Over the last 5 years there has actually been a confluence of a few different historical threats. We’ve had health data being increasingly digitalised and we’ve had the proliferation of accessible massive scale computing, both of which have un-locked a technique developed in the early 80’s called deep learning, which is really good at pattern recognition over large data sets.Key trends in the last year include the first randomised clinical trials in the clinical application of AI in health, the potential for AI in clinical discovery particularly using multimodal data (including electronic medical records, imaging data, genomic data) and combining that to find patterns in very large data sets. This is the real beginning of precision medicine. Finally there are day to day clinical process applications being used to predict resource allocation or disease outbreaks.At the same time there are some systemic challenges facing AI in health, including workflow integration, bias, equity and just access. How can we mitigate these biases and make them fair.Finally how do we make this sensitive data safe? Is the answer Federated machine learning where we send the AI algorithms out to local networks and apply them there?
We propose a Healthcare Graph Convolutional Network (HealGCN) to offer disease self-diagnosis service for online users, based on the Electronic Healthcare Records (EHRs). Two main challenges are focused in this paper for online disease self-diagnosis: (1) serving cold-start users via graph convolutional networks and (2) handling scarce clinical description via a symptom retrieval system. To this end, we first organize the EHR data into a heterogeneous graph that is capable of modeling complex interactions among users, symptoms and diseases, and tailor the graph representation learning towards disease diagnosis with an inductive learning paradigm. Then, we build a disease self-diagnosis system with a corresponding EHR Graph-based Symptom Retrieval System (GraphRet) that can search and provide a list of relevant alternative symptoms by tracing the predefined meta-paths. GraphRet helps enrich the seed symptom set through the EHR graph, resulting in better reasoning ability of our HealGCN model, when confronting users with scarce descriptions. At last, we validate our model on a large-scale EHR dataset, the superior performance does confirm our model's effectiveness in practice.
Despite the large number of patients in Electronic Health Records (EHRs), the subset of usable data for modeling outcomes of specific phenotypes are often imbalanced and of modest size. This can be attributed to the uneven coverage of medical concepts in EHRs. In this paper, we propose OMTL, an Ontology-driven Multi-Task Learning framework, that is designed to overcome such data limitations. The key contribution of our work is the effective use of knowledge from a predefined well-established medical relationship graph (ontology) to construct a novel deep learning network architecture that mirrors this ontology. It can effectively leverage knowledge from a well-established medical relationship graph (ontology) by constructing a deep learning network architecture that mirrors this graph. This enables common representations to be shared across related phenotypes, and was found to improve the learning performance. The proposed OMTL naturally allows for multitask learning of different phenotypes on distinct predictive tasks. These phenotypes are tied together by their semantic distance according to the external medical ontology. Using the publicly available MIMIC-III database, we evaluate OMTL and demonstrate its efficacy on several real patient outcome predictions over state-of-the-art multi-task learning schemes.
Causality is crucial to understanding the mechanisms behind complex systems and making decisions that lead to intended outcomes. Event sequence data is widely collected from many real-world processes, such as electronic health records, web clickstreams, and financial transactions, which transmit a great deal of information reflecting the causal relations among event types. Unfortunately, recovering causalities from observational event sequences is challenging, as the heterogeneous and high-dimensional event variables are often connected to rather complex underlying event excitation mechanisms that are hard to infer from limited observations. Many existing automated causal analysis techniques suffer from poor explainability and fail to include an adequate amount of human knowledge. In this paper, we introduce a visual analytics method for recovering causalities in event sequence data. We extend the Granger causality analysis algorithm on Hawkes processes to incorporate user feedback into causal model refinement. The visualization system includes an interactive causal analysis framework that supports bottom-up causal exploration, iterative causal verification and refinement, and causal comparison through a set of novel visualizations and interactions. We report two forms of evaluation: a quantitative evaluation of the model improvements resulting from the user-feedback mechanism, and a qualitative evaluation through case studies in different application domains to demonstrate the usefulness of the system.
Precision health leverages information from various sources, including omics, lifestyle, environment, social media, medical records, and medical insurance claims to enable personalized care, prevent and predict illness, and precise treatments. It extensively uses sensing technologies (e.g., electronic health monitoring devices), computations (e.g., machine learning), and communication (e.g., interaction between the health data centers). As health data contain sensitive private information, including the identity of patient and carer and medical conditions of the patient, proper care is required at all times. Leakage of these private information affects the personal life, including bullying, high insurance premium, and loss of job due to the medical history. Thus, the security, privacy of and trust on the information are of utmost importance. Moreover, government legislation and ethics committees demand the security and privacy of healthcare data. Herein, in the light of precision health data security, privacy, ethical and regulatory requirements, finding the best methods and techniques for the utilization of the health data, and thus precision health is essential. In this regard, firstly, this paper explores the regulations, ethical guidelines around the world, and domain-specific needs. Then it presents the requirements and investigates the associated challenges. Secondly, this paper investigates secure and privacy-preserving machine learning methods suitable for the computation of precision health data along with their usage in relevant health projects. Finally, it illustrates the best available techniques for precision health data security and privacy with a conceptual system model that enables compliance, ethics clearance, consent management, medical innovations, and developments in the health domain.
