Reinforcement Learning (RL) has been demonstrated through successful applications to games such as Go and Atari. However, while it is straightforward to evaluate the performance of an RL algorithm in a game setting by simply using it to play the game, evaluation is a major challenge in clinical settings where it could be unsafe to follow RL policies in practice. Thus, understanding sensitivity of RL policies to the host of decisions made during implementation is an important step toward building the type of trust in RL required for eventual clinical uptake. In this work, we perform a sensitivity analysis on a state-of-the-art RL algorithm (Dueling Double Deep Q-Networks)applied to hemodynamic stabilization treatment strategies for septic patients in the ICU. We consider sensitivity of learned policies to input features, embedding model architecture, time discretization, reward function, and random seeds. We find that varying these settings can significantly impact learned policies, which suggests a need for caution when interpreting RL agent output.