Faculty Bibliography

Clinical interactions are initially recorded and documented in free text medical notes. ICD coding is the task of classifying and coding all diagnoses, symptoms and procedures associated with a patient's visit. The process is often manual and extremely time-consuming and expensive for hospitals. In this paper, we propose a machine learning model, BERT-XML, for large scale automated ICD coding from EHR notes, utilizing recently developed unsupervised pretraining that have achieved state of the art performance on a variety of NLP tasks. We train a BERT model from scratch on EHR notes, learning with vocabulary better suited for EHR tasks and thus outperform off-the-shelf models. We adapt the BERT architecture for ICD coding with multi-label attention. While other works focus on small public medical datasets, we have produced the first large scale ICD-10 classification model using millions of EHR notes to predict thousands of unique ICD codes

The COVID-19 pandemic has challenged front-line clinical decision-making, leading to numerous published prognostic tools. However, few models have been prospectively validated and none report implementation in practice. Here, we use 3345 retrospective and 474 prospective hospitalizations to develop and validate a parsimonious model to identify patients with favorable outcomes within 96 h of a prediction, based on real-time lab values, vital signs, and oxygen support variables. In retrospective and prospective validation, the model achieves high average precision (88.6% 95% CI: [88.4-88.7] and 90.8% [90.8-90.8]) and discrimination (95.1% [95.1-95.2] and 86.8% [86.8-86.9]) respectively. We implemented and integrated the model into the EHR, achieving a positive predictive value of 93.3% with 41% sensitivity. Preliminary results suggest clinicians are adopting these scores into their clinical workflows.

During the COVID-19 pandemic, rapid and accurate triage of patients at the emergency department is critical to inform decision-making. We propose a data-driven approach for automatic prediction of deterioration risk using a deep neural network that learns from chest X-ray images, and a gradient boosting model that learns from routine clinical variables. Our AI prognosis system, trained using data from 3,661 patients, achieves an AUC of 0.786 (95% CI: 0.742-0.827) when predicting deterioration within 96 hours. The deep neural network extracts informative areas of chest X-ray images to assist clinicians in interpreting the predictions, and performs comparably to two radiologists in a reader study. In order to verify performance in a real clinical setting, we silently deployed a preliminary version of the deep neural network at NYU Langone Health during the first wave of the pandemic, which produced accurate predictions in real-time. In summary, our findings demonstrate the potential of the proposed system for assisting front-line physicians in the triage of COVID-19 patients.

Artificial intelligence (AI) has made stunning progress in the last decade, made possible largely due to the advances in training deep neural networks with large data sets. Many of these solutions, initially developed for natural images, speech, or text, are now becoming successful in medical imaging. In this article we briefly summarize in an accessible way the current state of the field of AI. Furthermore, we highlight the most promising approaches and describe the current challenges that will need to be solved to enable broad deployment of AI in clinical practice.

The cause of Alzheimer's disease (AD) is poorly understood, so forecasting AD remains a hard task in population health. Failure of clinical trials for AD treatments indicates that AD should be intervened at the earlier, pre-symptomatic stages. Developing an explainable method for predicting AD is critical for providing better treatment targets, better clinical trial recruitment, and better clinical care for the AD patients. In this paper, we present a novel approach for disease (AD) prediction based on Electronic Health Records (EHR) and graph neural network. Our method improves the performance on sparse data which is common in EHR, and obtains state-of-art results in predicting AD 12 to 24 months in advance on real-world EHR data, compared to other baseline results. Our approach also provides an insight into the structural relationship among different diagnosis, Lab values, and procedures from EHR as per graph structures learned by our model

Twitter data has been shown broadly applicable for public health surveillance. Previous public health studies based on Twitter data have largely relied on keyword-matching or topic models for clustering relevant tweets. However, both methods suffer from the short-length of texts and unpredictable noise that naturally occurs in user-generated contexts. In response, we introduce a deep learning approach that uses hashtags as a form of supervision and learns tweet embeddings for extracting informative textual features. In this case study, we address the specific task of estimating state-level obesity from dietary-related textual features. Our approach yields an estimation that strongly correlates the textual features to government data and outperforms the keyword-matching baseline. The results also demonstrate the potential of discovering risk factors using the textual features. This method is general-purpose and can be applied to a wide range of Twitter-based public health studies

As machine learning (ML) models, trained on real-world datasets, become common practice, it is critical to measure and quantify their potential biases. In this paper, we focus on renal failure and compare a commonly used traditional risk score, Tangri, with a more powerful machine learning model, which has access to a larger variable set and trained on 1.6 million patients' EHR data. We will compare and discuss the generalization and applicability of these two models, in an attempt to quantify biases of status quo clinical practice, compared to ML-driven models