This study explores the creation of a machine learning model to automatically identify whether a Neonatal Intensive Care Unit (NICU) patient was diagnosed with neonatal jaundice during a particular hospitalization based on their associated clinical notes. We develop a number of techniques for text preprocessing and feature selection and compare the effectiveness of different classification models. We show that using ensemble decision tree classification, both with AdaBoost and with bagging, outperforms support vector machines (SVM), the current state-of-the-art technique for neonatal jaundice coding.
Given the importance and time-intensive nature of medical coding, many scientists have started developing techniques for automated coding @cite_3 . For most of these attempts, the task was narrow (i.e. attempting to predict a single ICD code or a small set of related codes) and utilized a relatively small dataset.
@cite_3
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This study proposes a methodology to support coding professionals in assigning ICD-9-CM codes to inpatient episodes. This subject has been predominantly addressed through the use of natural language processing methods, which show limited generalizability. To surpass this issue, this paper proposes a methodology entailing an adaptive data processing method based on structured electronic health record data, whereby raw clinical data is mapped into a feature set, and based on which supervised learning algorithms are trained. After applying a filter method for feature selection, support vector machine (SVM) classifiers are trained to obtain predictions for assigning codes to each episode. This approach is tested using a dataset of inpatient episodes from a department of Internal Medicine. Classifiers exhibited F1-measure values around 52 . Recall was generally higher than precision, which is considered valuable for coding support purposes. Analyzing results on an individual code basis sheds light on some key-issues regarding the use of structured electronic health record data in supporting clinical coding. Abstract Widespread use of medical information systems and explosive growth of medical databases require traditional manual data analysis to be coupled with methods for efficient computer-assisted analysis. This paper presents selected data mining techniques that can be applied in medicine, and in particular some machine learning techniques including the mechanisms that make them better suited for the analysis of medical databases (derivation of symbolic rules, use of background knowledge, sensitivity and specificity of induced descriptions). The importance of the interpretability of results of data analysis is discussed and illustrated on selected medical applications. Background and objective The volume of healthcare data is growing rapidly with the adoption of health information technology. We focus on automated ICD9 code assignment from discharge summary content and methods for evaluating such assignments. Methods We study ICD9 diagnosis codes and discharge summaries from the publicly available Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC II) repository. We experiment with two coding approaches: one that treats each ICD9 code independently of each other (flat classifier), and one that leverages the hierarchical nature of ICD9 codes into its modeling (hierarchy-based classifier). We propose novel evaluation metrics, which reflect the distances among gold-standard and predicted codes and their locations in the ICD9 tree. Experimental setup, code for modeling, and evaluation scripts are made available to the research community. Results The hierarchy-based classifier outperforms the flat classifier with F-measures of 39.5 and 27.6 , respectively, when trained on 20 533 documents and tested on 2282 documents. While recall is improved at the expense of precision, our novel evaluation metrics show a more refined assessment: for instance, the hierarchy-based classifier identifies the correct sub-tree of gold-standard codes more often than the flat classifier. Error analysis reveals that gold-standard codes are not perfect, and as such the recall and precision are likely underestimated. Conclusions Hierarchy-based classification yields better ICD9 coding than flat classification for MIMIC patients. Automated ICD9 coding is an example of a task for which data and tools can be shared and for which the research community can work together to build on shared models and advance the state of the art. Despite tremendous progress in computer vision, there has not been an attempt to apply machine learning on very large-scale medical image databases. We present an interleaved text image deep learning system to extract and mine the semantic interactions of radiology images and reports from a national research hospital's Picture Archiving and Communication System. With natural language processing, we mine a collection of ∼216K representative two-dimensional images selected by clinicians for diagnostic reference and match the images with their descriptions in an automated manner. We then employ a weakly supervised approach using all of our available data to build models for generating approximate interpretations of patient images. Finally, we demonstrate a more strictly supervised approach to detect the presence and absence of a number of frequent disease types, providing more specific interpretations of patient scans. A relatively small amount of data is used for this part, due to the challenge in gathering quality labels from large raw text data. Our work shows the feasibility of large-scale learning and prediction in electronic patient records available in most modern clinical institutions. It also demonstrates the trade-offs to consider in designing machine learning systems for analyzing large medical data. The World Health Organization is beginning