Scalable and accurate deep learning for electronic health records
Authors: Alvin Rajkomar, Eyal Oren, Kai Chen, Andrew M. Dai, Nissan Hajaj, Peter J. Liu, Xiaobing Liu, Mimi Sun, Patrik Sundberg, Hector Yee, Kun Zhang, Gavin E. Duggan, Gerardo Flores, Michaela Hardt, Jamie Irvine, Quoc Le, Kurt Litsch, Jake Marcus, Alexander Mossin, Justin Tansuwan, De Wang, James Wexler, Jimbo Wilson, Dana Ludwig, Samuel L. Volchenboum, Katherine Chou, Michael Pearson, Srinivasan Madabushi, Nigam H. Shah, Atul J. Butte, Michael Howell, Claire Cui, Greg Corrado, Jeff Dean
AI-generated Key Points
- Electronic health record (EHR) data can revolutionize personalized medicine and improve healthcare quality
- Constructing predictive statistical models from normalized EHR data is labor-intensive and discards most of the information in each patient's record
- Researchers proposed a representation based on the Fast Healthcare Interoperability Resources (FHIR) format to address this issue
- This approach uses deep learning methods to accurately predict multiple medical events from multiple centers without site-specific data harmonization
- The researchers validated their approach using de-identified EHR data from two U.S. academic medical centers with 216,221 adult patients hospitalized for at least 24 hours
- The deep learning models achieved high accuracy for tasks such as predicting in-hospital mortality, 30-day unplanned readmission, prolonged length of stay, and all of a patient's final discharge diagnoses
- These models outperformed state-of-the-art traditional predictive models in all cases and offered transparency into the predictions through a case-study neural network attribution system that highlights evidence in the patient's chart and allows clinicians to gain insight into how predictions are made
- This approach has significant potential to create accurate and scalable predictions for various clinical scenarios while providing explanations directly linked to evidence in patients' charts - an essential step towards achieving personalized medicine and improving healthcare quality.
Abstract: Predictive modeling with electronic health record (EHR) data is anticipated to drive personalized medicine and improve healthcare quality. Constructing predictive statistical models typically requires extraction of curated predictor variables from normalized EHR data, a labor-intensive process that discards the vast majority of information in each patient's record. We propose a representation of patients' entire, raw EHR records based on the Fast Healthcare Interoperability Resources (FHIR) format. We demonstrate that deep learning methods using this representation are capable of accurately predicting multiple medical events from multiple centers without site-specific data harmonization. We validated our approach using de-identified EHR data from two U.S. academic medical centers with 216,221 adult patients hospitalized for at least 24 hours. In the sequential format we propose, this volume of EHR data unrolled into a total of 46,864,534,945 data points, including clinical notes. Deep learning models achieved high accuracy for tasks such as predicting in-hospital mortality (AUROC across sites 0.93-0.94), 30-day unplanned readmission (AUROC 0.75-0.76), prolonged length of stay (AUROC 0.85-0.86), and all of a patient's final discharge diagnoses (frequency-weighted AUROC 0.90). These models outperformed state-of-the-art traditional predictive models in all cases. We also present a case-study of a neural-network attribution system, which illustrates how clinicians can gain some transparency into the predictions. We believe that this approach can be used to create accurate and scalable predictions for a variety of clinical scenarios, complete with explanations that directly highlight evidence in the patient's chart.
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