Chronic Kidney Disease (CKD) affects nearly 10\% of the global population and often progresses to end-stage renal failure. Accurate prognosis prediction is vital for timely interventions and resource optimization. We present a transformer-based framework for predicting CKD progression using multi-modal electronic health records (EHR) from the Seoul National University Hospital OMOP Common Data Model. Our approach (\textbf{ProQ-BERT}) integrates demographic, clinical, and laboratory data, employing quantization-based tokenization for continuous lab values and attention mechanisms for interpretability. The model was pretrained with masked language modeling and fine-tuned for binary classification tasks predicting progression from stage 3a to stage 5 across varying follow-up and assessment periods. Evaluated on a cohort of 91,816 patients, our model consistently outperformed CEHR-BERT, achieving ROC-AUC up to 0.995 and PR-AUC up to 0.989 for short-term prediction. These results highlight the effectiveness of transformer architectures and temporal design choices in clinical prognosis modeling, offering a promising direction for personalized CKD care.

Realizing personalized medicine at scale calls for methods that distill insights from longitudinal patient journeys, which can be viewed as a sequence of medical events. Foundation models pretrained on large-scale medical event data represent a promising direction for scaling real-world evidence generation and generalizing to diverse downstream tasks. Using Epic Cosmos, a dataset with medical events from de-identified longitudinal health records for 16.3 billion encounters over 300 million unique patient records from 310 health systems, we introduce the Curiosity models, a family of decoder-only transformer models pretrained on 118 million patients representing 115 billion discrete medical events (151 billion tokens). We present the largest scaling-law study of medical event data, establishing a methodology for pretraining and revealing power-law scaling relationships for compute, tokens, and model size. Consequently, we pretrained a series of compute-optimal models with up to 1 billion parameters. Conditioned on a patient's real-world history, Curiosity autoregressively predicts the next medical event to simulate patient health timelines. We studied 78 real-world tasks, including diagnosis prediction, disease prognosis, and healthcare operations. Remarkably for a foundation model with generic pretraining and simulation-based inference, Curiosity generally outperformed or matched task-specific supervised models on these tasks, without requiring task-specific fine-tuning or few-shot examples. Curiosity's predictive power consistently improves as the model and pretraining scale. Our results show that Curiosity, a generative medical event foundation model, can effectively capture complex clinical dynamics, providing an extensible and generalizable framework to support clinical decision-making, streamline healthcare operations, and improve patient outcomes.

Electronic Health Records (EHR) have become a valuable resource for a wide range of predictive tasks in healthcare. However, existing approaches have largely focused on inter-visit event predictions, overlooking the importance of intra-visit nowcasting, which provides prompt clinical insights during an ongoing patient visit. To address this gap, we introduce the task of laboratory measurement prediction within a hospital visit. We study the laboratory data that, however, remained underexplored in previous work. We propose TRACE, a Transformer-based model designed for clinical event nowcasting by encoding patient trajectories. TRACE effectively handles long sequences and captures temporal dependencies through a novel timestamp embedding that integrates decay properties and periodic patterns of data. Additionally, we introduce a smoothed mask for denoising, improving the robustness of the model. Experiments on two large-scale electronic health record datasets demonstrate that the proposed model significantly outperforms previous methods, highlighting its potential for improving patient care through more accurate laboratory measurement nowcasting. The code is available at https://github.com/Amehi/TRACE.

