Recent Advances in Predictive Modeling with Electronic Health Records

The development of electronic health records (EHR) systems has enabled the collection of a vast amount of digitized patient data. However, utilizing EHR data for predictive modeling presents several challenges due to its unique characteristics. With the advancements in machine learning techniques, deep learning has demonstrated its superiority in various applications, including healthcare. This survey systematically reviews recent advances in deep learning-based predictive models using EHR data. Specifically, we begin by introducing the background of EHR data and providing a mathematical definition of the predictive modeling task. We then categorize and summarize predictive deep models from multiple perspectives. Furthermore, we present benchmarks and toolkits relevant to predictive modeling in healthcare. Finally, we conclude this survey by discussing open challenges and suggesting promising directions for future research.

Automated Fusion of Multimodal Electronic Health Records for Better Medical Predictions

The widespread adoption of Electronic Health Record (EHR) systems in healthcare institutes has generated vast amounts of medical data, offering significant opportunities for improving healthcare services through deep learning techniques. However, the complex and diverse modalities and feature structures in real-world EHR data pose great challenges for deep learning model design. To address the multi-modality challenge in EHR data, current approaches primarily rely on hand-crafted model architectures based on intuition and empirical experiences, leading to sub-optimal model architectures and limited performance. Therefore, to automate the process of model design for mining EHR data, we propose a novel neural architecture search (NAS) framework named AutoFM, which can automatically search for the optimal model architectures for encoding diverse input modalities and fusion strategies. We conduct thorough experiments on real-world multi-modal EHR data and prediction tasks, and the results demonstrate that our framework not only achieves significant performance improvement over existing state-of-the-art methods but also discovers meaningful network architectures effectively.

Hierarchical Pretraining on Multimodal Electronic Health Records

Pretraining has proven to be a powerful technique in natural language processing (NLP), exhibiting remarkable success in various NLP downstream tasks. However, in the medical domain, existing pretrained models on electronic health records (EHR) fail to capture the hierarchical nature of EHR data, limiting their generalization capability across diverse downstream tasks using a single pretrained model. To tackle this challenge, this paper introduces a novel, general, and unified pretraining framework called MEDHMP, specifically designed for hierarchically multimodal EHR data. The effectiveness of the proposed MEDHMP is demonstrated through experimental results on eight downstream tasks spanning three levels. Comparisons against eighteen baselines further highlight the efficacy of our approach.

MedDiffusion: Boosting Health Risk Prediction via Diffusion-based Data Augmentation

Health risk prediction is one of the fundamental tasks under predictive modeling in the medical domain, which aims to forecast the potential health risks that patients may face in the future using their historical Electronic Health Records (EHR). Researchers have developed several risk prediction models to handle the unique challenges of EHR data, such as its sequential nature, high dimensionality, and inherent noise. These models have yielded impressive results. Nonetheless, a key issue undermining their effectiveness is data insufficiency. A variety of data generation and augmentation methods have been introduced to mitigate this issue by expanding the size of the training data set through the learning of underlying data distributions. However, the performance of these methods is often limited due to their task-unrelated design. To address these shortcomings, this paper introduces a novel, end-to-end diffusion-based risk prediction model, named MedDiffusion. It enhances risk prediction performance by creating synthetic patient data during training to enlarge sample space. Furthermore, MedDiffusion discerns hidden relationships between patient visits using a step-wise attention mechanism, enabling the model to automatically retain the most vital information for generating high-quality data. Experimental evaluation on four real-world medical datasets demonstrates that MedDiffusion outperforms 14 cutting-edge baselines in terms of PR-AUC, F1, and Cohen's Kappa. We also conduct ablation studies and benchmark our model against GAN-based alternatives to further validate the rationality and adaptability of our model design. Additionally, we analyze generated data to offer fresh insights into the model's interpretability.

Client-Level Differential Privacy via Adaptive Intermediary in Federated Medical Imaging

Despite recent progress in enhancing the privacy of federated learning (FL) via differential privacy (DP), the trade-off of DP between privacy protection and performance is still underexplored for real-world medical scenario. In this paper, we propose to optimize the trade-off under the context of client-level DP, which focuses on privacy during communications. However, FL for medical imaging involves typically much fewer participants (hospitals) than other domains (e.g., mobile devices), thus ensuring clients be differentially private is much more challenging. To tackle this problem, we propose an adaptive intermediary strategy to improve performance without harming privacy. Specifically, we theoretically find splitting clients into sub-clients, which serve as intermediaries between hospitals and the server, can mitigate the noises introduced by DP without harming privacy. Our proposed approach is empirically evaluated on both classification and segmentation tasks using two public datasets, and its effectiveness is demonstrated with significant performance improvements and comprehensive analytical studies. Code is available at: https://github.com/med-air/Client-DP-FL.

