Following the success of transformer-based methods across various machine learning applications, their adoption for healthcare predictive tasks using electronic health records (EHRs) has also expanded extensively. Similarly, graph-based methods have been shown to be very effective in capturing inherent graph-type relationships in EHRs, leading to improved downstream performance. Although integrating these two families of approaches seems like a natural next step, in practice, creating such a design is challenging and has not been done. This is partly due to known EHR problems, such as high sparsity, making extracting meaningful temporal representations of medical visits challenging. In this study, we propose GT-BEHRT, a new approach that leverages temporal visit embeddings extracted from a graph transformer and uses a BERT-based model to obtain more robust patient representations, especially on longer EHR sequences. The graph-based approach allows GT-BEHRT to implicitly capture the intrinsic graphical relationships between medical observations, while the BERT model extracts the temporal relationships between visits, loosely mimicking the clinicians' decision-making process. As part of our method, we also present a two-step pre-training strategy for learning better graphical and temporal representations. Our proposed method achieves state-of-the-art performance in a variety of standard medical predictive tasks, demonstrating the versatility of our approach.

Various types of machine learning techniques are available for analyzing electronic health records (EHRs). For predictive tasks, most existing methods either explicitly or implicitly divide these time-series datasets into predetermined observation and prediction windows. Patients have different lengths of medical history and the desired predictions (for purposes such as diagnosis or treatment) are required at different times in the future. In this paper, we propose a method that uses a sequence-to-sequence generator model to transfer an input sequence of EHR data to a sequence of user-defined target labels, providing the end-users with "flexible" observation and prediction windows to define. We use adversarial and semi-supervised approaches in our design, where the sequence-to-sequence model acts as a generator and a discriminator distinguishes between the actual (observed) and generated labels. We evaluate our models through an extensive series of experiments using two large EHR datasets from adult and pediatric populations. In an obesity predicting case study, we show that our model can achieve superior results in flexible-window prediction tasks, after being trained once and even with large missing rates on the input EHR data. Moreover, using a number of attention analysis experiments, we show that the proposed model can effectively learn more relevant features in different prediction tasks.

Machine learning algorithms have been widely used to capture the static and temporal patterns within electronic health records (EHRs). While many studies focus on the (primary) prevention of diseases, primordial prevention (preventing the factors that are known to increase the risk of a disease occurring) is still widely under-investigated. In this study, we propose a multi-target regression model leveraging transformers to learn the bidirectional representations of EHR data and predict the future values of 11 major modifiable risk factors of cardiovascular disease (CVD). Inspired by the proven results of pre-training in natural language processing studies, we apply the same principles on EHR data, dividing the training of our model into two phases: pre-training and fine-tuning. We use the fine-tuned transformer model in a "multi-target regression" theme. Following this theme, we combine the 11 disjoint prediction tasks by adding shared and target-specific layers to the model and jointly train the entire model. We evaluate the performance of our proposed method on a large publicly available EHR dataset. Through various experiments, we demonstrate that the proposed method obtains a significant improvement (12.6% MAE on average across all 11 different outputs) over the baselines.