Real-time prediction of clinical interventions remains a challenge within intensive care units (ICUs). This task is complicated by data sources that are noisy, sparse, heterogeneous and outcomes that are imbalanced. In this paper, we integrate data from all available ICU sources (vitals, labs, notes, demographics) and focus on learning rich representations of this data to predict onset and weaning of multiple invasive interventions. In particular, we compare both long short-term memory networks (LSTM) and convolutional neural networks (CNN) for prediction of five intervention tasks: invasive ventilation, non-invasive ventilation, vasopressors, colloid boluses, and crystalloid boluses. Our predictions are done in a forward-facing manner to enable "real-time" performance, and predictions are made with a six hour gap time to support clinically actionable planning. We achieve state-of-the-art results on our predictive tasks using deep architectures. We explore the use of feature occlusion to interpret LSTM models, and compare this to the interpretability gained from examining inputs that maximally activate CNN outputs. We show that our models are able to significantly outperform baselines in intervention prediction, and provide insight into model learning, which is crucial for the adoption of such models in practice.
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. Disparate areas of machine learning have benefited from models that can take raw data with little preprocessing as input and learn rich representations of that raw data in order to perform well on a given prediction task. We evaluate this approach in healthcare by using longitudinal measurements of lab tests, one of the more raw signals of a patient's health state widely available in clinical data, to predict disease onsets. In particular, we train a Long Short-Term Memory (LSTM) recurrent neural network and two novel convolutional neural networks for multi-task prediction of disease onset for 133 conditions based on 18 common lab tests measured over time in a cohort of 298K patients derived from 8 years of administrative claims data. We compare the neural networks to a logistic regression with several hand-engineered, clinically relevant features. We find that the representation-based learning approaches significantly outperform this baseline. We believe that our work suggests a new avenue for patient risk stratification based solely on lab results.