Disease progression models are instrumental in predicting individual-level health trajectories and understanding disease dynamics. Existing models are capable of providing either accurate predictions of patients prognoses or clinically interpretable representations of disease pathophysiology, but not both. In this paper, we develop the phased attentive state space (PASS) model of disease progression, a deep probabilistic model that captures complex representations for disease progression while maintaining clinical interpretability. Unlike Markovian state space models which assume memoryless dynamics, PASS uses an attention mechanism to induce "memoryful" state transitions, whereby repeatedly updated attention weights are used to focus on past state realizations that best predict future states. This gives rise to complex, non-stationary state dynamics that remain interpretable through the generated attention weights, which designate the relationships between the realized state variables for individual patients. PASS uses phased LSTM units (with time gates controlled by parametrized oscillations) to generate the attention weights in continuous time, which enables handling irregularly-sampled and potentially missing medical observations. Experiments on data from a realworld cohort of patients show that PASS successfully balances the tradeoff between accuracy and interpretability: it demonstrates superior predictive accuracy and learns insightful individual-level representations of disease progression.
There have been various attempts to create interpretable RNN-based predictive models using attention. The models in @cite_27 and @cite_4 use the reverse-time attention mechanism to learn visit-level and variable-level attention weights that explain the prediction of a target label through measures of variable importance. The phased attention mechanism proposed in Section is a generalization of the reverse-time attention mechanism in @cite_27 that can operate in continuous-time, and update the attention weights at irregularly-spaced and potentially incomplete observations. The main difference between the way attention is used in PASS and the way it is used in models like @cite_27 can be summarized as follows. PASS applies attention to the latent state space , whereas applies attention to the observable sample space . Hence, the attention mechanism gives different types of explanations in the two models. In PASS, the phased attention mechanism interprets the hidden disease dynamics, and hence it provides an explanation for the mechanisms underlying disease progression. On the contrary, uses attention to measure feature importance, and hence it only explains predictions, but does not explain the disease progression mechanisms.
@cite_27 @cite_4
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Accuracy and interpretation are two goals of any successful predictive models. Most existing works have to suffer the tradeoff between the two by either picking complex black box models such as recurrent neural networks (RNN) or relying on less accurate traditional models with better interpretation such as logistic regression. To address this dilemma, we present REverse Time AttentIoN model (RETAIN) for analyzing Electronic Health Records (EHR) data that achieves high accuracy while remaining clinically interpretable. RETAIN is a two-level neural attention model that can find influential past visits and significant clinical variables within those visits (e.g,. key diagnoses). RETAIN mimics physician practice by attending the EHR data in a reverse time order so that more recent clinical visits will likely get higher attention. Experiments on a large real EHR dataset of 14 million visits from 263K patients over 8 years confirmed the comparable predictive accuracy and computational scalability to the state-of-the-art methods such as RNN. Finally, we demonstrate the clinical interpretation with concrete examples from RETAIN. The dominant sequence transduction models are based on complex recurrent or convolutional neural networks in an encoder-decoder configuration. The best performing models also connect the encoder and decoder through an attention mechanism. We propose a new simple network architecture, the Transformer, based solely on attention mechanisms, dispensing with recurrence and convolutions entirely. Experiments on two machine translation tasks show these models to be superior in quality while being more parallelizable and requiring significantly less time to train. Our model achieves 28.4 BLEU on the WMT 2014 English-to-German translation task, improving over the existing best results, including ensembles by over 2 BLEU. On the WMT 2014 English-to-French translation task, our model establishes a new single-model state-of-the-art BLEU score of 41.8 after training for 3.5 days on eight GPUs, a small fraction of the training costs of the best models from the literature. We show that the Transformer generalizes well to other tasks by applying it successfully to English constituency parsing both with large and limited training data.