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Scalable and accurate deep learning for electronic health records

Alvin Rishi Rajkomar
Eyal Oren
Kai Chen
Nissan Hajaj
Mila Hardt
Xiaobing Liu
Jake Marcus
Patrik Per Sundberg
Kun Zhang
Yi Zhang
Gerardo Flores
Gavin Duggan
Jamie Irvine
Kurt Litsch
Alex Mossin
Justin Jesada Tansuwan
De Wang
Dana Ludwig
Samuel Volchenboum
Kat Chou
Michael Pearson
Srinivasan Madabushi
Nigam Shah
Atul Butte
npj Digital Medicine (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 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.

Research Areas