Analyzing the health status of patients based on Electronic Health Records (EHR) is a fundamental research problem in medical informatics. The presence of extensive missing values in EHR makes it challenging for deep neural networks (DNNs) to directly model the patient's health status. Existing DNNs training protocols, including Impute-then-Regress Procedure and Jointly Optimizing of Impute-n-Regress Procedure, require the additional imputation models to reconstruction missing values. However, Impute-then-Regress Procedure introduces the risk of injecting imputed, non-real data into downstream clinical prediction tasks, resulting in power loss, biased estimation, and poorly performing models, while Jointly Optimizing of Impute-n-Regress Procedure is also difficult to generalize due to the complex optimization space and demanding data requirements. Inspired by the recent advanced literature of learnable prompt in the fields of NLP and CV, in this work, we rethought the necessity of the imputation model in downstream clinical tasks, and proposed Learnable Prompt as Pseudo-Imputation (PAI) as a new training protocol to assist EHR analysis. PAI no longer introduces any imputed data but constructs a learnable prompt to model the implicit preferences of the downstream model for missing values, resulting in a significant performance improvement for all state-of-the-arts EHR analysis models on four real-world datasets across two clinical prediction tasks. Further experimental analysis indicates that PAI exhibits higher robustness in situations of data insufficiency and high missing rates. More importantly, as a plug-and-play protocol, PAI can be easily integrated into any existing or even imperceptible future EHR analysis models. The code of this work is deployed publicly available at https://github.com/MrBlankness/PAI to help the research community reproduce the results and assist the EHR analysis tasks.

Recent studies have indicated that Large Language Models (LLMs) harbor an inherent understanding of truthfulness, yet often fail to consistently express it and generate false statements. This gap between ''knowing'' and ''telling'' poses a challenge for ensuring the truthfulness of generated content. Inspired by recent work on the practice of encoding human-interpretable concepts linearly within large language models, we treat truthfulness as a specially linearly encoded concept within LLMs, and introduce Adaptive Activation Steering (ACT), a tuning-free method that adaptively shifts LLM's activations in the ''truthful'' direction during inference. ACT addresses diverse categories of hallucinations by utilizing diverse truthfulness-related steering vectors and adjusting the steering intensity adaptively. Applied as an add-on across various models, ACT significantly improves truthfulness in LLaMA (↑142%), LLaMA2 (↑24%), Alpaca (↑36%), Vicuna (↑28%), LLaMA2-Chat (↑19%), and LLaMA3(↑34%). Furthermore, we verify ACT's scalability across larger models (13B, 33B, 65B), underscoring the adaptability of ACT to large-scale language models. Our code is available at https://github.com/tianlwang/ACT.

We introduce ColaCare, a framework that enhances Electronic Health Record (EHR) modeling through multi-agent collaboration driven by Large Language Models (LLMs). Our approach seamlessly integrates domain-specific expert models with LLMs to bridge the gap between structured EHR data and text-based reasoning. Inspired by the Multidisciplinary Team (MDT) approach used in clinical settings, ColaCare employs two types of agents: DoctorAgents and a MetaAgent, which collaboratively analyze patient data. Expert models process and generate predictions from numerical EHR data, while LLM agents produce reasoning references and decision-making reports within the MDT-driven collaborative consultation framework. The MetaAgent orchestrates the discussion, facilitating consultations and evidence-based debates among DoctorAgents, simulating diverse expertise in clinical decision-making. We additionally incorporate the Merck Manual of Diagnosis and Therapy (MSD) medical guideline within a retrieval-augmented generation (RAG) module for medical evidence support, addressing the challenge of knowledge currency. Extensive experiments conducted on three EHR datasets demonstrate ColaCare's superior performance in clinical mortality outcome and readmission prediction tasks, underscoring its potential to revolutionize clinical decision support systems and advance personalized precision medicine. All code, case studies and a questionnaire are available at the project website: https://colacare.netlify.app.

The integration of multimodal Electronic Health Records (EHR) data has significantly advanced clinical predictive capabilities. Existing models, which utilize clinical notes and multivariate time-series EHR data, often fall short of incorporating the necessary medical context for accurate clinical tasks, while previous approaches with knowledge graphs (KGs) primarily focus on structured knowledge extraction. In response, we propose EMERGE, a Retrieval-Augmented Generation (RAG) driven framework to enhance multimodal EHR predictive modeling. We extract entities from both time-series data and clinical notes by prompting Large Language Models (LLMs) and align them with professional PrimeKG, ensuring consistency. In addition to triplet relationships, we incorporate entities' definitions and descriptions for richer semantics. The extracted knowledge is then used to generate task-relevant summaries of patients' health statuses. Finally, we fuse the summary with other modalities using an adaptive multimodal fusion network with cross-attention. Extensive experiments on the MIMIC-III and MIMIC-IV datasets' in-hospital mortality and 30-day readmission tasks demonstrate the superior performance of the EMERGE framework over baseline models. Comprehensive ablation studies and analysis highlight the efficacy of each designed module and robustness to data sparsity. EMERGE contributes to refining the utilization of multimodal EHR data in healthcare, bridging the gap with nuanced medical contexts essential for informed clinical predictions. We have publicly released the code at https://github.com/yhzhu99/EMERGE.

