With the widespread of machine learning models for healthcare applications, there is increased interest in building applications for personalized medicine. Despite the plethora of proposed research for personalized medicine, very few focus on representing missingness and learning from the missingness patterns in time-series Electronic Health Records (EHR) data. The lack of focus on missingness representation in an individualized way limits the full utilization of machine learning applications towards true personalization. In this brief communication, we highlight new insights into patterns of missingness with real-world examples and implications of missingness in EHRs. The insights in this work aim to bridge the gap between theoretical assumptions and practical observations in real-world EHRs. We hope this work will open new doors for exploring directions for better representation in predictive modelling for true personalization.
The burden of diseases is rising worldwide, with unequal treatment efficacy for patient populations that are underrepresented in clinical trials. Healthcare, however, is driven by the average population effect of medical treatments and, therefore, operates in a "one-size-fits-all" approach, not necessarily what best fits each patient. These facts suggest a pressing need for methodologies to study individualized treatment effects (ITE) to drive personalized treatment. Despite the increased interest in machine-learning-driven ITE estimation models, the vast majority focus on tabular data with limited review and understanding of methodologies proposed for time-series electronic health records (EHRs). To this end, this work provides an overview of ITE works for time-series data and insights into future research. The work summarizes the latest work in the literature and reviews it in light of theoretical assumptions, types of treatment settings, and computational frameworks. Furthermore, this work discusses challenges and future research directions for ITEs in a time-series setting. We hope this work opens new directions and serves as a resource for understanding one of the exciting yet under-studied research areas.
Electronic Health Records present a valuable modality for driving personalized medicine, where treatment is tailored to fit individual-level differences. For this purpose, many data-driven machine learning and statistical models rely on the wealth of longitudinal EHRs to study patients' physiological and treatment effects. However, longitudinal EHRs tend to be sparse and highly missing, where missingness could also be informative and reflect the underlying patient's health status. Therefore, the success of data-driven models for personalized medicine highly depends on how the EHR data is represented from physiological data, treatments, and the missing values in the data. To this end, we propose a novel deep-learning model that learns the underlying patient dynamics over time across multivariate data to generate personalized realistic values conditioning on an individual's demographic characteristics and treatments. Our proposed model, IGNITE (Individualized GeNeration of Imputations in Time-series Electronic health records), utilises a conditional dual-variational autoencoder augmented with dual-stage attention to generate missing values for an individual. In IGNITE, we further propose a novel individualized missingness mask (IMM), which helps our model generate values based on the individual's observed data and missingness patterns. We further extend the use of IGNITE from imputing missingness to a personalized data synthesizer, where it generates missing EHRs that were never observed prior or even generates new patients for various applications. We validate our model on three large publicly available datasets and show that IGNITE outperforms state-of-the-art approaches in missing data reconstruction and task prediction.
Survival analysis helps approximate underlying distributions of time-to-events which in the case of critical care like in the ICU can be a powerful tool for dynamic mortality risk prediction. Extending beyond the classical Cox model, deep learning techniques have been leveraged over the last years relaxing the many constraints of their counterparts from statistical methods. In this work, we propose a novel conditional variational autoencoder-based method called DySurv which uses a combination of static and time-series measurements from patient electronic health records in estimating risk of death dynamically in the ICU. DySurv has been tested on standard benchmarks where it outperforms most existing methods including other deep learning methods and we evaluate it on a real-world patient database from MIMIC-IV. The predictive capacity of DySurv is consistent and the survival estimates remain disentangled across different datasets supporting the idea that dynamic deep learning models based on conditional variational inference in multi-task cases can be robust models for survival analysis.
Semantic communications (SC) have been expected to be a new paradigm shifting to catalyze the next generation communication, whose main concerns shift from accurate bit transmission to effective semantic information exchange in communications. However, the previous and widely-used metrics for images are not applicable to evaluate the image semantic similarity in SC. Classical metrics to measure the similarity between two images usually rely on the pixel level or the structural level, such as the PSNR and the MS-SSIM. Straightforwardly using some tailored metrics based on deep-learning methods in CV community, such as the LPIPS, is infeasible for SC. To tackle this, inspired by BERTScore in NLP community, we propose a novel metric for evaluating image semantic similarity, named Vision Transformer Score (ViTScore). We prove theoretically that ViTScore has 3 important properties, including symmetry, boundedness, and normalization, which make ViTScore convenient and intuitive for image measurement. To evaluate the performance of ViTScore, we compare ViTScore with 3 typical metrics (PSNR, MS-SSIM, and LPIPS) through 5 classes of experiments. Experimental results demonstrate that ViTScore can better evaluate the image semantic similarity than the other 3 typical metrics, which indicates that ViTScore is an effective performance metric when deployed in SC scenarios.
