Measures to predict 30-day readmission are considered an important quality factor for hospitals as accurate predictions can reduce the overall cost of care by identifying high risk patients before they are discharged. While recent deep learning-based studies have shown promising empirical results on readmission prediction, several limitations exist that may hinder widespread clinical utility, such as (a) only patients with certain conditions are considered, (b) existing approaches do not leverage data temporality, (c) individual admissions are assumed independent of each other, which is unrealistic, (d) prior studies are usually limited to single source of data and single center data. To address these limitations, we propose a multimodal, modality-agnostic spatiotemporal graph neural network (MM-STGNN) for prediction of 30-day all-cause hospital readmission that fuses multimodal in-patient longitudinal data. By training and evaluating our methods using longitudinal chest radiographs and electronic health records from two independent centers, we demonstrate that MM-STGNN achieves AUROC of 0.79 on both primary and external datasets. Furthermore, MM-STGNN significantly outperforms the current clinical reference standard, LACE+ score (AUROC=0.61), on the primary dataset. For subset populations of patients with heart and vascular disease, our model also outperforms baselines on predicting 30-day readmission (e.g., 3.7 point improvement in AUROC in patients with heart disease). Lastly, qualitative model interpretability analysis indicates that while patients' primary diagnoses were not explicitly used to train the model, node features crucial for model prediction directly reflect patients' primary diagnoses. Importantly, our MM-STGNN is agnostic to node feature modalities and could be utilized to integrate multimodal data for triaging patients in various downstream resource allocation tasks.

Machine learning models for medical image analysis often suffer from poor performance on important subsets of a population that are not identified during training or testing. For example, overall performance of a cancer detection model may be high, but the model still consistently misses a rare but aggressive cancer subtype. We refer to this problem as hidden stratification, and observe that it results from incompletely describing the meaningful variation in a dataset. While hidden stratification can substantially reduce the clinical efficacy of machine learning models, its effects remain difficult to measure. In this work, we assess the utility of several possible techniques for measuring and describing hidden stratification effects, and characterize these effects both on multiple medical imaging datasets and via synthetic experiments on the well-characterised CIFAR-100 benchmark dataset. We find evidence that hidden stratification can occur in unidentified imaging subsets with low prevalence, low label quality, subtle distinguishing features, or spurious correlates, and that it can result in relative performance differences of over 20% on clinically important subsets. Finally, we explore the clinical implications of our findings, and suggest that evaluation of hidden stratification should be a critical component of any machine learning deployment in medical imaging.

Department of Biomedical Data Science, Stanford University, Stanford, California, USA Labeling training datasets has become a key barrier to building medical machine learning models. One strategy is to generate training labels programmatically, for example by applying natural language processing pipelines to text reports associated with imaging studies. We propose cross-modal data programming, which generalizes this intuitive strategy in a theoretically-grounded way that enables simpler, clinician-driven input, reduces required labeling time, and improves with additional unlabeled data. In this approach, clinicians generate training labels for models defined over a target modality (e.g. The resulting technical challenge consists of estimating the accuracies and correlations of these rules; we extend a recent unsupervised generative modeling technique to handle this cross-modal setting in a provably consistent way. Across four applications in radiography, computed tomography, and electroencephalography, and using only several hours of clinician time, our approach matches or exceeds the efficacy of physician-months of hand-labeling with statistical significance, demonstrating a fundamentally faster and more flexible way of building machine learning models in medicine. In addition to being extremely costly, these training sets are inflexible: given a new classification schema, imaging system, patient population, or other change in the data distribution or modeling task, the training set generally needs to be relabeled from scratch. One manifestation of this shift in the broader machine learning community is the increasing use of weak supervision approaches, where training data is labeled in noisier, higher-level, often programmatic ways, rather than manually by experts. We broadly characterize these methods as cross-modal weak supervision approaches, in which the strategy is to programmatically extract labels from an auxiliary modality--e.g. the unstructured text reports accompanying an imaging study--which are then used as training labels for a model defined over the target modality, e.g. These methods follow the intuition that programmatically extracting labels from the auxiliary modality can be far faster and easier than hand-labeling or deriving labels from the target modality directly.

As machine learning models continue to increase in complexity, collecting large hand-labeled training sets has become one of the biggest roadblocks in practice. Instead, weaker forms of supervision that provide noisier but cheaper labels are often used. However, these weak supervision sources have diverse and unknown accuracies, may output correlated labels, and may label different tasks or apply at different levels of granularity. We propose a framework for integrating and modeling such weak supervision sources by viewing them as labeling different related sub-tasks of a problem, which we refer to as the multi-task weak supervision setting. We show that by solving a matrix completion-style problem, we can recover the accuracies of these multi-task sources given their dependency structure, but without any labeled data, leading to higher-quality supervision for training an end model. Theoretically, we show that the generalization error of models trained with this approach improves with the number of unlabeled data points, and characterize the scaling with respect to the task and dependency structures. On three fine-grained classification problems, we show that our approach leads to average gains of 20.2 points in accuracy over a traditional supervised approach, 6.8 points over a majority vote baseline, and 4.1 points over a previously proposed weak supervision method that models tasks separately.

Data augmentation is a ubiquitous technique for increasing the size of labeled training sets by leveraging task-specific data transformations that preserve class labels. While it is often easy for domain experts to specify individual transformations, constructing and tuning the more sophisticated compositions typically needed to achieve state-of-the-art results is a time-consuming manual task in practice. We propose a method for automating this process by learning a generative sequence model over user-specified transformation functions using a generative adversarial approach. Our method can make use of arbitrary, non-deterministic transformation functions, is robust to misspecified user input, and is trained on unlabeled data. The learned transformation model can then be used to perform data augmentation for any end discriminative model. In our experiments, we show the efficacy of our approach on both image and text datasets, achieving improvements of 4.0 accuracy points on CIFAR-10, 1.4 F1 points on the ACE relation extraction task, and 3.4 accuracy points when using domain-specific transformation operations on a medical imaging dataset as compared to standard heuristic augmentation approaches.

Data augmentation is a ubiquitous technique for increasing the size of labeled training sets by leveraging task-specific data transformations that preserve class labels. While it is often easy for domain experts to specify individual transformations, constructing and tuning the more sophisticated compositions typically needed to achieve state-of-the-art results is a time-consuming manual task in practice. We propose a method for automating this process by learning a generative sequence model over user-specified transformation functions using a generative adversarial approach. Our method can make use of arbitrary, non-deterministic transformation functions, is robust to misspecified user input, and is trained on unlabeled data. The learned transformation model can then be used to perform data augmentation for any end discriminative model. In our experiments, we show the efficacy of our approach on both image and text datasets, achieving improvements of 4.0 accuracy points on CIFAR-10, 1.4 F1 points on the ACE relation extraction task, and 3.4 accuracy points when using domain-specific transformation operations on a medical imaging dataset as compared to standard heuristic augmentation approaches.