Electronic Health Records (EHRs) provide valuable patient data but often suffer from sparsity issue, posing significant challenges in predictive modeling. Conventional imputation methods inadequately distinguish between real and imputed data, leading to potential inaccuracies of patient representations. To address these issues, we introduce PRISM, a framework that indirectly imputes data through prototype representations of similar patients, thus ensuring denser and more accurate embeddings. PRISM also includes a feature confidence learner module, which evaluates the reliability of each feature considering missing statuses. Additionally, it incorporates a new patient similarity metric that accounts for feature confidence, avoiding overreliance on imprecise imputed values. Our extensive experiments on the MIMIC-III, MIMIC-IV, PhysioNet Challenge 2012, eICU datasets demonstrate PRISM's superior performance in predicting in-hospital mortality and 30-day readmission tasks, showcasing its effectiveness in handling EHR data sparsity. For the sake of reproducibility and further research, we have publicly released the code at https://github.com/yhzhu99/PRISM.

KDD AIDSH 2024 aims to foster discussions and developments that push the boundaries of Artificial Intelligence (AI) and Data Science (DS) in healthcare, enhance diagnostic accuracy and promote human-centric approaches to healthcare, thus stimulating future interdisciplinary collaborations. This year's symposium will focus on expanding the application of AI/DS in healthcare/medicine and bridging existing gaps. The workshop invites submissions of full papers as well as work-in-progress on the application of AI/DS in healthcare. The workshop will feature three invited talks from eminent speakers, spanning academia, industry, and clinical researchers. In addition, selected papers will be invited to publish in Health Data Science, a Science Partner Journal. This summary provides a brief description of the half-day workshop to be held on August 26th, 2024. The webpage for the workshop can be found at https://aimel.ai/kdd2024aidsh.

Exploiting the correlations between medical features is essential to the success of healthcare data analysis. However, most existing methods are either suffering large estimation variance for data insufficiency or inflexible in terms of demanding task-specific medical knowledge. In this paper, we propose a novel patient health representation learning framework dubbedSAFARI.SAFARIlearns a compact representation by imposing a clinical-fact-inspired task-agnostic correlational sparsity prior to the correlations of medical feature pairs. Specifically, we learn the compact representation by solving the bi-level optimization problem, which involves solving the high-level inter-group correlations and the nested lower-level intra-group correlations. We leverage the Laplacian kernel as a robust metric for feature grouping and graph neural networks for solving the bi-level optimization problem following the optimal value reformulation paradigm. Experiments on five datasets of various inputs and tasks demonstrate the efficacy ofSAFARI. The discovered findings are also consistent with our insights and medical literature, which can provide valuable clinical explanations.

Multimodal electronic health record (EHR) data are widely used in clinical applications. Conventional methods usually assume that each sample (patient) is associated with the unified observed modalities, and all modalities are available for each sample. However, missing modality caused by various clinical and social reasons is a common issue in real-world clinical scenarios. Existing methods mostly rely on solving a generative model that learns a mapping from the latent space to the original input space, which is an unstable ill-posed inverse problem. To relieve the underdetermined system, we propose a model solving a direct problem, dubbed learning with Missing Modalities in Multimodal healthcare data (M3Care). M3Care is an end-to-end model compensating the missing information of the patients with missing modalities to perform clinical analysis. Instead of generating raw missing data, M3Care imputes the task-related information of the missing modalities in the latent space by the auxiliary information from each patient's similar neighbors, measured by a task-guided modality-adaptive similarity metric, and thence conducts the clinical tasks. The task-guided modality-adaptive similarity metric utilizes the uncensored modalities of the patient and the other patients who also have the same uncensored modalities to find similar patients. Experiments on real-world datasets show that M3Care outperforms the state-of-the-art baselines. Moreover, the findings discovered by M3Care are consistent with experts and medical knowledge, demonstrating the capability and the potential of providing useful insights and explanations.

Due to the characteristics of COVID-19, the epidemic develops rapidly and overwhelms health service systems worldwide. Many patients suffer from life-threatening systemic problems and need to be carefully monitored in ICUs. An intelligent prognosis can help physicians take an early intervention, prevent adverse outcomes, and optimize the medical resource allocation, which is urgently needed, especially in this ongoing global pandemic crisis. However, in the early stage of the epidemic outbreak, the data available for analysis is limited due to the lack of effective diagnostic mechanisms, the rarity of the cases, and privacy concerns. In this paper, we propose a distilled transfer learning framework, which leverages the existing publicly available online Electronic Medical Records to enhance the prognosis for inpatients with emerging infectious diseases. It learns to embed the COVID-19-related medical features based on massive existing EMR data. The transferred parameters are further trained to imitate the teacher model’s representation based on distillation, which embeds the health status more comprehensively on the source dataset. We conduct Length-of-Stay prediction experiments for patients in ICUs on real-world COVID-19 datasets. The experiment results indicate that our proposed model consistently outperforms competitive baseline methods. In order to further verify the scalability of o deal with different clinical tasks on different EMR datasets, we conduct an additional mortality prediction experiment on End-Stage Renal Disease datasets. The extensive experiments demonstrate that an benefit the prognosis for emerging pandemics and other diseases with limited EMR.