The "Patient Instruction" (PI), which contains critical instructional information provided bothtocarers andtothepatient atthetimeofdischarge,isessential for the patient to manage their condition outside hospital.

Electronic healthcare records (EHR) contain a huge wealth of data that can support the prediction of clinical outcomes. EHR data is often stored and analysed using clinical codes (ICD10, SNOMED), however these can differ across registries and healthcare providers. Integrating data across systems involves mapping between different clinical ontologies requiring domain expertise, and at times resulting in data loss. To overcome this, code-agnostic models have been proposed. We assess the effectiveness of a code-agnostic representation approach on the task of long-term microvascular complication prediction for individuals living with Type 2 Diabetes. Our method encodes individual EHRs as text using fine-tuned, pretrained clinical language models. Leveraging large-scale EHR data from the UK, we employ a multi-label approach to simultaneously predict the risk of microvascular complications across 1-, 5-, and 10-year windows. We demonstrate that a code-agnostic approach outperforms a code-based model and illustrate that performance is better with longer prediction windows but is biased to the first occurring complication. Overall, we highlight that context length is vitally important for model performance. This study highlights the possibility of including data from across different clinical ontologies and is a starting point for generalisable clinical models.

Medication recommendation systems have gained significant attention in healthcare as a means of providing tailored and effective drug combinations based on patients' clinical information. However, existing approaches often suffer from fairness issues, as recommendations tend to be more accurate for patients with common diseases compared to those with rare conditions. In this paper, we propose a novel model called Robust and Accurate REcommendations for Medication (RAREMed), which leverages the pretrain-finetune learning paradigm to enhance accuracy for rare diseases. RAREMed employs a transformer encoder with a unified input sequence approach to capture complex relationships among disease and procedure codes. Additionally, it introduces two self-supervised pre-training tasks, namely Sequence Matching Prediction (SMP) and Self Reconstruction (SR), to learn specialized medication needs and interrelations among clinical codes. Experimental results on two real-world datasets demonstrate that RAREMed provides accurate drug sets for both rare and common disease patients, thereby mitigating unfairness in medication recommendation systems.

Availability of diagnostic codes in Electronic Health Records (EHRs) is crucial for patient care as well as reimbursement purposes. However, entering them in the EHR is tedious, and some clinical codes may be overlooked. Given an in-complete list of clinical codes, we investigate the performance of ML methods on predicting the complete ones, and assess the added predictive value of including other clinical patient data in this task. We used the MIMIC-III dataset and frame the task of completing the clinical codes as a recommendation problem. We con-sider various autoencoder approaches plus two strong baselines; item co-occurrence and Singular Value Decomposition (SVD). Inputs are 1) a record's known clinical codes, 2) the codes plus variables. The co-occurrence-based ap-proach performed slightly better (F1 score=0.26, Mean Average Precision [MAP]=0.19) than the SVD (F1=0.24, MAP=0.18). However, the adversarial autoencoder achieved the best performance when using the codes plus variables (F1=0.32, MAP=0.25). Adversarial autoencoders performed best in terms of F1 and were equal to vanilla and denoising autoencoders in term of MAP. Using clinical variables in addition to the incomplete codes list, improves the predictive performance of the models.

Early diagnosis of disease can lead to improved health outcomes, including higher survival rates and lower treatment costs. With the massive amount of information available in electronic health records (EHRs), there is great potential to use machine learning (ML) methods to model disease progression aimed at early prediction of disease onset and other outcomes. In this work, we employ recent innovations in neural ODEs combined with rich semantic embeddings of clinical codes to harness the full temporal information of EHRs. We propose ICE-NODE (Integration of Clinical Embeddings with Neural Ordinary Differential Equations), an architecture that temporally integrates embeddings of clinical codes and neural ODEs to learn and predict patient trajectories in EHRs. We apply our method to the publicly available MIMIC-III and MIMIC-IV datasets, and we find improved prediction results compared to state-of-the-art methods, specifically for clinical codes that are not frequently observed in EHRs. We also show that ICE-NODE is more competent at predicting certain medical conditions, like acute renal failure, pulmonary heart disease and birth-related problems, where the full temporal information could provide important information. Furthermore, ICE-NODE is also able to produce patient risk trajectories over time that can be exploited for further detailed predictions of disease evolution.

Complication risk profiling is a key challenge in the healthcare domain due to the complex interaction between heterogeneous entities (e.g., visit, disease, medication) in clinical data. With the availability of real-world clinical data such as electronic health records and insurance claims, many deep learning methods are proposed for complication risk profiling. However, these existing methods face two open challenges. First, data heterogeneity relates to those methods leveraging clinical data from a single view only while the data can be considered from multiple views (e.g., sequence of clinical visits, set of clinical features). Second, generalized prediction relates to most of those methods focusing on single-task learning, whereas each complication onset is predicted independently, leading to suboptimal models. We propose a multi-view multi-task network (MuViTaNet) for predicting the onset of multiple complications to tackle these issues. In particular, MuViTaNet complements patient representation by using a multi-view encoder to effectively extract information by considering clinical data as both sequences of clinical visits and sets of clinical features. In addition, it leverages additional information from both related labeled and unlabeled datasets to generate more generalized representations by using a new multi-task learning scheme for making more accurate predictions. The experimental results show that MuViTaNet outperforms existing methods for profiling the development of cardiac complications in breast cancer survivors. Furthermore, thanks to its multi-view multi-task architecture, MuViTaNet also provides an effective mechanism for interpreting its predictions in multiple perspectives, thereby helping clinicians discover the underlying mechanism triggering the onset and for making better clinical treatments in real-world scenarios.

--Effective representation learning of electronic health records is a challenging task and is becoming more important as the availability of such data is becoming pervasive. The data contained in these records are irregular and contain multiple modalities such as notes, and medical codes. They are preempted by medical conditions the patient may have, and are typically recorded by medical staff. Accompanying codes are notes containing valuable information about patients beyond the structured information contained in electronic health records. We use transformer networks and the recently proposed BERT language model to embed these data streams into a unified vector representation. The presented approach effectively encodes a patient's visit data into a single distributed representation, which can be used for downstream tasks. Our model demonstrates superior performance and generalization on mortality, readmission and length of stay tasks using the publicly available MIMIC-III ICU dataset. LECTRONIC health records (EHR) are commonly adopted in hospitals to improve patient care. In an intensive care unit (ICU), various data sources are collected on a daily basis as preempted by medical staff as the patient undergoes care in the unit. The collected data consists of data from different modalities: medical codes such as diagnosis which are standardized by well-organized ontology's like the International Classification of Disease (ICD) Additionally, lab tests and bedside monitoring devices are used to collect signals each of which are collected at varying frequencies for a quantitative measure of the patient care.

In rare disease physician targeting, a major challenge is how to identify physicians who are treating diagnosed or underdiagnosed rare diseases patients. Rare diseases have extremely low incidence rate. For a specified rare disease, only a small number of patients are affected and a fractional of physicians are involved. The existing targeting methodologies, such as segmentation and profiling, are developed under mass market assumption. They are not suitable for rare disease market where the target classes are extremely imbalanced. The authors propose a graphical model approach to predict targets by jointly modeling physician and patient features from different data spaces and utilizing the extra relational information. Through an empirical example with medical claim and prescription data, the proposed approach demonstrates better accuracy in finding target physicians. The graph representation also provides visual interpretability of relationship among physicians and patients. The model can be extended to incorporate more complex dependency structures. This article contributes to the literature of exploring the benefit of utilizing relational dependencies among entities in healthcare industry.