Integrating modern machine learning and clinical decision-making has great promise for mitigating healthcare's increasing cost and complexity. We introduce the Enhanced Transformer for Health Outcome Simulation (ETHOS), a novel application of the transformer deep-learning architecture for analyzing high-dimensional, heterogeneous, and episodic health data. ETHOS is trained using Patient Health Timelines (PHTs)-detailed, tokenized records of health events-to predict future health trajectories, leveraging a zero-shot learning approach. ETHOS represents a significant advancement in foundation model development for healthcare analytics, eliminating the need for labeled data and model fine-tuning. Its ability to simulate various treatment pathways and consider patient-specific factors positions ETHOS as a tool for care optimization and addressing biases in healthcare delivery. Future developments will expand ETHOS' capabilities to incorporate a wider range of data types and data sources. Our work demonstrates a pathway toward accelerated AI development and deployment in healthcare.
Intensive Care Units usually carry patients with a serious risk of mortality. Recent research has shown the ability of Machine Learning to indicate the patients' mortality risk and point physicians toward individuals with a heightened need for care. Nevertheless, healthcare data is often subject to privacy regulations and can therefore not be easily shared in order to build Centralized Machine Learning models that use the combined data of multiple hospitals. Federated Learning is a Machine Learning framework designed for data privacy that can be used to circumvent this problem. In this study, we evaluate the ability of deep Federated Learning to predict the risk of Intensive Care Unit mortality at an early stage. We compare the predictive performance of Federated, Centralized, and Local Machine Learning in terms of AUPRC, F1-score, and AUROC. Our results show that Federated Learning performs equally well as the centralized approach and is substantially better than the local approach, thus providing a viable solution for early Intensive Care Unit mortality prediction. In addition, we show that the prediction performance is higher when the patient history window is closer to discharge or death. Finally, we show that using the F1-score as an early stopping metric can stabilize and increase the performance of our approach for the task at hand.
The recent success of machine learning methods applied to time series collected from Intensive Care Units (ICU) exposes the lack of standardized machine learning benchmarks for developing and comparing such methods. While raw datasets, such as MIMIC-IV or eICU, can be freely accessed on Physionet, the choice of tasks and pre-processing is often chosen ad-hoc for each publication, limiting comparability across publications. In this work, we aim to improve this situation by providing a benchmark covering a large spectrum of ICU-related tasks. Using the HiRID dataset, we define multiple clinically relevant tasks in collaboration with clinicians. In addition, we provide a reproducible end-to-end pipeline to construct both data and labels. Finally, we provide an in-depth analysis of current state-of-the-art sequence modeling methods, highlighting some limitations of deep learning approaches for this type of data. With this benchmark, we hope to give the research community the possibility of a fair comparison of their work.
Imagine a patient in critical condition. What and when should be measured to forecast detrimental events, especially under the budget constraints? We answer this question by deep reinforcement learning (RL) that jointly minimizes the measurement cost and maximizes predictive gain, by scheduling strategically-timed measurements. We learn our policy to be dynamically dependent on the patient's health history. To scale our framework to exponentially large action space, we distribute our reward in a sequential setting that makes the learning easier. In our simulation, our policy outperforms heuristic-based scheduling with higher predictive gain and lower cost. In a real-world ICU mortality prediction task (MIMIC3), our policies reduce the total number of measurements by $31\%$ or improve predictive gain by a factor of $3$ as compared to physicians, under the off-policy policy evaluation.