to use Semantic Web technologies in the development of the 11th revision of the International Classification of Diseases (ICD-11). Health officials use ICD in all United Nations member countries to compile basic health statistics, to monitor health-related spending, and to inform policy makers. While previous revisions of ICD encoded minimal information about a disease, and were mainly published as books and tabulation lists, the creators of ICD-11 envision that it will become a multipurpose and coherent classification ready for electronic health records. Most important, they plan to have ICD-11 applied for a much broader variety of uses than previous revisions. The new requirements entail significant changes in the way we represent disease information, as well as in the technologies and processes that we use to acquire the new content. In this paper, we describe the previous processes and technologies used for developing ICD. We then describe the requirements for the new development process and present the SemanticWeb technologies that we use for ICD-11. We outline the experiences of the domain experts using the software system that we implemented using Semantic Web technologies. We then discuss the benefits and challenges in following this approach and conclude with lessons learned from this experience. Automated tissue characterization is one of the most crucial components of a computer aided diagnosis (CAD) system for interstitial lung diseases (ILDs). Although much research has been conducted in this field, the problem remains challenging. Deep learning techniques have recently achieved impressive results in a variety of computer vision problems, raising expectations that they might be applied in other domains, such as medical image analysis. In this paper, we propose and evaluate a convolutional neural network (CNN), designed for the classification of ILD patterns. The proposed network consists of 5 convolutional layers with 2 @math 2 kernels and LeakyReLU activations, followed by average pooling with size equal to the size of the final feature maps and three dense layers. The last dense layer has 7 outputs, equivalent to the classes considered: healthy, ground glass opacity (GGO), micronodules, consolidation, reticulation, honeycombing and a combination of GGO reticulation. To train and evaluate the CNN, we used a dataset of 14696 image patches, derived by 120 CT scans from different scanners and hospitals. To the best of our knowledge, this is the first deep CNN designed for the specific problem. A comparative analysis proved the effectiveness of the proposed CNN against previous methods in a challenging dataset. The classification performance ( @math ) demonstrated the potential of CNNs in analyzing lung patterns. Future work includes, extending the CNN to three-dimensional data provided by CT volume scans and integrating the proposed method into a CAD system that aims to provide differential diagnosis for ILDs as a supportive tool for radiologists. International Classification of Diseases(ICD) is an authoritative health care classification system of different diseases and conditions for clinical and management purposes. Considering the complicated and dedicated process to assign correct codes to each patient admission based on overall diagnosis, we propose a hierarchical deep learning model with attention mechanism which can automatically assign ICD diagnostic codes given written diagnosis. We utilize character-aware neural language models to generate hidden representations of written diagnosis descriptions and ICD codes, and design an attention mechanism to address the mismatch between the numbers of descriptions and corresponding codes. Our experimental results show the strong potential of automated ICD coding from diagnosis descriptions. Our best model achieves 0.53 and 0.90 of F1 score and area under curve of receiver operating characteristic respectively. The result outperforms those achieved using character-unaware encoding method or without attention mechanism. It indicates that our proposed deep learning model can code automatically in a reasonable way and provide a framework for computer-auxiliary ICD coding. There are two major challenges to overcome when developing a classifier to perform automatic disease diagnosis. First, the amount of labeled medical data is typically very limited, and a classifier cannot be effectively trained to attain high disease-detection accuracy. Second, medical domain knowledge is required to identify representative features in data for detecting a target disease. Most computer scientists and statisticians do not have such domain knowledge. In this work, we show that employing transfer learning can remedy both problems. We use Otitis Media (OM) to conduct our case study. Instead of using domain knowledge to extract features from labeled OM images, we construct features based on a dataset entirely OM-irrelevant. More specifically, we first learn a codebook in an unsupervised way from 15 million images collected from ImageNet. The codebook gives us what the encoders consider being the fundamental elements of those 15 million images. We then encode OM images using the codebook and obtain a weighting vector for each OM image. Using the resulting weighting vectors as the feature vectors of the OM images, we employ a traditional supervised learning algorithm to train an OM classifier. The achieved detection accuracy is 88.5 (89.63 in sensitivity and 86.9 in specificity), markedly higher than all previous attempts, which relied on domain experts to help extract features. Abstract Machine learning (ML) algorithms have made a tremendous impact in the field of medical imaging. While medical imaging datasets have been growing in size, a challenge for supervised ML algorithms that is frequently mentioned is the lack of annotated data. As a result, various methods