TASTE: Temporal and Static Tensor Factorization for Phenotyping Electronic Health Records

Identify and mitigate bias in electronic phenotyping: A comprehensive study from computational perspective

Electronic phenotyping is a fundamental task that identifies the special group of patients, which plays an important role in precision medicine in the era of digital health. Phenotyping provides real-world evidence for other related biomedical research and clinical tasks, e.g., disease diagnosis, drug development, and clinical trials, etc. With the development of electronic health records, the performance of electronic phenotyping has been significantly boosted by advanced machine learning techniques. In the healthcare domain, precision and fairness are both essential aspects that should be taken into consideration. However, most related efforts are put into designing phenotyping models with higher accuracy. Few attention is put on the fairness perspective of phenotyping. The neglection of bias in phenotyping leads to subgroups of patients being underrepresented which will further affect the following healthcare activities such as patient recruitment in clinical trials. In this work, we are motivated to bridge this gap through a comprehensive experimental study to identify the bias existing in electronic phenotyping models and evaluate the widely-used debiasing methods' performance on these models. We choose pneumonia and sepsis as our phenotyping target diseases. We benchmark 9 kinds of electronic phenotyping methods spanning from rule-based to data-driven methods. Meanwhile, we evaluate the performance of the 5 bias mitigation strategies covering pre-processing, in-processing, and post-processing. Through the extensive experiments, we summarize several insightful findings from the bias identified in the phenotyping and key points of the bias mitigation strategies in phenotyping.

Creating High-Quality Synthetic Health Data: Framework for Model Development and Validation

BACKGROUND

Electronic health records are a valuable source of patient information that must be properly deidentified before being shared with researchers. This process requires expertise and time. In addition, synthetic data have considerably reduced the restrictions on the use and sharing of real data, allowing researchers to access it more rapidly with far fewer privacy constraints. Therefore, there has been a growing interest in establishing a method to generate synthetic data that protects patients' privacy while properly reflecting the data.

OBJECTIVE

This study aims to develop and validate a model that generates valuable synthetic longitudinal health data while protecting the privacy of the patients whose data are collected.

METHODS

We investigated the best model for generating synthetic health data, with a focus on longitudinal observations. We developed a generative model that relies on the generalized canonical polyadic (GCP) tensor decomposition. This model also involves sampling from a latent factor matrix of GCP decomposition, which contains patient factors, using sequential decision trees, copula, and Hamiltonian Monte Carlo methods. We applied the proposed model to samples from the MIMIC-III (version 1.4) data set. Numerous analyses and experiments were conducted with different data structures and scenarios. We assessed the similarity between our synthetic data and the real data by conducting utility assessments. These assessments evaluate the structure and general patterns present in the data, such as dependency structure, descriptive statistics, and marginal distributions. Regarding privacy disclosure, our model preserves privacy by preventing the direct sharing of patient information and eliminating the one-to-one link between the observed and model tensor records. This was achieved by simulating and modeling a latent factor matrix of GCP decomposition associated with patients.

RESULTS

The findings show that our model is a promising method for generating synthetic longitudinal health data that is similar enough to real data. It can preserve the utility and privacy of the original data while also handling various data structures and scenarios. In certain experiments, all simulation methods used in the model produced the same high level of performance. Our model is also capable of addressing the challenge of sampling patients from electronic health records. This means that we can simulate a variety of patients in the synthetic data set, which may differ in number from the patients in the original data.

CONCLUSIONS

We have presented a generative model for producing synthetic longitudinal health data. The model is formulated by applying the GCP tensor decomposition. We have provided 3 approaches for the synthesis and simulation of a latent factor matrix following the process of factorization. In brief, we have reduced the challenge of synthesizing massive longitudinal health data to synthesizing a nonlongitudinal and significantly smaller data set.

Improving Diagnostics with Deep Forest Applied to Electronic Health Records

An electronic health record (EHR) is a vital high-dimensional part of medical concepts. Discovering implicit correlations in the information of this data set and the research and informative aspects can improve the treatment and management process. The challenge of concern is the data sources' limitations in finding a stable model to relate medical concepts and use these existing connections. This paper presents Patient Forest, a novel end-to-end approach for learning patient representations from tree-structured data for readmission and mortality prediction tasks. By leveraging statistical features, the proposed model is able to provide an accurate and reliable classifier for predicting readmission and mortality. Experiments on MIMIC-III and eICU datasets demonstrate Patient Forest outperforms existing machine learning models, especially when the training data are limited. Additionally, a qualitative evaluation of Patient Forest is conducted by visualising the learnt representations in 2D space using the t-SNE, which further confirms the effectiveness of the proposed model in learning EHR representations.

