Led by David Sontag, the Clinical Machine Learning Group is interested in advancing machine learning and artificial intelligence, and using these techniques to advance health care.
Broadly, we have two goals:
Our team includes postdocs, students, clinical collaborators, and research scientists.
Overlap between treatment groups is required for non-parametric estimation of causal effects. If a subgroup of subjects always receives the same intervention, we cannot estimate the effect of intervention changes on that subgroup without further assumptions. When overlap does not hold globally, characterizing local regions of overlap can inform the relevance of causal conclusions for new subjects, and can help guide additional data collection. To have impact, these descriptions must be interpretable for downstream users who are not machine learning experts, such as policy makers. We formalize overlap estimation as a problem of finding minimum volume sets subject to coverage constraints and reduce this problem to binary classification with Boolean rule classifiers. We then generalize this method to estimate overlap in off-policy policy evaluation. In several real-world applications, we demonstrate that these rules have comparable accuracy to black-box estimators and provide intuitive and informative explanations that can inform policy making.
Learning algorithms are often used in conjunction with expert decision makers in practical scenarios, however this fact is largely ignored when designing these algorithms. In this paper we explore how to learn predictors that can either predict or choose to defer the decision to a downstream expert. Given only samples of the expert’s decisions, we give a procedure based on learning a classifier and a rejector and analyze it theoretically. Our approach is based on a novel reduction to cost sensitive learning where we give a consistent surrogate loss for cost sensitive learning that generalizes the cross entropy loss. We show the effectiveness of our approach on a variety of experimental tasks.
We present a system that uses a learned autocompletion mechanism to facilitate rapid creation of semi-structured clinical documentation. We dynamically suggest relevant clinical concepts as a doctor drafts a note by leveraging features from both unstructured and structured medical data. By constraining our architecture to shallow neural networks, we are able to make these suggestions in real time. Furthermore, as our algorithm is used to write a note, we can automatically annotate the documentation with clean labels of clinical concepts drawn from well-structured medical hierarchies to make notes more structured and readable for physicians, patients, and future algorithms. To our knowledge, this system is the only machine learning-based documentation utility for clinical notes deployed in a live hospital setting, and it reduces keystroke burden of clinical concepts by 67% in real environments.
Clinical studies often require understanding elements of a patient’s narrative that exist only in free text clinical notes. To transform notes into structured data for downstream use, these elements are commonly extracted and normalized to medical vocabularies. In this work, we audit the performance of and indicate areas of improvement for state-of-the-art systems. We find that high task accuracies for clinical entity normalization systems on the 2019 n2c2 Shared Task are misleading, and underlying performance is still brittle — normalization accuracy is high for common concepts (95.3%), but much lower for concepts unseen in training data (69.3%). We demonstrate that current approaches are hindered in part by inconsistencies in medical vocabularies, limitations of existing labeling schemas, and narrow evaluation techniques. We reformulate the annotation framework for clinical entity extraction to factor in these issues to allow for robust end-to-end system benchmarking. We evaluate concordance of annotations from our new framework between two annotators and achieve a Jaccard similarity of 0.73 for entity recognition and an agreement of 0.83 for entity normalization. We propose a path forward to address the demonstrated need for the creation of a reference standard to spur method development in entity recognition and normalization.