Balancing Interpretability and Flexibility in Modeling Diagnostic Trajectories with an Embedded Neural Hawkes Process Model

The Hawkes process (HP) is commonly used to model event sequences with self-reinforcing dynamics, including electronic health records (EHRs). Traditional HPs capture self-reinforcement via parametric impact functions that can be inspected to understand how each event modulates the intensity of others. Neural network-based HPs offer greater flexibility, resulting in improved fit and prediction performance, but at the cost of interpretability, which is often critical in healthcare. In this work, we aim to understand and improve upon this tradeoff. We propose a novel HP formulation in which impact functions are modeled by defining a flexible impact kernel, instantiated as a neural network, in event embedding space, which allows us to model large-scale event sequences with many event types. This approach is more flexible than traditional HPs yet more interpretable than other neural network approaches, and allows us to explicitly trade flexibility for interpretability by adding transformer encoder layers to further contextualize the event embeddings. Results show that our method accurately recovers impact functions in simulations, achieves competitive performance on MIMIC-IV procedure dataset, and gains clinically meaningful interpretation on XX-EHR with children diagnosis dataset even without transformer layers. This suggests that our flexible impact kernel is often sufficient to capture self-reinforcing dynamics in EHRs and other data effectively, implying that interpretability can be maintained without loss of performance.

Neural Conditional Event Time Models

Event time models predict occurrence times of an event of interest based on known features. Recent work has demonstrated that neural networks achieve state-of-the-art event time predictions in a variety of settings. However, standard event time models suppose that the event occurs, eventually, in all cases. Consequently, no distinction is made between a) the probability of event occurrence, and b) the predicted time of occurrence. This distinction is critical when predicting medical diagnoses, equipment defects, social media posts, and other events that or may not occur, and for which the features affecting a) may be different from those affecting b). In this work, we develop a conditional event time model that distinguishes between these components, implement it as a neural network with a binary stochastic layer representing finite event occurrence, and show how it may be learned from right-censored event times via maximum likelihood estimation. Results demonstrate superior event occurrence and event time predictions on synthetic data, medical events (MIMIC-III), and social media posts (Reddit), comprising 21 total prediction tasks.

Predicting Smoking Events with a Time-Varying Semi-Parametric Hawkes Process Model

Health risks from cigarette smoking -- the leading cause of preventable death in the United States -- can be substantially reduced by quitting. Although most smokers are motivated to quit, the majority of quit attempts fail. A number of studies have explored the role of self-reported symptoms, physiologic measurements, and environmental context on smoking risk, but less work has focused on the temporal dynamics of smoking events, including daily patterns and related nicotine effects. In this work, we examine these dynamics and improve risk prediction by modeling smoking as a self-triggering process, in which previous smoking events modify current risk. Specifically, we fit smoking events self-reported by 42 smokers to a time-varying semi-parametric Hawkes process (TV-SPHP) developed for this purpose. Results show that the TV-SPHP achieves superior prediction performance compared to related and existing models, with the incorporation of time-varying predictors having greatest benefit over longer prediction windows. Moreover, the impact function illustrates previously unknown temporal dynamics of smoking, with possible connections to nicotine metabolism to be explored in future work through a randomized study design. By more effectively predicting smoking events and exploring a self-triggering component of smoking risk, this work supports development of novel or improved cessation interventions that aim to reduce death from smoking.