Diffusion models have recently emerged as a state-of-the-art approach for synthetic Electronic Health Record (EHR) generation, offering superior fidelity and diversity over traditional generative models. However, existing diffusion-based methods struggle with unique challenges: limited representation learning and modality utilization, where they fail to explicitly capture inter-modality dependencies and fine-grained code-level interactions, and constrained adaptability due to reliance on U-Net-based architectures, which are not well-suited for handling the heterogeneous and evolving nature of EHR data. Furthermore, current evaluation paradigms rely on either perplexity-based sequence modeling or global distributional measures, lacking robustness in assessing both intra-visit code relationships and inter-visit temporal patterns. To address these limitations, we propose MedDiTPro, a diffusion transformer-based framework that enhances multimodal EHR generation by integrating structured modality-aware guidance. Through a unified transformer for intra-visit representation learning, a modality-specific and datawise prompt learner, and a diffusion transformer with structured guidance, MedDiTPro achieves state-of-the-art performance in generating diverse and clinically meaningful synthetic records. Extensive experiments on publicly available datasets demonstrate that MedDiTPro achieves state-of-the-art fidelity, privacy preservation, and utility.

Geographic health disparities pose a pressing global challenge, particularly in underserved regions of low- and middle-income nations. Addressing this issue requires a collaborative approach to enhance healthcare quality, leveraging support from medically more developed areas. Federated learning emerges as a promising tool for this purpose. However, the scarcity of medical data and limited computation resources in underserved regions make collaborative training of powerful machine learning models challenging. Furthermore, there exists an asymmetrical reciprocity between underserved and developed regions. To overcome these challenges, we propose a novel cross-silo federated learning framework, named FedHelp, aimed at alleviating geographic health disparities and fortifying the diagnostic capabilities of underserved regions. Specifically, FedHelp leverages foundational model knowledge via one-time API access to guide the learning process of underserved small clients, addressing the challenge of insufficient data. Additionally, we introduce a novel asymmetric dual knowledge distillation module to manage the issue of asymmetric reciprocity, facilitating the exchange of necessary knowledge between developed large clients and underserved small clients. We validate the effectiveness and utility of FedHelp through extensive experiments on both medical image classification and segmentation tasks. The experimental results demonstrate significant performance improvement compared to state-of-the-art baselines, particularly benefiting clients in underserved regions.

Collaborative fairness is a crucial challenge in federated learning. However, existing approaches often overlook a practical yet complex form of heterogeneity: imbalanced covariate shift. We provide a theoretical analysis of this setting, which motivates the design of FedAKD (Federated Asynchronous Knowledge Distillation) - a simple yet effective approach that balances accurate prediction with collaborative fairness. FedAKD consists of client and server updates. In the client update, we introduce a novel asynchronous knowledge distillation strategy based on our preliminary analysis, which reveals that while correctly predicted samples exhibit similar feature distributions across clients, incorrectly predicted samples show significant variability. This suggests that imbalanced covariate shift primarily arises from misclassified samples. Leveraging this insight, our approach first applies traditional knowledge distillation to update client models while keeping the global model fixed. Next, we select the correctly predicted high-confidence samples and update the global model using these samples, while keeping the client models fixed. The server update simply aggregates all client models. We further provide a theoretical proof of FedAKD's convergence. Experimental results on both public datasets (FashionMNIST and CIFAR10) and a real-world Electronic Health Records (EHR) dataset demonstrate that FedAKD significantly improves collaborative fairness, enhances predictive accuracy, and fosters client participation, even under highly heterogeneous data distributions.

Synthesizing electronic health records (EHR) data has become a preferred strategy to address data scarcity, improve data quality, and model fairness in healthcare. However, existing approaches for EHR data generation predominantly rely on state-of-the-art generative techniques like generative adversarial networks, variational autoencoders, and language models. These methods typically replicate input visits, resulting in inadequate modeling of temporal dependencies between visits and overlooking the generation of time information, a crucial element in EHR data. Moreover, their ability to learn visit representations is limited due to simple linear mapping functions, thus compromising generation quality. To address these limitations, we propose a novel EHR data generation model called EHRPD. It is a diffusion-based model designed to predict the next visit based on the current one while also incorporating time interval estimation. To enhance generation quality and diversity, we introduce a novel time-aware visit embedding module and a pioneering predictive denoising diffusion probabilistic model (P-DDPM). Additionally, we devise a predictive U-Net (PU-Net) to optimize P-DDPM. We conduct experiments on two public datasets and evaluate EHRPD from fidelity, privacy, and utility perspectives. The experimental results demonstrate the efficacy and utility of the proposed EHRPD in addressing the aforementioned limitations and advancing EHR data generation.

The widespread adoption of Electronic Health Record (EHR) systems in healthcare institutes has generated vast amounts of medical data, offering significant opportunities for improving healthcare services through deep learning techniques. However, the complex and diverse modalities and feature structures in real-world EHR data pose great challenges for deep learning model design. To address the multi-modality challenge in EHR data, current approaches primarily rely on hand-crafted model architectures based on intuition and empirical experiences, leading to sub-optimal model architectures and limited performance. Therefore, to automate the process of model design for mining EHR data, we propose a novel neural architecture search (NAS) framework named AutoFM, which can automatically search for the optimal model architectures for encoding diverse input modalities and fusion strategies. We conduct thorough experiments on real-world multi-modal EHR data and prediction tasks, and the results demonstrate that our framework not only achieves significant performance improvement over existing state-of-the-art methods but also discovers meaningful network architectures effectively.

