Foresight -- Deep Generative Modelling of Patient Timelines using Electronic Health Records

Electronic Health Records (EHRs) hold detailed longitudinal information about each patient's health status and general clinical history, a large portion of which is stored within the unstructured text. Temporal modelling of this medical history, which considers the sequence of events, can be used to forecast and simulate future events, estimate risk, suggest alternative diagnoses or forecast complications. While most prediction approaches use mainly structured data or a subset of single-domain forecasts and outcomes, we processed the entire free-text portion of EHRs for longitudinal modelling. We present Foresight, a novel GPT3-based pipeline that uses NER+L tools (i.e. MedCAT) to convert document text into structured, coded concepts, followed by providing probabilistic forecasts for future medical events such as disorders, medications, symptoms and interventions. Since large portions of EHR data are in text form, such an approach benefits from a granular and detailed view of a patient while introducing modest additional noise. On tests in two large UK hospitals (King's College Hospital, South London and Maudsley) and the US MIMIC-III dataset precision@10 of 0.80, 0.81 and 0.91 was achieved for forecasting the next biomedical concept. Foresight was also validated on 34 synthetic patient timelines by 5 clinicians and achieved relevancy of 97% for the top forecasted candidate disorder. Foresight can be easily trained and deployed locally as it only requires free-text data (as a minimum). As a generative model, it can simulate follow-on disorders, medications and interventions for as many steps as required. Foresight is a general-purpose model for biomedical concept modelling that can be used for real-world risk estimation, virtual trials and clinical research to study the progression of diseases, simulate interventions and counterfactuals, and for educational purposes.

Deployment of a Free-Text Analytics Platform at a UK National Health Service Research Hospital: CogStack at University College London Hospitals

As more healthcare organisations transition to using electronic health record (EHR) systems it is important for these organisations to maximise the secondary use of their data to support service improvement and clinical research. These organisations will find it challenging to have systems which can mine information from the unstructured data fields in the record (clinical notes, letters etc) and more practically have such systems interact with all of the hospitals data systems (legacy and current). To tackle this problem at University College London Hospitals, we have deployed an enhanced version of the CogStack platform; an information retrieval platform with natural language processing capabilities which we have configured to process the hospital's existing and legacy records. The platform has improved data ingestion capabilities as well as better tools for natural language processing. To date we have processed over 18 million records and the insights produced from CogStack have informed a number of clinical research use cases at the hospitals.