KAIST, Republic of Korea Abstract Lab tests are fundamental for diagnosing diseases and monitoring patient conditions. However, frequent testing can be burdensome for patients, and test results may not always be immediately available. To address these challenges, we propose Lab Test Outcome Predictor (LabTOP), a unified model that predicts lab test outcomes by leveraging a language modeling approach on EHR data. Unlike conventional methods that estimate only a subset of lab tests or classify discrete value ranges, LabTOP performs continuous numerical predictions for a diverse range of lab items. We evaluate LabTOP on three publicly available EHR datasets and demonstrate that it outperforms existing methods, including traditional machine learning models and state-of-the-art large language models. We also conduct extensive ablation studies to confirm the effectiveness of our design choices. We believe that LabTOP will serve as an accurate and generalizable framework for lab test outcome prediction, with potential applications in clinical decision support and early detection of critical conditions. Data and Code Availability This paper uses the three EHR datasets, MIMIC-IV (Johnson et al., 2023), eICU (Pollard et al., 2018), and HiRID (Hy-land et al., 2020), which are publicly available on the PhysioNet repository (Johnson et al., 2020; Pollard et al., 2019; Faltys et al., 2021). More details about datasets can be found at Section 4.1. Our implementation code can be accessed at this repository. 1 Institutional Review Board (IRB) This research does not require IRB approval. These authors contributed equally 1. https://anonymous.4open.science/r/LabTOP-DE7B1. Introduction Electronic Health Records (EHR) are essential to modern healthcare systems, serving as comprehensive databases of patient data, including treatments, clinical interventions, and lab test results (Gunter and Terry, 2005). These records provide a longitudinal view of a patient's medical history, allowing for the tracking of individual health trends (Kruse et al., 2017).

Problem: How can we design patient cost prediction models that effectively address the challenges of heterogeneity in administrative claims (AC) data to ensure accurate, fair, and generalizable predictions, especially for high-need (HN) patients with complex chronic conditions? Relevance: Accurate and equitable patient cost predictions are vital for developing health management policies and optimizing resource allocation, which can lead to significant cost savings for healthcare payers, including government agencies and private insurers. Addressing disparities in prediction outcomes for HN patients ensures better economic and clinical decision-making, benefiting both patients and payers. Methodology: This study is grounded in socio-technical considerations that emphasize the interplay between technical systems (e.g., deep learning models) and humanistic outcomes (e.g., fairness in healthcare decisions). It incorporates representation learning and entropy measurement to address heterogeneity and complexity in data and patient profiles, particularly for HN patients. We propose a channel-wise deep learning framework that mitigates data heterogeneity by segmenting AC data into separate channels based on types of codes (e.g., diagnosis, procedures) and costs. This approach is paired with a flexible evaluation design that uses multi-channel entropy measurement to assess patient heterogeneity. Results: The proposed channel-wise models reduce prediction errors by 23% compared to single-channel models, leading to 16.4% and 19.3% reductions in overpayments and underpayments, respectively. Notably, the reduction in prediction bias is significantly higher for HN patients, demonstrating effectiveness in handling heterogeneity and complexity in data and patient profiles. This demonstrates the potential for applying channel-wise modeling to domains with similar heterogeneity challenges.

Medication Recommendation (MR) is a promising research topic which booms diverse applications in the healthcare and clinical domains. However, existing methods mainly rely on sequential modeling and static graphs for representation learning, which ignore the dynamic correlations in diverse medical events of a patient's temporal visits, leading to insufficient global structural exploration on nodes. Additionally, mitigating drug-drug interactions (DDIs) is another issue determining the utility of the MR systems. To address the challenges mentioned above, this paper proposes a novel MR method with the integration of dynamic networks and multi-view drug representations (DNMDR). Specifically, weighted snapshot sequences for dynamic heterogeneous networks are constructed based on discrete visits in temporal EHRs, and all the dynamic networks are jointly trained to gain both structural correlations in diverse medical events and temporal dependency in historical health conditions, for achieving comprehensive patient representations with both semantic features and structural relationships. Moreover, combining the drug co-occurrences and adverse drug-drug interactions (DDIs) in internal view of drug molecule structure and interactive view of drug pairs, the safe drug representations are available to obtain high-quality medication combination recommendation. Finally, extensive experiments on real world datasets are conducted for performance evaluation, and the experimental results demonstrate that the proposed DNMDR method outperforms the state-of-the-art baseline models with a large margin on various metrics such as PRAUC, Jaccard, DDI rates and so on.