Shallow Convolution Neural Network (CNN) is a time-tested tool for the information extraction from cancer pathology reports. Shallow CNN performs competitively on this task to other deep learning models including BERT, which holds the state-of-the-art for many NLP tasks. The main insight behind this eccentric phenomenon is that the information extraction from cancer pathology reports require only a small number of domain-specific text segments to perform the task, thus making the most of the texts and contexts excessive for the task. Shallow CNN model is well-suited to identify these key short text segments from the labeled training set; however, the identified text segments remain obscure to humans. In this study, we fill this gap by developing a model reduction tool to make a reliable connection between CNN filters and relevant text segments by discarding the spurious connections. We reduce the complexity of shallow CNN representation by approximating it with a linear transformation of n-gram presence representation with a non-negativity and sparsity prior on the transformation weights to obtain an interpretable model. Our approach bridge the gap between the conventionally perceived trade-off boundary between accuracy on the one side and explainability on the other by model reduction.
Despite diverse efforts to mine various modalities of medical data, the conversations between physicians and patients at the time of care remain an untapped source of insights. In this paper, we leverage this data to extract structured information that might assist physicians with post-visit documentation in electronic health records, potentially lightening the clerical burden. In this exploratory study, we describe a new dataset consisting of conversation transcripts, post-visit summaries, corresponding supporting evidence (in the transcript), and structured labels. We focus on the tasks of recognizing relevant diagnoses and abnormalities in the review of organ systems (RoS). One methodological challenge is that the conversations are long (around 1500 words), making it difficult for modern deep-learning models to use them as input. To address this challenge, we extract noteworthy utterances---parts of the conversation likely to be cited as evidence supporting some summary sentence. We find that by first filtering for (predicted) noteworthy utterances, we can significantly boost predictive performance for recognizing both diagnoses and RoS abnormalities.
Clinical trials play important roles in drug development but often suffer from expensive, inaccurate and insufficient patient recruitment. The availability of massive electronic health records (EHR) data and trial eligibility criteria (EC) bring a new opportunity to data driven patient recruitment. One key task named patient-trial matching is to find qualified patients for clinical trials given structured EHR and unstructured EC text (both inclusion and exclusion criteria). How to match complex EC text with longitudinal patient EHRs? How to embed many-to-many relationships between patients and trials? How to explicitly handle the difference between inclusion and exclusion criteria? In this paper, we proposed CrOss-Modal PseudO-SiamEse network (COMPOSE) to address these challenges for patient-trial matching. One path of the network encodes EC using convolutional highway network. The other path processes EHR with multi-granularity memory network that encodes structured patient records into multiple levels based on medical ontology. Using the EC embedding as query, COMPOSE performs attentional record alignment and thus enables dynamic patient-trial matching. COMPOSE also introduces a composite loss term to maximize the similarity between patient records and inclusion criteria while minimize the similarity to the exclusion criteria. Experiment results show COMPOSE can reach 98.0% AUC on patient-criteria matching and 83.7% accuracy on patient-trial matching, which leads 24.3% improvement over the best baseline on real-world patient-trial matching tasks.
Healthcare professionals have long envisioned using the enormous processing powers of computers to discover new facts and medical knowledge locked inside electronic health records. These vast medical archives contain time-resolved information about medical visits, tests and procedures, as well as outcomes, which together form individual patient journeys. By assessing the similarities among these journeys, it is possible to uncover clusters of common disease trajectories with shared health outcomes. The assignment of patient journeys to specific clusters may in turn serve as the basis for personalized outcome prediction and treatment selection. This procedure is a non-trivial computational problem, as it requires the comparison of patient data with multi-dimensional and multi-modal features that are captured at different times and resolutions. In this review, we provide a comprehensive overview of the tools and methods that are used in patient similarity analysis with longitudinal data and discuss its potential for improving clinical decision making.
Increased availability of electronic health records (EHR) has enabled researchers to study various medical questions. Cohort selection for the hypothesis under investigation is one of the main consideration for EHR analysis. For uncommon diseases, cohorts extracted from EHRs contain very limited number of records - hampering the robustness of any analysis. Data augmentation methods have been successfully applied in other domains to address this issue mainly using simulated records. In this paper, we present ODVICE, a data augmentation framework that leverages the medical concept ontology to systematically augment records using a novel ontologically guided Monte-Carlo graph spanning algorithm. The tool allows end users to specify a small set of interactive controls to control the augmentation process. We analyze the importance of ODVICE by conducting studies on MIMIC-III dataset for two learning tasks. Our results demonstrate the predictive performance of ODVICE augmented cohorts, showing ~30% improvement in area under the curve (AUC) over the non-augmented dataset and other data augmentation strategies.