Recent advancements in AI applications to healthcare have shown incredible promise in surpassing human performance in diagnosis and disease prognosis. With the increasing complexity of AI models, however, concerns regarding their opacity, potential biases, and the need for interpretability. To ensure trust and reliability in AI systems, especially in clinical risk prediction models, explainability becomes crucial. Explainability is usually referred to as an AI system's ability to provide a robust interpretation of its decision-making logic or the decisions themselves to human stakeholders. In clinical risk prediction, other aspects of explainability like fairness, bias, trust, and transparency also represent important concepts beyond just interpretability. In this review, we address the relationship between these concepts as they are often used together or interchangeably. This review also discusses recent progress in developing explainable models for clinical risk prediction, highlighting the importance of quantitative and clinical evaluation and validation across multiple common modalities in clinical practice. It emphasizes the need for external validation and the combination of diverse interpretability methods to enhance trust and fairness. Adopting rigorous testing, such as using synthetic datasets with known generative factors, can further improve the reliability of explainability methods. Open access and code-sharing resources are essential for transparency and reproducibility, enabling the growth and trustworthiness of explainable research. While challenges exist, an end-to-end approach to explainability in clinical risk prediction, incorporating stakeholders from clinicians to developers, is essential for success.
External validation is often recommended to ensure the generalizability of ML models. However, it neither guarantees generalizability nor equates to a model's clinical usefulness (the ultimate goal of any clinical decision-support tool). External validation is misaligned with current healthcare ML needs. First, patient data changes across time, geography, and facilities. These changes create significant volatility in the performance of a single fixed model (especially for deep learning models, which dominate clinical ML). Second, newer ML techniques, current market forces, and updated regulatory frameworks are enabling frequent updating and monitoring of individual deployed model instances. We submit that external validation is insufficient to establish ML models' safety or utility. Proposals to fix the external validation paradigm do not go far enough. Continued reliance on it as the ultimate test is likely to lead us astray. We propose the MLOps-inspired paradigm of recurring local validation as an alternative that ensures the validity of models while protecting against performance-disruptive data variability. This paradigm relies on site-specific reliability tests before every deployment, followed by regular and recurrent checks throughout the life cycle of the deployed algorithm. Initial and recurrent reliability tests protect against performance-disruptive distribution shifts, and concept drifts that jeopardize patient safety.
Heart attack remain one of the greatest contributors to mortality in the United States and globally. Patients admitted to the intensive care unit (ICU) with diagnosed heart attack (myocardial infarction or MI) are at higher risk of death. In this study, we use two retrospective cohorts extracted from the eICU and MIMIC-IV databases, to develop a novel pseudo-dynamic machine learning framework for mortality prediction in the ICU with interpretability and clinical risk analysis. The method provides accurate prediction for ICU patients up to 24 hours before the event and provide time-resolved interpretability results. The performance of the framework relying on extreme gradient boosting was evaluated on a held-out test set from eICU, and externally validated on the MIMIC-IV cohort using the most important features identified by time-resolved Shapley values achieving AUCs of 91.0 (balanced accuracy of 82.3) for 6-hour prediction of mortality respectively. We show that our framework successfully leverages time-series physiological measurements by translating them into stacked static prediction problems to be robustly predictive through time in the ICU stay and can offer clinical insight from time-resolved interpretability
Safeguarding personal information is paramount for healthcare data sharing, a challenging issue without any silver bullet thus far. We study the prospect of a recent deep-learning advent, dataset condensation (DC), in sharing healthcare data for AI research, and the results are promising. The condensed data abstracts original records and irreversibly conceals individual-level knowledge to achieve a bona fide de-identification, which permits free sharing. Moreover, the original deep-learning utilities are well preserved in the condensed data with compressed volume and accelerated model convergences. In PhysioNet-2012, a condensed dataset of 20 samples can orient deep models attaining 80.3% test AUC of mortality prediction (versus 85.8% of 5120 original records), an inspiring discovery generalised to MIMIC-III and Coswara datasets. We also interpret the inhere privacy protections of DC through theoretical analysis and empirical evidence. Dataset condensation opens a new gate to sharing healthcare data for AI research with multiple desirable traits.
The lack of data democratization and information leakage from trained models hinder the development and acceptance of robust deep learning-based healthcare solutions. This paper argues that irreversible data encoding can provide an effective solution to achieve data democratization without violating the privacy constraints imposed on healthcare data and clinical models. An ideal encoding framework transforms the data into a new space where it is imperceptible to a manual or computational inspection. However, encoded data should preserve the semantics of the original data such that deep learning models can be trained effectively. This paper hypothesizes the characteristics of the desired encoding framework and then exploits random projections and random quantum encoding to realize this framework for dense and longitudinal or time-series data. Experimental evaluation highlights that models trained on encoded time-series data effectively uphold the information bottleneck principle and hence, exhibit lesser information leakage from trained models.