With U.S. healthcare spending approaching $5T (NHE Fact Sheet 2024), and 25% of it estimated to be wasteful (Waste in the US the health care system: estimated costs and potential for savings, n.d.), the need to better predict risk and optimal patient care is evermore important. This paper introduces the Large Medical Model (LMM), a generative pre-trained transformer (GPT) designed to guide and predict the broad facets of patient care and healthcare administration. The model is trained on medical event sequences from over 140M longitudinal patient claims records with a specialized vocabulary built from medical terminology systems and demonstrates a superior capability to forecast healthcare costs and identify potential risk factors. Through experimentation and validation, we showcase the LMM's proficiency in not only in cost and risk predictions, but also in discerning intricate patterns within complex medical conditions and an ability to identify novel relationships in patient care. The LMM is able to improve both cost prediction by 14.1% over the best commercial models and chronic conditions prediction by 1.9% over the best transformer models in research predicting a broad set of conditions. The LMM is a substantial advancement in healthcare analytics, offering the potential to significantly enhance risk assessment, cost management, and personalized medicine.

Chest X-ray imaging (CXR) is an important diagnostic tool used in hospitals to assess patient conditions and monitor changes over time. Generative models, specifically diffusion-based models, have shown promise in generating realistic synthetic X-rays. However, these models mainly focus on conditional generation using single-time-point data, i.e., typically CXRs taken at a specific time with their corresponding reports, limiting their clinical utility, particularly for capturing temporal changes. To address this limitation, we propose a novel framework, EHRXDiff, which predicts future CXR images by integrating previous CXRs with subsequent medical events, e.g., prescriptions, lab measures, etc. Our framework dynamically tracks and predicts disease progression based on a latent diffusion model, conditioned on the previous CXR image and a history of medical events. We comprehensively evaluate the performance of our framework across three key aspects, including clinical consistency, demographic consistency, and visual realism. We demonstrate that our framework generates high-quality, realistic future images that capture potential temporal changes, suggesting its potential for further development as a clinical simulation tool. This could offer valuable insights for patient monitoring and treatment planning in the medical field.

Deep learning-based predictive models, leveraging Electronic Health Records (EHR), are receiving increasing attention in healthcare. An effective representation of a patient's EHR should hierarchically encompass both the temporal relationships between historical visits and medical events, and the inherent structural information within these elements. Existing patient representation methods can be roughly categorized into sequential representation and graphical representation. The sequential representation methods focus only on the temporal relationships among longitudinal visits. On the other hand, the graphical representation approaches, while adept at extracting the graph-structured relationships between various medical events, fall short in effectively integrate temporal information. To capture both types of information, we model a patient's EHR as a novel temporal heterogeneous graph. This graph includes historical visits nodes and medical events nodes. It propagates structured information from medical event nodes to visit nodes and utilizes time-aware visit nodes to capture changes in the patient's health status. Furthermore, we introduce a novel temporal graph transformer (TRANS) that integrates temporal edge features, global positional encoding, and local structural encoding into heterogeneous graph convolution, capturing both temporal and structural information. We validate the effectiveness of TRANS through extensive experiments on three real-world datasets. The results show that our proposed approach achieves state-of-the-art performance.

In clinical practice, one often needs to identify whether a patient is at high risk of adverse outcomes after some key medical event; for example, the short-term risk of death after an admission for heart failure. This task is challenging due to the complexity, variability, and heterogeneity of longitudinal medical data, especially for individuals suffering from chronic diseases like heart failure. In this paper, we introduce Event-Based Contrastive Learning (EBCL), a method for learning embeddings of heterogeneous patient data that preserves temporal information before and after key index events. We demonstrate that EBCL produces models that yield better fine-tuning performance on critical downstream tasks for a heart failure cohort, including 30-day readmission, 1-year mortality, and 1-week length of stay, relative to other pretraining methods. Our findings also reveal that EBCL pretraining alone can effectively cluster patients with similar mortality and readmission risks, offering valuable insights for clinical decision-making and personalized patient care.