that can learn with less other types of supervision, have been proposed. We give an overview of semi-supervised, multiple instance, and transfer learning in medical imaging, both in diagnosis or segmentation tasks. We also discuss connections between these learning scenarios, and opportunities for future research. A dataset with the details of the surveyed papers is available via https: figshare.com articles Database_of_surveyed_literature_in_Not-so-supervised_a_survey_of_semi-supervised_multi-instance_and_transfer_learning_in_medical_image_analysis_ 7479416 . Objective To summarize literature describing approaches aimed at automatically identifying patients with a common phenotype. @PARASPLIT Materials and methods We performed a review of studies describing systems or reporting techniques developed for identifying cohorts of patients with specific phenotypes. Every full text article published in (1) Journal of American Medical Informatics Association , (2) Journal of Biomedical Informatics , (3) Proceedings of the Annual American Medical Informatics Association Symposium , and (4) Proceedings of Clinical Research Informatics Conference within the past 3 years was assessed for inclusion in the review. Only articles using automated techniques were included. @PARASPLIT Results Ninety-seven articles met our inclusion criteria. Forty-six used natural language processing (NLP)-based techniques, 24 described rule-based systems, 41 used statistical analyses, data mining, or machine learning techniques, while 22 described hybrid systems. Nine articles described the architecture of large-scale systems developed for determining cohort eligibility of patients. @PARASPLIT Discussion We observe that there is a rise in the number of studies associated with cohort identification using electronic medical records. Statistical analyses or machine learning, followed by NLP techniques, are gaining popularity over the years in comparison with rule-based systems. @PARASPLIT Conclusions There are a variety of approaches for classifying patients into a particular phenotype. Different techniques and data sources are used, and good performance is reported on datasets at respective institutions. However, no system makes comprehensive use of electronic medical records addressing all of their known weaknesses. Abstract A multitude of information sources is present in the electronic health record (EHR), each of which can contain clues to automatically assign diagnosis and procedure codes. These sources however show information overlap and quality differences, which complicates the retrieval of these clues. Through feature selection, a denser representation with a consistent quality and less information overlap can be obtained. We introduce and compare coverage-based feature selection methods, based on confidence and information gain. These approaches were evaluated over a range of medical specialties, with seven different medical specialties for ICD-9-CM code prediction (six at the Antwerp University Hospital and one in the MIMIC-III dataset) and two different medical specialties for ICD-10-CM code prediction. Using confidence coverage to integrate all sources in an EHR shows a consistent improvement in F-measure (49.83 for diagnosis codes on average), both compared with the baseline (44.25 for diagnosis codes on average) and with using the best standalone source (44.41 for diagnosis codes on average). Confidence coverage creates a concise patient stay representation independent of a rigid framework such as UMLS, and contains easily interpretable features. Confidence coverage has several advantages to a baseline setup. In our baseline setup, feature selection was limited to a filter removing features with less than five total occurrences in the trainingset. Prediction results improved consistently when using multiple heterogeneous sources to predict clinical codes, while reducing the number of features and the processing time. Objective : Development of a general natural-language processor that identifies clinical information in narrative reports and maps that information into a structured representation containing clinical terms. @PARASPLIT Design : The natural-language processor provides three phases of processing, all of which are driven by different knowledge sources. The first phase performs the parsing. It identifies the structure of the text through use of a grammar that defines semantic patterns and a target form. The second phase, regularization, standardizes the terms in the initial target structure via a compositional mapping of multi-word phrases. The third phase, encoding, maps the terms to a controlled vocabulary. Radiology is the test domain for the processor and the target structure is a formal model for representing clinical information in that domain. @PARASPLIT Measurements : The impression sections of 230 radiology reports were encoded by the processor. Results of an automated query of the resultant database for the occurrences of four diseases were compared with the analysis of a panel of three physicians to determine recall and precision. @PARASPLIT Results : Without training specific to the four diseases, recall and precision of the system(combined effect of the processor and query generator) were 70 and 87 . Training of the query component increased recall to 85 without changing precision. Background: Electronic medical records (EMRs) are revolutionizing health-related research. One key issue for study quality is the accurate identification of patients with the condition of interest. Information in EMRs can be entered as structured codes or unstructured free text. The majority of research studies have used only coded parts of EMRs for case-detection, which may bias findings, miss cases, and reduce study quality. This review examines whether incorporating information from text into case-detection algorithms can