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Learning to Adapt Dynamic Clinical Event Sequences with Residual Mixture of Experts

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Artificial Intelligence in Medicine (AIME 2022)

Abstract

Clinical event sequences in Electronic Health Records (EHRs) record detailed information about the patient condition and patient care as they occur in time. Recent years have witnessed increased interest of machine learning community in developing machine learning models solving different types of problems defined upon information in EHRs. More recently, neural sequential models, such as RNN and LSTM, became popular and widely applied models for representing patient sequence data and for predicting future events or outcomes based on such data. However, a single neural sequential model may not properly represent complex dynamics of all patients and the differences in their behaviors. In this work, we aim to alleviate this limitation by refining a one-fits-all model using a Mixture-of-Experts (MoE) architecture. The architecture consists of multiple (expert) RNN models covering patient sub-populations and refining the predictions of the base model. That is, instead of training expert RNN models from scratch we define them on the residual signal that attempts to model the differences from the population-wide model. The heterogeneity of various patient sequences is modeled through multiple experts that consist of RNN. Particularly, instead of directly training MoE from scratch, we augment MoE based on the prediction signal from pretrained base GRU model. With this way, the mixture of experts can provide flexible adaptation to the (limited) predictive power of the single base RNN model. We experiment with the newly proposed model on real-world EHRs data and the multivariate clinical event prediction task. We implement RNN using Gated Recurrent Units (GRU). We show 4.1% gain on AUPRC statistics compared to a single RNN prediction.

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References

  1. Bajor, J.M., Lasko, T.A.: Predicting medications from diagnostic codes with recurrent neural networks. In: ICLR (2017)

    Google Scholar 

  2. Cho, K., et al.: Learning phrase representations using RNN encoder-decoder for statistical machine translation. arXiv:1406.1078 (2014)

  3. Choi, E., et al.: Medical concept representation learning from electronic health records and its application on heart failure prediction. arXiv:1602.03686 (2016)

  4. Choi, E., et al.: RETAIN: an interpretable predictive model for healthcare using reverse time attention mechanism. In: Advances in NeurIPS (2016)

    Google Scholar 

  5. Choi, E., et al.: Using recurrent neural network models for early detection of heart failure onset. J. AMIA 24(2), 361–370 (2017)

    Google Scholar 

  6. Choi, Y., et al.: Learning low-dimensional representations of medical concepts. AMIA Summits Transl. Sci. Proc. 2016, 41 (2016)

    Google Scholar 

  7. Fojo, A.T., et al.: A precision medicine approach for psychiatric disease based on repeated symptom scores. J. Psychiatr. Res. 95, 147–155 (2017)

    Article  Google Scholar 

  8. Grave, E., et al.: Unbounded cache model for online language modeling with open vocabulary. In: Advances in NeurIPS, pp. 6042–6052 (2017)

    Google Scholar 

  9. Hauskrecht, M., Batal, I., Valko, M., Visweswaran, S., Cooper, G.F., Clermont, G.: Outlier detection for patient monitoring and alerting. J. Biomed. Inform. 46(1), 47–55 (2013)

    Article  Google Scholar 

  10. Hauskrecht, M., et al.: Outlier-based detection of unusual patient-management actions: an ICU study. J. Biomed. Inform. 64, 211–221 (2016)

    Article  Google Scholar 

  11. Henry, K.E., Hager, D.N., Pronovost, P.J., Saria, S.: A targeted real-time early warning score (trewscore) for septic shock. Sci. Transl. Med. (2015)

    Google Scholar 

  12. Huang, Z., et al.: Medical inpatient journey modeling and clustering: a Bayesian hidden Markov model based approach. In: AMIA, vol. 2015 (2015)

    Google Scholar 

  13. Huang, Z., et al.: Similarity measure between patient traces for clinical pathway analysis: problem, method, and applications. IEEE J-BHI 18, 4–14 (2013)

    Google Scholar 

  14. Jacobs, R.A., Jordan, M.I., Nowlan, S.J., Hinton, G.E.: Adaptive mixtures of local experts. Neural Comput. 3(1), 79–87 (1991)

    Article  Google Scholar 

  15. Johnson, A.E., et al.: MIMIC-III, a freely accessible critical care database. Sci. Data 3, 160035 (2016)

    Google Scholar 

  16. Kingma, D.P., Ba, J.: A method for stochastic optimization. arXiv:1412.6980 (2014)

  17. Krause, B., et al.: Dynamic evaluation of neural sequence models. In: International Conference on Machine Learning, pp. 2766–2775 (2018)

