machine learning & decision support in healthcare · clinical decision support •cds...
TRANSCRIPT
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Machine Learning & Decision Support in Healthcare
Hamed Abbaszadegan, MD, MBA, FACP, FAMIAChief Health Innovation & Informatics Officer
Phoenix VA Health Care SystemProgram Director
Clinical Informatics Fellowship U of A College of Medicine-Phoenix
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Financial Disclosures
• None
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Presentation Overview
• What is Machine Learning & how is it integrated into practice
• Coming of age of pharmacogenomics in decision support
• Informatics in clinical care
• The Clinical Informatics Fellowship Training Program
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Learning Objectives
• Describe the role of Machine Learning in healthcare
• Interpret advanced decision support
• Evaluate clinical use cases for Machine Learning algorithms
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Machine Learning
• ...Branch of AI where systems can learn from data, pattern recognition, and decision making.
https://www.ibm.com/analytics/machine-learning
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Concern
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Reality
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Common Machine Learning Applications
• Amazon recommendations (Market Basket Analysis)
– Pattern recognition → Ex: If you buy salsa, what else will you buy?
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More Machine Learning Applications
• Fraud Detection
• https://www.sas.com/en_us/insights/articles/risk-fraud/fraud-detection-machine-learning.html
• http://forms.cybersource.com/LP=1259?dcid=701F0000001Ipdo&utm_source=The%20Paypers%20Case%20Study&utm_medium=Paid%20Advertisement&utm_content=EMEA%20Machine%20Learning%20Whitepaper&utm_campaign=EMEA_Q316_Machine%20Learning%20Whitepaper_The%20Paypers
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Machine Learning ModelSTEPS:• Data from warehouse• Determine health factors• Split data →Training/Test• Feed data into algorithms• Analyze performance of
algorithms• Best performing algorithm
becomes the model (least error – most correct classification)
https://orange.biolab.si/
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Download and Use for Free…
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Classify Your Data
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Projections
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Variation in Data
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Prediction
• Analysis of health data can lead to → Pattern Recognition
– Labs
– Vitals
– Medications
– Compliance
– Follow up
– Diagnoses
– Genomics
• Pattern Recognition leads to → PREDICTION
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Example of Data Input (Social Determinants)
• Basic item defining factors
• Z-codes: social determinant codes
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ICD-codes
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Ability to Localize Care Needs
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End Goal
• Patient outreach:
– Programs built around advanced analytics
– How will you do with these patients?
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Next Application: PTSD
ICD-10Code Description
Z560 UNEMPLOYMENT,UNSP
Z5681 SEXUALHARASSMENTONTHEJOB
Z5682 MILITARYDEPLOYMENTSTATUS
Z5689 OTHERPROBLEMSRELATEDTOEMPLOYMENT
Z569 UNSPPROBLEMSRELATEDTOEMPLOYMENT
Z590 HOMELESSNESS
Z591 INADEQUATEHOUSING
Z594 LACKOFADEQUATEFOODANDSAFEDRINKINGWATER
Z595 EXTREMEPOVERTY
Z596 LOWINCOME
Z600 PROBLEMSOFADJUSTMENTTOLIFE-CYCLETRANSITIONS
Z602 PROBLEMSRELATEDTOLIVINGALONE
Z609 PROBLEMRELATEDTOSOCIALENVIRONMENT,UNSP
Z62810 PERSONALHISTORYOFPHYSICALANDSEXUALABUSEINCHILDHOOD
Z62811 PERSONALHISTORYOFPSYCHOLOGICALABUSEINCHILDHOOD
Z62812 PERSONALHISTORYOFNEGLECTINCHILDHOOD
Z62819 PERSONALHISTORYOFUNSPABUSEINCHILDHOOD
Z629 PROBLEMSRELATEDTOUPBRINGING
Z630 PROBLEMSINRELATIONSHIPWITHSPOUSEORPARTNER
Z634 DISAPPERANCEANDDEATHOFFAMILYMEMBER
Z635 DISRUPTIONOFFAMILYBYSEPARATIONANDDIVORCE
Z6371 STRESSONFAMILYDUETORETURNOFFAMILYMEMBERFROMMILITARYDEPLOYMENT
Z6379 OTHERSTRESSFULLIFEEVENTSAFFECTINGFAMILYANDHOUSEHOLD
Z650 CONVICTIONINCIVILANDCRIMINALPROCEEDINGSWITHOUTIMPRISONMENT
Z651 IMPRISONMENTANDOTHERINCARCERATION
Z652 PROBLEMSRELATEDTORELEASEFROMPRISON
Z653 PROBLEMSRELATEDTOOTHERLEGALCIRCUMSTANCES
Z654 VICTIMOFCRIMEANDTERRORISM
Z655 EXPOSURETODISASTER,WAR,ANDOTHERHOSTILITIES
Z7141 ALCOHOLABUSECOUNSELINGANDSURVEILLENCEOFALCOHOLIC
SocialDeterminantsofHealthforPTSD
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Interpreting Machine Learning Results
• Which algorithmic model predicted most correctly?
– Training data is classified and can confirm if machine “learned correctly”
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Moment of Reflection
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Support the Decision
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Decision Support
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Clinical Decision Support
• CDS – clinical knowledge or patient-related information, filtered or presented at appropriate times to enhance patient care.
• Clinical decision support systems (CDSS) are computer systems designed to impact clinician decision making about individual patients at the point in time that these decisions are made.
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5 Rights of CDS:
• Right information,
• Right person,
• Right format,
• Right channel,
• Right time in workflow.
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EHR Decision Support
• Examples…
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CDS…
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Decision Support & Precision Medicine
• Precision medicine is a medical model that proposes the customization of healthcare, with medical decisions, treatments, practices, or products being tailored to the individual patient.
Lu, Y.-F.; Goldstein, D. B.; Angrist, M.; Cavalleri, G. (24 July 2014). “Personalized Medicine and Human Genetic Diversity”. Cold Spring Harbor Perspectives in Medicine. 4 (9): a008581–a008581.
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My Pharmacogenomic Profile
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Meaning of Results
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Deeper Interpretation
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Integrate the Results!
• Input of results obtained in a structured manner
• Hard wire drug orders to those results
– Think of Lab orders linked to alerts
– Allergy profiles liked to medication orders
– Drug-drug interactions
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Administrative Decision Support
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Rapid Fire
• Other informatics applications
• Tools
• CI Fellowship
• Technology
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Analytics in Action: Lung CA Screening
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Analytics in Action: Care Assessment Needs
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Analysis Leading to the Right Person
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Analytics in Action: Fall Risk
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Registries
• Paraphrased Definition for Clinical Use:
– Code based (ICD) data that evaluates outcomes of a particular condition/disease.
• Combines data from multiple sources so that it can be queried quickly
https://www.ncbi.nlm.nih.gov/books/NBK164514/
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Breast Care Registries
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CI Fellowship
1. Stanford University
2. University of Chicago
3. OHSU
4. Regenstrief Institute
5. Banner/UA COM-Phoenix
6. Children’s Hospital of Philadelphia
7. Beth Israel Deaconess
8. UCLA
9. Boston Children’s Hospital
10. Geisinger Health System
11. Vanderbilt University
12. University of Washington
13. Columbia University
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Clinical Informatics Subspecialty est. 2013
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Natural Language Processing (NLP)
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API’s
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Discussion
• Lets collaborate!
Or