Deep learning for temporal data representation in electronic health records: A systematic review of challenges and methodologies

OBJECTIVE

Temporal electronic health records (EHRs) contain a wealth of information for secondary uses, such as clinical events prediction and chronic disease management. However, challenges exist for temporal data representation. We therefore sought to identify these challenges and evaluate novel methodologies for addressing them through a systematic examination of deep learning solutions.

METHODS

We searched five databases (PubMed, Embase, the Institute of Electrical and Electronics Engineers [IEEE] Xplore Digital Library, the Association for Computing Machinery [ACM] Digital Library, and Web of Science) complemented with hand-searching in several prestigious computer science conference proceedings. We sought articles that reported deep learning methodologies on temporal data representation in structured EHR data from January 1, 2010, to August 30, 2020. We summarized and analyzed the selected articles from three perspectives: nature of time series, methodology, and model implementation.

RESULTS

We included 98 articles related to temporal data representation using deep learning. Four major challenges were identified, including data irregularity, heterogeneity, sparsity, and model opacity. We then studied how deep learning techniques were applied to address these challenges. Finally, we discuss some open challenges arising from deep learning.

CONCLUSION

Temporal EHR data present several major challenges for clinical prediction modeling and data utilization. To some extent, current deep learning solutions can address these challenges. Future studies may consider designing comprehensive and integrated solutions. Moreover, researchers should incorporate clinical domain knowledge into study designs and enhance model interpretability to facilitate clinical implementation.

Pay Attention to Evolution: Time Series Forecasting with Deep Graph-Evolution Learning

Time-series forecasting is one of the most active research topics in artificial intelligence. A still open gap in that literature is that statistical and ensemble learning approaches systematically present lower predictive performance than deep learning methods. They generally disregard the data sequence aspect entangled with multivariate data represented in more than one time series. Conversely, this work presents a novel neural network architecture for time-series forecasting that combines the power of graph evolution with deep recurrent learning on distinct data distributions; we named our method Recurrent Graph Evolution Neural Network (ReGENN). The idea is to infer multiple multivariate relationships between co-occurring time-series by assuming that the temporal data depends not only on inner variables and intra-temporal relationships (i.e., observations from itself) but also on outer variables and inter-temporal relationships (i.e., observations from other-selves). An extensive set of experiments was conducted comparing ReGENN with dozens of ensemble methods and classical statistical ones, showing sound improvement of up to 64.87% over the competing algorithms. Furthermore, we present an analysis of the intermediate weights arising from ReGENN, showing that by looking at inter and intra-temporal relationships simultaneously, time-series forecasting is majorly improved if paying attention to how multiple multivariate data synchronously evolve.

LogPar: Logistic PARAFAC2 Factorization for Temporal Binary Data with Missing Values

Binary data with one-class missing values are ubiquitous in real-world applications. They can be represented by irregular tensors with varying sizes in one dimension, where value one means presence of a feature while zero means unknown (i.e., either presence or absence of a feature). Learning accurate low-rank approximations from such binary irregular tensors is a challenging task. However, none of the existing models developed for factorizing irregular tensors take the missing values into account, and they assume Gaussian distributions, resulting in a distribution mismatch when applied to binary data. In this paper, we propose Logistic PARAFAC2 (LogPar) by modeling the binary irregular tensor with Bernoulli distribution parameterized by an underlying real-valued tensor. Then we approximate the underlying tensor with a positive-unlabeled learning loss function to account for the missing values. We also incorporate uniqueness and temporal smoothness regularization to enhance the interpretability. Extensive experiments using large-scale real-world datasets show that LogPar outperforms all baselines in both irregular tensor completion and downstream predictive tasks. For the irregular tensor completion, LogPar achieves up to 26% relative improvement compared to the best baseline. Besides, LogPar obtains relative improvement of 13.2% for heart failure prediction and 14% for mortality prediction on average compared to the state-of-the-art PARAFAC2 models.