Evaluating the clinical similarities between pairwise patients is a fundamental problem in healthcare informatics. A proper patient similarity measure enables various downstream applications, such as cohort study and treatment comparative effectiveness research. One major carrier for conducting patient similarity research is Electronic Health Records(EHRs), which are usually heterogeneous, longitudinal, and sparse. Though existing studies on learning patient similarity from EHRs have shown being useful in solving real clinical problems, their applicability is limited due to the lack of medical interpretations. Moreover, most previous methods assume a vector-based representation for patients, which typically requires aggregation of medical events over a certain time period. As a consequence, temporal information will be lost. In this paper, we propose a patient similarity evaluation framework based on the temporal matching of longitudinal patient EHRs. Two efficient methods are presented, unsupervised and supervised, both of which preserve the temporal properties in EHRs. The supervised scheme takes a convolutional neural network architecture and learns an optimal representation of patient clinical records with medical concept embedding. The empirical results on real-world clinical data demonstrate substantial improvement over the baselines. We make our code and sample data available for further study.
In healthcare informatics domain, there are a lot of works focusing on patient similarity. For example, @cite_3 proposed a patient similarity algorithm named SimSvm that uses Support Vector Machine(SVM) to weight the similarity measures. @cite_6 proposed a patient similarity based disease prognosis strategy named SimProX. This model uses a Local Spline Regression (LSR) based method to embed these patient events into an intrinsic space, then measure the patient similarity by the Euclidean distance in the embedded space. These methods do not take the temporal information into consideration when evaluating patient similarities. Wang @cite_18 presented an One-Sided Convolutional Matrix Factorization for detection of temporal patterns. Cheng @cite_2 @cite_15 proposed an adjustable temporal fusion scheme using CNN-extracted features. Based on patients similarity, plenty of applications are enabled. In @cite_12 , Ng provided personalized predictive healthcare model by matching clinical similar patients with a locally supervised metric learning measure. @cite_21 proposed Integrated Method for Personalised Modelling (IMPM) to provide personalised treatment and personalised drug design.
@cite_18 @cite_21 @cite_6 @cite_3 @cite_2 @cite_15 @cite_12
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Identifying historical records of patients who are similar to the new patient could help to retrieve similar reference cases for predicting the clinical outcome of the new patient. Amongst different potential applications, this study illustrates use of patient similarity in predicting survival of patients suffering from hepatocellular carcinoma (HCC) treated with locoregional chemotherapy. This study used 14 similarity measures derived from relevant clinical and imaging parameters to classify the HCC patient pairs into two classes, namely the difference between their survival time being longer or no longer than 12 months. Furthermore, this paper proposes and presents a patient similarity algorithm for the classification, named SimSVM. With the 14 similarity measures as input, SimSVM outputs the predicted class and the degree of similarity or dissimilarity. A dataset was collected from 30 patients, forming 300 and 135 patient pairs as training and test datasets respectively. The trained SimSVM with linear kernel gave the best accuracy (66.7 ), sensitivity (64.8 ) and specificity (67.9 ) on the test dataset. Objective Build probabilistic topic model representations of hospital admissions processes and compare the ability of such models to predict clinical order patterns as compared to preconstructed order sets. @PARASPLIT Materials and Methods The authors evaluated the first 24 hours of structured electronic health record data for > 10 K inpatients. Drawing an analogy between structured items (e.g., clinical orders) to words in a text document, the authors performed latent Dirichlet allocation probabilistic topic modeling. These topic models use initial clinical information to predict clinical orders for a separate validation set of > 4 K patients. The authors evaluated these topic model-based predictions vs existing human-authored order sets by area under the receiver operating characteristic curve, precision, and recall for subsequent clinical orders. @PARASPLIT Results Existing order sets predict clinical orders used within 24 hours with area under the receiver operating characteristic curve 0.81, precision 16 , and recall 35 . This can be improved to 0.90, 24 , and 47 ( P < 10−20) by using probabilistic topic models to summarize clinical data into up to 32 topics. Many of these latent topics yield natural clinical interpretations (e.g., “critical care,” “pneumonia,” “neurologic evaluation”). @PARASPLIT Discussion Existing order sets tend to provide nonspecific, process-oriented aid, with usability limitations impairing more precise, patient-focused support. Algorithmic summarization has the potential to breach this usability barrier by automatically inferring patient context, but with potential tradeoffs in interpretability. @PARASPLIT Conclusion Probabilistic topic modeling provides an automated approach to detect thematic trends in patient care and generate decision support content. A potential use case finds related clinical orders for decision support. Domain specific (dis-)similarity or proximity measures used e.g. in alignment algorithms of sequence data are popular to analyze complicated data objects and to cover domain specific data properties. Without an underlying vector space these data are given as pairwise (dis-)similarities only. The few available methods for such data focus widely on similarities and do not scale to large datasets. Kernel methods are very effective for metric similarity matrices, also at large scale, but costly transformations are necessary starting with non-metric (dis-) similarities. We propose an integrative combination of Nystrom approximation, potential double centering and eigenvalue correction to obtain valid kernel matrices at linear costs in the number of samples. By the proposed approach effective kernel approaches become accessible. Experiments with several larger (dis-)similarity datasets show that the proposed method achieves much better runtime performance than the standard strategy while keeping competitive model accuracy. The main contribution is an efficient and accurate technique, to convert (potentially non-metric) large scale dissimilarity matrices into approximated positive semi-definite kernel matrices at linear costs. HighlightsWe propose a linear time and memory efficient approach for converting low rank dissimilarity matrices to similarity matrices and vice versa.Our approach is applicable for proximities obtained from non-metric proximity measures (indefinite kernels, non-standard dissimilarity measures).The presented approach also comprises a generalization of Landmark MDS - the presented approach is in general more accurate and flexible than Landmark MDS.We provide an alternative derivation of the Nystrom approximation together with a convergence proof, also for indefinite kernels not given in the workshop paper as a core element of the approach. 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.