Health risk prediction aims to forecast the potential health risks that patients may face using their historical Electronic Health Records (EHR). Although several effective models have developed, data insufficiency is a key issue undermining their effectiveness. Various data generation and augmentation methods have been introduced to mitigate this issue by expanding the size of the training data set through learning underlying data distributions. However, the performance of these methods is often limited due to their task-unrelated design. To address these shortcomings, this paper introduces a novel, end-to-end diffusion-based risk prediction model, named MedDiffusion. It enhances risk prediction performance by creating synthetic patient data during training to enlarge sample space. Furthermore, MedDiffusion discerns hidden relationships between patient visits using a step-wise attention mechanism, enabling the model to automatically retain the most vital information for generating high-quality data. Experimental evaluation on four real-world medical datasets demonstrates that MedDiffusion outperforms 14 cutting-edge baselines in terms of PR-AUC, F1, and Cohen's Kappa. We also conduct ablation studies and benchmark our model against GAN-based alternatives to further validate the rationality and adaptability of our model design. Additionally, we analyze generated data to offer fresh insights into the model's interpretability. The source code is available via https://shorturl.at/aerT0.

Federated learning (FL) enables multiple clients to train models collaboratively without sharing local data, which has achieved promising results in different areas, including the Internet of Things (IoT). However, end IoT devices do not have abilities to automatically annotate their collected data, which leads to the label shortage issue at the client side. To collaboratively train an FL model, we can only use a small number of labeled data stored on the server. This is a new yet practical scenario in federated learning, i.e., labels-at-server semi-supervised federated learning (SemiFL). Although several SemiFL approaches have been proposed recently, none of them can focus on the personalization issue in their model design. IoT environments make SemiFL more challenging, as we need to take device computational constraints and communication cost into consideration simultaneously. To tackle these new challenges together, we propose a novel SemiFL framework named pFedKnow. pFedKnow generates lightweight personalized client models via neural network pruning techniques to reduce communication cost. Moreover, it incorporates pretrained large models as prior knowledge to guide the aggregation of personalized client models and further enhance the framework performance. Experiment results on both image and text datasets show that the proposed pFedKnow outperforms state-of-the-art baselines as well as reducing considerable communication cost. The source code of the proposed pFedKnow is available at https://github.com/JackqqWang/pfedknow/tree/master.

Health risk prediction is a challenge task that aims to predict whether patients would suffer from a certain disease/condition in the near future based on their historical EHR data. Although existing approaches can achieve better performance, none of them can deal with the noise existing in the EHR data explicitly. In this paper, we hypothesize that automatically removing noise from EHR data should help the models further improve the performance. Correspondingly, we propose a novel model named MedSkim, which is able to automatically rule out irrelevant visits and codes by effectively skimming through the EHR data. In particular, the proposed model has a code selection module that can directly make a skipping decision to each individual diagnosis codes and then remove the target-irrelevant ones. A backward probing RNN (BPRNN) is designed to reversely process the EHR data and provide a coarse grained representation learning for visits. Besides, a forward skipping RNN (FSRNN) is proposed to read the EHR in a preceding way and dynamically select important visits and codes based on the results of previous two modules. Finally, the risk prediction module uses the output hidden states from FSRNN for generating the final representation to make predictions. Additionally, we also design an extra regularization term based on the skip rate of the model and combine it with standard cross entropy loss to train the model in an end-to-end setting. Experimental results show that MedSkim achieves the best performance on three real-world datasets compared with the state-of-the-art baselines in terms of PR-AUC, F1 and Cohen’s Kappa. Moreover, the ablation study and case study confirm that the proposed MedSkim is reasonable and effective for removing noise from EHR data1.1The source code of the proposed MedSkim is available at https://github.com/SH-Src/MedSkim

Federated Learning has shown great potentials for the distributed data utilization and privacy protection. Most existing federated learning approaches focus on the supervised setting, which means all the data stored in each client has labels. However, in real-world applications, the client data are impossible to be fully labeled. Thus, how to exploit the unlabeled data should be a new challenge for federated learning. Although a few studies are attempting to overcome this challenge, they may suffer from information leakage or misleading information usage problems. To tackle these issues, in this paper, we propose a novel federated semi-supervised learning method named FedTriNet, which consists of two learning phases. In the first phase, we pre-train FedTriNet using labeled data with FedAvg. In the second phase, we aim to make most of the unlabeled data to help model learning. In particular, we propose to use three networks and a dynamic quality control mechanism to generate high-quality pseudo labels for unlabeled data, which are added to the training set. Finally, FedTriNet uses the new training set to retrain the model. Experimental results on three publicly available datasets show that the proposed FedTriNet outperforms state-of-the-art baselines under both IID and Non-IID settings.