Rajkomar Alvin, Oren Eyal, Chen Kai, Dai Andrew M, Hajaj Nissan, Hardt Michaela, Liu Peter J, Liu Xiaobing, Marcus Jake, Sun Mimi, Sundberg Patrik, Yee Hector, Zhang Kun, Zhang Yi, Flores Gerardo, Duggan Gavin E, Irvine Jamie, Le Quoc, Litsch Kurt, Mossin Alexander, Tansuwan Justin, Wang De, Wexler James, Wilson Jimbo, Ludwig Dana, Volchenboum Samuel L, Chou Katherine, Pearson Michael, Madabushi Srinivasan, Shah Nigam H, Butte Atul J, Howell Michael D, Cui Claire, Corrado Greg S, Dean Jeffrey
1Google Inc, Mountain View, CA USA.
2University of California, San Francisco, San Francisco, CA USA.
NPJ Digit Med. 2018 May 8;1:18. doi: 10.1038/s41746-018-0029-1. eCollection 2018.
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 US academic medical centers with 216,221 adult patients hospitalized for at least 24 h. 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 (area under the receiver operator curve [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 traditional, clinically-used predictive models in all cases. We believe that this approach can be used to create accurate and scalable predictions for a variety of clinical scenarios. In a case study of a particular prediction, we demonstrate that neural networks can be used to identify relevant information from the patient's chart.
NPJ Digit Med. 2018-5-8
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