improve research quality. Methods: A systematic search returned 9659 papers, 67 of which reported on the extraction of information from free text of EMRs with the stated purpose of detecting cases of a named clinical condition. Methods for extracting information from text and the technical accuracy of case-detection algorithms were reviewed. Results: Studies mainly used US hospital-based EMRs, and extracted information from text for 41 conditions using keyword searches, rule-based algorithms, and machine learning methods. There was no clear difference in case-detection algorithm accuracy between rule-based and machine learning methods of extraction. Inclusion of information from text resulted in a significant improvement in algorithm sensitivity and area under the receiver operating characteristic in comparison to codes alone (median sensitivity 78 (codes + text) vs 62 (codes), P = .03; median area under the receiver operating characteristic 95 (codes + text) vs 88 (codes), P = .025). Conclusions: Text in EMRs is accessible, especially with open source information extraction algorithms, and significantly improves case detection when combined with codes. More harmonization of reporting within EMR studies is needed, particularly standardized reporting of algorithm accuracy metrics like positive predictive value (precision) and sensitivity (recall). Background The Sixth Informatics for Integrating Biology and the Bedside (i2b2) Natural Language Processing Challenge for Clinical Records focused on the temporal relations in clinical narratives. The organizers provided the research community with a corpus of discharge summaries annotated with temporal information, to be used for the development and evaluation of temporal reasoning systems. 18 teams from around the world participated in the challenge. During the workshop, participating teams presented comprehensive reviews and analysis of their systems, and outlined future research directions suggested by the challenge contributions. @PARASPLIT Methods The challenge evaluated systems on the information extraction tasks that targeted: (1) clinically significant events, including both clinical concepts such as problems, tests, treatments, and clinical departments, and events relevant to the patient's clinical timeline, such as admissions, transfers between departments, etc; (2) temporal expressions, referring to the dates, times, durations, or frequencies phrases in the clinical text. The values of the extracted temporal expressions had to be normalized to an ISO specification standard; and (3) temporal relations, between the clinical events and temporal expressions. Participants determined pairs of events and temporal expressions that exhibited a temporal relation, and identified the temporal relation between them. @PARASPLIT Results For event detection, statistical machine learning (ML) methods consistently showed superior performance. While ML and rule based methods seemed to detect temporal expressions equally well, the best systems overwhelmingly adopted a rule based approach for value normalization. For temporal relation classification, the systems using hybrid approaches that combined ML and heuristics based methods produced the best results. With the latest developments in database technologies, it becomes easier to store the medical records of hospital patients from their first day of admission than was previously possible. In Intensive Care Units (ICU), modern medical information systems can record patient events in relational databases every second. Knowledge mining from these huge volumes of medical data is beneficial to both caregivers and patients. Given a set of electronic patient records, a system that effectively assigns the disease labels can facilitate medical database management and also benefit other researchers, e.g., pathologists. In this paper, we have proposed a framework to achieve that goal. Medical chart and note data of a patient are used to extract distinctive features. To encode patient features, we apply a Bag-of-Words encoding method for both chart and note data. We also propose a model that takes into account both global information and local correlations between diseases. Correlated diseases are characterized by a graph structure that is embedded in our sparsity-based framework. Our algorithm captures the disease relevance when labeling disease codes rather than making individual decision with respect to a specific disease. At the same time, the global optimal values are guaranteed by our proposed convex objective function. Extensive experiments have been conducted on a real-world large-scale ICU database. The evaluation results demonstrate that our method improves multi-label classification results by successfully incorporating disease correlations. Diagnosis prediction aims to predict the future health status of patients according to their historical visit records, which is an important yet challenging task in healthcare informatics. Existing diagnosis prediction approaches mainly employ recurrent neural networks (RNNs) with attention mechanisms to make predictions. However, these approaches ignore the importance of code descriptions, i.e., the medical definitions of diagnosis codes. We believe that taking diagnosis code descriptions into account can help the state-of-the-art models not only to learn meaningful code representations, but also to improve the predictive performance. Thus, in this paper, we propose a simple, but general diagnosis prediction framework, which includes two basic components: diagnosis code embedding and predictive model. To learn the interpretable code embeddings, we apply convolutional neural networks (CNNs) to model medical descriptions of diagnosis codes extracted from online medical websites. The learned medical embedding matrix is used to embed the input visits into vector representations, which are