A GPT-based EHR modeling system for unsupervised novel disease detection

[Display omitted] To develop an Artificial Intelligence (AI)-based anomaly detection model as a complement of an “astute physician” in detecting novel disease cases in a hospital and preventing emerging outbreaks. Data included hospitalized patients (n = 120,714) at a safety-net hospital in Massachu...

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Bibliographic Details
Published in:Journal of biomedical informatics 2024-09, Vol.157, p.104706, Article 104706
Main Authors: Hao, Boran, Hu, Yang, Adams, William G., Assoumou, Sabrina A., Hsu, Heather E., Bhadelia, Nahid, Paschalidis, Ioannis Ch
Format: Article
Language:English
Subjects:
Deep learning
EHR modeling
GPT
Novel disease detection
Pandemic prevention
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Summary:[Display omitted] To develop an Artificial Intelligence (AI)-based anomaly detection model as a complement of an “astute physician” in detecting novel disease cases in a hospital and preventing emerging outbreaks. Data included hospitalized patients (n = 120,714) at a safety-net hospital in Massachusetts. A novel Generative Pre-trained Transformer (GPT)-based clinical anomaly detection system was designed and further trained using Empirical Risk Minimization (ERM), which can model a hospitalized patient’s Electronic Health Records (EHR) and detect atypical patients. Methods and performance metrics, similar to the ones behind the recent Large Language Models (LLMs), were leveraged to capture the dynamic evolution of the patient’s clinical variables and compute an Out-Of-Distribution (OOD) anomaly score. In a completely unsupervised setting, hospitalizations for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection could have been predicted by our GPT model at the beginning of the COVID-19 pandemic, with an Area Under the Receiver Operating Characteristic Curve (AUC) of 92.2 %, using 31 extracted clinical variables and a 3-day detection window. Our GPT achieves individual patient-level anomaly detection and mortality prediction AUC of 78.3 % and 94.7 %, outperforming traditional linear models by 6.6 % and 9 %, respectively. Different types of clinical trajectories of a SARS-CoV-2 infection are captured by our model to make interpretable detections, while a trend of over-pessimistic outcome prediction yields a more effective detection pathway. Furthermore, our comprehensive GPT model can potentially assist clinicians with forecasting patient clinical variables and developing personalized treatment plans. This study demonstrates that an emerging outbreak can be accurately detected within a hospital, by using a GPT to model patient EHR time sequences and labeling them as anomalous when actual outcomes are not supported by the model. Such a GPT is also a comprehensive model with the functionality of generating future patient clinical variables, which can potentially assist clinicians in developing personalized treatment plans.
ISSN:1532-0464
1532-0480
1532-0480
DOI:10.1016/j.jbi.2024.104706