Kejing Yin

Integrating multi-modal clinical data, such as electronic health records (EHR) and chest X-ray images (CXR), is particularly beneficial for clinical prediction tasks. However, in a temporal setting, multi-modal data are often inherently asynchronous. EHR can be continuously collected but CXR is generally taken with a much longer interval due to its high cost and radiation dose. When clinical prediction is needed, the last available CXR image might have been outdated, leading to suboptimal predictions. To address this challenge, we propose DDL-CXR, a method that dynamically generates an up-to-date latent representation of the individualized CXR images. Our approach leverages latent diffusion models for patient-specific generation strategically conditioned on a previous CXR image and EHR time series, providing information regarding anatomical structures and disease progressions, respectively. In this way, the interaction across modalities could be better captured by the latent CXR generation process, ultimately improving the prediction performance. Experiments using MIMIC datasets show that the proposed model could effectively address asynchronicity in multimodal fusion and consistently outperform existing methods.

The combination of electronic health records (EHR) and medical images is crucial for clinicians in making diagnoses and forecasting prognoses. Strategically fusing these two data modalities has great potential to improve the accuracy of machine learning models in clinical prediction tasks. However, the asynchronous and complementary nature of EHR and medical images presents unique challenges. Missing modalities due to clinical and administrative factors are inevitable in practice, and the significance of each data modality varies depending on the patient and the prediction target, resulting in inconsistent predictions and suboptimal model performance. To address these challenges, we propose DrFuse to achieve effective clinical multi-modal fusion. It tackles the missing modality issue by disentangling the features shared across modalities and those unique within each modality. Furthermore, we address the modal inconsistency issue via a disease-wise attention layer that produces the patient- and disease-wise weighting for each modality to make the final prediction. We validate the proposed method using real-world large-scale datasets, MIMIC-IV and MIMIC-CXR. Experimental results show that the proposed method significantly outperforms the state-of-the-art models.

The real-world Electronic Health Records (EHRs) present irregularities due to changes in the patient’s health status, resulting in various time intervals between observations and different physiological variables examined at each observation point. There have been recent applications of Transformer-based models in the field of irregular time series. However, the full attention mechanism in Transformer overly focuses on distant information, ignoring the short-term correlations of the condition. Thereby, the model is not able to capture localized changes or short-term fluctuations in patients’ conditions. Therefore, we propose a novel end-to-end Deformable Neighborhood Attention Transformer (DNA-T) for irregular medical time series. The DNA-T captures local features by dynamically adjusting the receptive field of attention and aggregating relevant deformable neighborhoods in irregular time series. Specifically, we design a Deformable Neighborhood Attention (DNA) module that enables the network to attend to relevant neighborhoods by drifting the receiving field of neighborhood attention. The DNA enhances the model’s sensitivity to local information and representation of local features, thereby capturing the correlation of localized changes in patients’ conditions. We conduct extensive experiments to validate the effectiveness of DNA-T, outperforming existing state-of-the-art methods in predicting the mortality risk of patients. Moreover, we visualize an example to validate the effectiveness of the proposed DNA. Our code is available at https://github.com/Nekumiya-x/DNA-T.

Predictive analysis of electronic health records (EHR) is a fundamental task that could provide actionable insights to help clinicians improve the efficiency and quality of care. EHR are commonly recorded in binary format and contain inevitable missing data. The nature of missingness may vary by patients, clinical features, and time, which incurs observation bias. It is essential to account for the binary missingness and observation bias or the predictive performance could be substantially compromised. In this paper, we develop a propensity-adjusted temporal network (PATNet) to conduct data imputation and predictive analysis simultaneously. PATNet contains three subnetworks: 1) an imputation subnetwork that generates the initial imputation based on historical observations, 2) a propensity subnetwork that infers the patient-, feature-, and time-dependent propensity scores, and 3) a prediction subnetwork that produces the missing-informative prediction using the propensity-adjusted imputations and the missing probabilities. To allow the propensity scores to be inferred from data, we use the expectation-maximization (EM) algorithm to learn the imputation and propensity subnetworks and incorporate a low-rank constraint via PARAFAC2 approximation. Extensive evaluation using the MIMIC-III and eICU datasets demonstrates that PATNet outperforms the state-of-the-art methods in terms of binary data imputation, disease progression modeling, and mortality prediction tasks.

Non-negative tensor factorization has been shown a practical solution to automatically discover phenotypes from the electronic health records (EHR) with minimal human supervision. Such methods generally require an input tensor describing the inter-modal interactions to be pre-established; however, the correspondence between different modalities (e.g., correspondence between medications and diagnoses) can often be missing in practice. Although heuristic methods can be applied to estimate them, they inevitably introduce errors, and leads to sub-optimal phenotype quality. This is particularly important for patients with complex health conditions (e.g., in critical care) as multiple diagnoses and medications are simultaneously present in the records. To alleviate this problem and discover phenotypes from EHR with unobserved inter-modal correspondence, we propose the collective hidden interaction tensor factorization (cHITF) to infer the correspondence between multiple modalities jointly with the phenotype discovery. We assume that the observed matrix for each modality is marginalization of the unobserved inter-modal correspondence, which are reconstructed by maximizing the likelihood of the observed matrices. Extensive experiments conducted on the real-world MIMIC-III dataset demonstrate that cHITF effectively infers clinically meaningful inter-modal correspondence, discovers phenotypes that are more clinically relevant and diverse, and achieves better predictive performance compared with a number of state-of-the-art computational phenotyping models.