fed into the predictive models. Any existing diagnosis prediction approach (referred to as the base model) can be cast into the proposed framework as the predictive model (called the enhanced model). We conduct experiments on two real medical datasets: the MIMIC-III dataset and the Heart Failure claim dataset. Experimental results show that the enhanced diagnosis prediction approaches significantly improve the prediction performance. An extensive amount of information is currently available to clinical specialists, ranging from details of clinical symptoms to various types of biochemical data and outputs of imaging devices. Each type of data provides information that must be evaluated and assigned to a particular pathology during the diagnostic process. To streamline the diagnostic process in daily routine and avoid misdiagnosis, artificial intelligence methods (especially computer aided diagnosis and artificial neural networks) can be employed. These adaptive learning algorithms can handle diverse types of medical data and integrate them into categorized outputs. In this paper, we briefly review and discuss the philosophy, capabilities, and limitations of artificial neural networks in medical diagnosis through selected examples. Many machine learning and pattern classification methods have been applied to the diagnosis of Alzheimer’s disease (AD) and its prodromal stage, i.e., mild cognitive impairment (MCI). Recently, rather than predicting categorical variables as in classification, several pattern regression methods have also been used to estimate continuous clinical variables from brain images. However, most existing regression methods focus on estimating multiple clinical variables separately and thus cannot utilize the intrinsic useful correlation information among different clinical variables. On the other hand, in those regression methods, only a single modality of data (usually only the structural MRI) is often used, without considering the complementary information that can be provided by different modalities. In this paper, we propose a general methodology, namely Multi-Modal Multi-Task (M3T) learning, to jointly predict multiple variables from multi-modal data. Here, the variables include not only the clinical variables used for regression but also the categorical variable used for classification, with different tasks corresponding to prediction of different variables. Specifically, our method contains two key components, i.e., (1) a multi-task feature selection which selects the common subset of relevant features for multiple variables from each modality, and (2) a multi-modal support vector machine which fuses the above-selected features from all modalities to predict multiple (regression and classification) variables. To validate our method, we perform two sets of experiments on ADNI baseline MRI, FDG-PET, and cerebrospinal fluid (CSF) data from 45 AD patients, 91 MCI patients, and 50 healthy controls (HC). In the first set of experiments, we estimate two clinical variables such as Mini Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale - Cognitive Subscale (ADAS-Cog), as well as one categorical variable (with value of ‘AD’, ‘MCI’ or ‘HC’), from the baseline MRI, FDG-PET, and CSF data. In the second set of experiments, we predict the 2-year changes of MMSE and ADAS-Cog scores and also the conversion of MCI to AD from the baseline MRI, FDG-PET, and CSF data. The results on both sets of experiments demonstrate that our proposed M3T learning scheme can achieve better performance on both regression and classification tasks than the conventional learning methods. The monumental cost of health care, especially for chronic disease treatment, is quickly becoming unmanageable. This crisis has motivated the drive towards preventative medicine, where the primary concern is recognizing disease risk and taking action at the earliest signs. However, universal testing is neither time nor cost efficient. We propose CARE, a Collaborative Assessment and Recommendation Engine, which relies only on a patient's medical history using ICD-9-CM codes in order to predict future diseases risks. CARE uses collaborative filtering to predict each patient's greatest disease risks based on their own medical history and that of similar patients. We also describe an Iterative version, ICARE, which incorporates ensemble concepts for improved performance. These novel systems require no specialized information and provide predictions for medical conditions of all kinds in a single run. We present experimental results on a Medicare dataset, demonstrating that CARE and ICARE perform well at capturing future disease risks. Abstract To provide more sophisticated healthcare services, it is necessary to collect the precise information on a patient. One impressive area of study to obtain meaningful information is human activity recognition, which has proceeded through the use of supervised learning techniques in recent decades. Previous studies, however, have suffered from generating a training dataset and extending the number of activities to be recognized. In this paper, to find out a new approach that avoids these problems, we propose unsupervised learning methods for human activity recognition, with sensor data collected from smartphone sensors even when the number of activities is unknown. Experiment results show that the mixture of Gaussian exactly distinguishes those activities when the number of activities k is known, while hierarchical clustering or DBSCAN achieve above 90 accuracy by obtaining k based on Calinski–Harabasz index, or by choosing appropriate values for ɛ and MinPts when k is unknown. We believe that the results of our approach provide a way of automatically selecting an appropriate value of k at which the accuracy is maximized for activity recognition, without the generation of training datasets by hand.