Learning medical triage from clinicians using Deep Q-Learning

Medical Triage is of paramount importance to healthcare systems, allowing for the correct orientation of patients and allocation of the necessary resources to treat them adequately. While reliable decision-tree methods exist to triage patients based on their presentation, those trees implicitly require human inference and are not immediately applicable in a fully automated setting. On the other hand, learning triage policies directly from experts may correct for some of the limitations of hard-coded decision-trees. In this work, we present a Deep Reinforcement Learning approach (a variant of DeepQ-Learning) to triage patients using curated clinical vignettes. The dataset, consisting of 1374 clinical vignettes, was created by medical doctors to represent real-life cases. Each vignette is associated with an average of 3.8 expert triage decisions given by medical doctors relying solely on medical history. We show that this approach is on a par with human performance, yielding safe triage decisions in 94% of cases, and matching expert decisions in 85% of cases. The trained agent learns when to stop asking questions, acquires optimized decision policies requiring less evidence than supervised approaches, and adapts to the novelty of a situation by asking for more information. Overall, we demonstrate that a Deep Reinforcement Learning approach can learn effective medical triage policies directly from expert decisions, without requiring expert knowledge engineering. This approach is scalable and can be deployed in healthcare settings or geographical regions with distinct triage specifications, or where trained experts are scarce, to improve decision making in the early stage of care.

MultiVerse: Causal Reasoning using Importance Sampling in Probabilistic Programming

We elaborate on using importance sampling for causal reasoning, in particular for counterfactual inference. We show how this can be implemented natively in probabilistic programming. By considering the structure of the counterfactual query, one can significantly optimise the inference process. We also consider design choices to enable further optimisations. We introduce MultiVerse, a probabilistic programming prototype engine for approximate causal reasoning. We provide experimental results and compare with Pyro, an existing probabilistic programming framework with some of causal reasoning tools.

Universal Marginaliser for Deep Amortised Inference for Probabilistic Programs

Probabilistic programming languages (PPLs) are powerful modelling tools which allow to formalise our knowledge about the world and reason about its inherent uncertainty. Inference methods used in PPL can be computationally costly due to significant time burden and/or storage requirements; or they can lack theoretical guarantees of convergence and accuracy when applied to large scale graphical models. To this end, we present the Universal Marginaliser (UM), a novel method for amortised inference, in PPL. We show how combining samples drawn from the original probabilistic program prior with an appropriate augmentation method allows us to train one neural network to approximate any of the corresponding conditional marginal distributions, with any separation into latent and observed variables, and thus amortise the cost of inference. Finally, we benchmark the method on multiple probabilistic programs, in Pyro, with different model structure.

A comparative study of artificial intelligence and human doctors for the purpose of triage and diagnosis

Online symptom checkers have significant potential to improve patient care, however their reliability and accuracy remain variable. We hypothesised that an artificial intelligence (AI) powered triage and diagnostic system would compare favourably with human doctors with respect to triage and diagnostic accuracy. We performed a prospective validation study of the accuracy and safety of an AI powered triage and diagnostic system. Identical cases were evaluated by both an AI system and human doctors. Differential diagnoses and triage outcomes were evaluated by an independent judge, who was blinded from knowing the source (AI system or human doctor) of the outcomes. Independently of these cases, vignettes from publicly available resources were also assessed to provide a benchmark to previous studies and the diagnostic component of the MRCGP exam. Overall we found that the Babylon AI powered Triage and Diagnostic System was able to identify the condition modelled by a clinical vignette with accuracy comparable to human doctors (in terms of precision and recall). In addition, we found that the triage advice recommended by the AI System was, on average, safer than that of human doctors, when compared to the ranges of acceptable triage provided by independent expert judges, with only a minimal reduction in appropriateness.

A Universal Marginalizer for Amortized Inference in Generative Models

We consider the problem of inference in a causal generative model where the set of available observations differs between data instances. We show how combining samples drawn from the graphical model with an appropriate masking function makes it possible to train a single neural network to approximate all the corresponding conditional marginal distributions and thus amortize the cost of inference. We further demonstrate that the efficiency of importance sampling may be improved by basing proposals on the output of the neural network. We also outline how the same network can be used to generate samples from an approximate joint posterior via a chain decomposition of the graph.

Resting state brain networks from EEG: Hidden Markov states vs. classical microstates

Functional brain networks exhibit dynamics on the sub-second temporal scale and are often assumed to embody the physiological substrate of cognitive processes. Here we analyse the temporal and spatial dynamics of these states, as measured by EEG, with a hidden Markov model and compare this approach to classical EEG microstate analysis. We find dominating state lifetimes of 100--150\,ms for both approaches. The state topographies show obvious similarities. However, they also feature distinct spatial and especially temporal properties. These differences may carry physiological meaningful information originating from patterns in the data that the HMM is able to integrate while the microstate analysis is not. This hypothesis is supported by a consistently high pairwise correlation of the temporal evolution of EEG microstates which is not observed for the HMM states and which seems unlikely to be a good description of the underlying physiology. However, further investigation is required to determine the robustness and the functional and clinical relevance of EEG HMM states in comparison to EEG microstates.