3DSAM-adapter: Holistic Adaptation of SAM from 2D to 3D for Promptable Medical Image Segmentation

Despite that the segment anything model (SAM) achieved impressive results on general-purpose semantic segmentation with strong generalization ability on daily images, its demonstrated performance on medical image segmentation is less precise and not stable, especially when dealing with tumor segmentation tasks that involve objects of small sizes, irregular shapes, and low contrast. Notably, the original SAM architecture is designed for 2D natural images, therefore would not be able to extract the 3D spatial information from volumetric medical data effectively. In this paper, we propose a novel adaptation method for transferring SAM from 2D to 3D for promptable medical image segmentation. Through a holistically designed scheme for architecture modification, we transfer the SAM to support volumetric inputs while retaining the majority of its pre-trained parameters for reuse. The fine-tuning process is conducted in a parameter-efficient manner, wherein most of the pre-trained parameters remain frozen, and only a few lightweight spatial adapters are introduced and tuned. Regardless of the domain gap between natural and medical data and the disparity in the spatial arrangement between 2D and 3D, the transformer trained on natural images can effectively capture the spatial patterns present in volumetric medical images with only lightweight adaptations. We conduct experiments on four open-source tumor segmentation datasets, and with a single click prompt, our model can outperform domain state-of-the-art medical image segmentation models on 3 out of 4 tasks, specifically by 8.25%, 29.87%, and 10.11% for kidney tumor, pancreas tumor, colon cancer segmentation, and achieve similar performance for liver tumor segmentation. We also compare our adaptation method with existing popular adapters, and observed significant performance improvement on most datasets.

On Fairness of Medical Image Classification with Multiple Sensitive Attributes via Learning Orthogonal Representations

Mitigating the discrimination of machine learning models has gained increasing attention in medical image analysis. However, rare works focus on fair treatments for patients with multiple sensitive demographic ones, which is a crucial yet challenging problem for real-world clinical applications. In this paper, we propose a novel method for fair representation learning with respect to multi-sensitive attributes. We pursue the independence between target and multi-sensitive representations by achieving orthogonality in the representation space. Concretely, we enforce the column space orthogonality by keeping target information on the complement of a low-rank sensitive space. Furthermore, in the row space, we encourage feature dimensions between target and sensitive representations to be orthogonal. The effectiveness of the proposed method is demonstrated with extensive experiments on the CheXpert dataset. To our best knowledge, this is the first work to mitigate unfairness with respect to multiple sensitive attributes in the field of medical imaging.

Analytical Shaping Method for Low-Thrust Rendezvous Trajectory Using Cubic Spline Functions

Preliminary mission design requires an efficient and accurate approximation to the low-thrust rendezvous trajectories, which might be generally three-dimensional and involve multiple revolutions. In this paper, a new shaping method using cubic spline functions is developed for the analytical approximation, which shows advantages in the optimality and computational efficiency. The rendezvous constraints on the boundary states and transfer time are all satisfied analytically, under the assumption that the boundary conditions and segment numbers of cubic spline functions are designated in advance. Two specific shapes are then formulated according to whether they have free optimization parameters. The shape without free parameters provides an efficient and robust estimation, while the other one allows a subsequent optimization for the satisfaction of additional constraints such as the constraint on the thrust magnitude. Applications of the proposed method in combination with the particle swarm optimization algorithm are discussed through two typical interplanetary rendezvous missions, that is, an inclined multi-revolution trajectory from the Earth to asteroid Dionysus and a multi-rendezvous trajectory of sample return. Simulation examples show that the proposed method is superior to existing methods in terms of providing good estimation for the global search and generating suitable initial guess for the subsequent trajectory optimization.

Time-based Sequence Model for Personalization and Recommendation Systems

In this paper we develop a novel recommendation model that explicitly incorporates time information. The model relies on an embedding layer and TSL attention-like mechanism with inner products in different vector spaces, that can be thought of as a modification of multi-headed attention. This mechanism allows the model to efficiently treat sequences of user behavior of different length. We study the properties of our state-of-the-art model on statistically designed data set. Also, we show that it outperforms more complex models with longer sequence length on the Taobao User Behavior dataset.