title: Incorporating temporal EHR data in predictive models for risk stratification of renal function deterioration.
abstract: Predictive models built using temporal data in electronic health records (EHRs) can potentially play a major role in improving management of chronic diseases. However, these data present a multitude of technical challenges, including irregular sampling of data and varying length of available patient history. In this paper, we describe and evaluate three different approaches that use machine learning to build predictive models using temporal EHR data of a patient. The first approach is a commonly used non-temporal approach that aggregates values of the predictors in the patient's medical history. The other two approaches exploit the temporal dynamics of the data. The two temporal approaches vary in how they model temporal information and handle missing data. Using data from the EHR of Mount Sinai Medical Center, we learned and evaluated the models in the context of predicting loss of estimated glomerular filtration rate (eGFR), the most common assessment of kidney function. Our results show that incorporating temporal information in patient's medical history can lead to better prediction of loss of kidney function. They also demonstrate that exactly how this information is incorporated is important. In particular, our results demonstrate that the relative importance of different predictors varies over time, and that using multi-task learning to account for this is an appropriate way to robustly capture the temporal dynamics in EHR data. Using a case study, we also demonstrate how the multi-task learning based model can yield predictive models with better performance for identifying patients at high risk of short-term loss of kidney function.
authors.affiliation: Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA. Electronic address: anima@mit.edu.
authors.forename: Anima
authors.initials: A
authors.lastname: Singh
authors.affiliation: The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
authors.forename: Girish
authors.initials: G
authors.lastname: Nadkarni
authors.affiliation: The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
authors.forename: Omri
authors.initials: O
authors.lastname: Gottesman
authors.affiliation: The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Ellis
authors.affiliation: The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA. Electronic address: erwin.bottinger@mssm.edu.
authors.forename: Erwin P
authors.initials: EP
authors.lastname: Bottinger
authors.affiliation: Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA.
authors.forename: John V
authors.initials: JV
authors.lastname: Guttag
mesh_terms: D000465:Algorithms; D019540:Area Under Curve; D018450:Disease Progression; D057286:Electronic Health Records; D005919:Glomerular Filtration Rate; D006761:Hospitals; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000175:diagnosis* / Q000503:physiopathology*; D000069550:Machine Learning; D008490:Medical Informatics / Q000379:methods; D015233:Models, Statistical; D009519:New York City; D012306:Risk; D012984:Software; D013997:Time Factors
keywords: Electronic health records; Progression of kidney function loss; Risk stratification; Temporal analysis