    Google Scholar 

  18. Lee, J.M., Hauskrecht, M.: Recent context-aware LSTM for clinical event time-series prediction. In: Riaño, D., Wilk, S., ten Teije, A. (eds.) AIME 2019. LNCS (LNAI), vol. 11526, pp. 13–23. Springer, Cham (2019). https://doi.org/10.1007/978-3-030-21642-9_3

    Chapter  Google Scholar 

  19. Lee, J.M., Hauskrecht, M.: Clinical event time-series modeling with periodic events. In: The 33rd International FLAIRS Conference (2020)

    Google Scholar 

  20. Lee, J.M., Hauskrecht, M.: Multi-scale temporal memory for clinical event time-series prediction. In: Michalowski, M., Moskovitch, R. (eds.) AIME 2020. LNCS (LNAI), vol. 12299, pp. 313–324. Springer, Cham (2020). https://doi.org/10.1007/978-3-030-59137-3_28

    Chapter  Google Scholar 

  21. Lee, J.M., Hauskrecht, M.: Modeling multivariate clinical event time-series with recurrent temporal mechanisms. Artif. Intell. Med. (2021)

    Google Scholar 

  22. Lee, J.M., Hauskrecht, M.: Neural clinical event sequence prediction through personalized online adaptive learning. In: Tucker, A., Henriques Abreu, P., Cardoso, J., Pereira Rodrigues, P., Riaño, D. (eds.) AIME 2021. LNCS (LNAI), vol. 12721, pp. 175–186. Springer, Cham (2021). https://doi.org/10.1007/978-3-030-77211-6_20

    Chapter  Google Scholar 

  23. Liu, S., Hauskrecht, M.: Nonparametric regressive point processes based on conditional Gaussian processes. In: Advances in NeurIPS (2019)

    Google Scholar 

  24. Liu, Z., Hauskrecht, M.: Learning adaptive forecasting models from irregularly sampled multivariate clinical data. In: The 30th AAAI Conference (2016)

    Google Scholar 

  25. Malakouti, S., Hauskrecht, M.: Hierarchical adaptive multi-task learning framework for patient diagnoses and diagnostic category classification. In: IEEE BIBM (2019)

    Google Scholar 

  26. Malakouti, S., Hauskrecht, M.: Predicting patient’s diagnoses and diagnostic categories from clinical-events in EHR data. In: Riaño, D., Wilk, S., ten Teije, A. (eds.) AIME 2019. LNCS (LNAI), vol. 11526, pp. 125–130. Springer, Cham (2019). https://doi.org/10.1007/978-3-030-21642-9_17

    Chapter  Google Scholar 

  27. Miotto, R., Li, L., Kidd, B.A., Dudley, J.T.: Deep patient: an unsupervised representation to predict the future of patients from the electronic health records. Sci. Rep. 6, 26094 (2016)

    Article  Google Scholar 

  28. Nguyen, P., Tran, T., Venkatesh, S.: Finding algebraic structure of care in time: a deep learning approach. arXiv abs/1711.07980 (2017)

    Google Scholar 

  29. Nguyen, P., et al.: Deepr: a convolutional net for medical records. IEEE J. Biomed. Health Inform. 21(1), 22–30 (2016)

    Article  Google Scholar 

  30. Pham, T., et al.: Predicting healthcare trajectories from medical records: a deep learning approach. J. Biomed. Inform. 69, 218–229 (2017)

    Article  Google Scholar 

  31. Saito, T., Rehmsmeier, M.: The precision-recall plot is more informative than ROC plot when evaluating binary classifiers on imbalanced datasets. PloS One (2015)

    Google Scholar 

  32. Visweswaran, S., Cooper, G.F.: Instance-specific Bayesian model averaging for classification. In: Advances in NeurIPS (2005)

    Google Scholar 

  33. Yu, K., et al.: Monitoring ICU mortality risk with a long short-term memory recurrent neural network. In: Pacific Symposium on Biocomputing. World Scientific (2020)

    Google Scholar 

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Correspondence to Jeong Min Lee .

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Appendix: Event-Specific Prediction Results (AURPC)

Appendix: Event-Specific Prediction Results (AURPC)

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Lee, J.M., Hauskrecht, M. (2022). Learning to Adapt Dynamic Clinical Event Sequences with Residual Mixture of Experts. In: Michalowski, M., Abidi, S.S.R., Abidi, S. (eds) Artificial Intelligence in Medicine. AIME 2022. Lecture Notes in Computer Science(), vol 13263. Springer, Cham. https://doi.org/10.1007/978-3-031-09342-5_15

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  • DOI: https://doi.org/10.1007/978-3-031-09342-5_15

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