Machine Learning for Administrative Health Records: A Systematic Review of Techniques and Applications

Machine learning provides many powerful and effective techniques for analysing heterogeneous electronic health records (EHR). Administrative Health Records (AHR) are a subset of EHR collected for administrative purposes, and the use of machine learning on AHRs is a growing subfield of EHR analytics. Existing reviews of EHR analytics emphasise that the data-modality of the EHR limits the breadth of suitable machine learning techniques, and pursuable healthcare applications. Despite emphasising the importance of data modality, the literature fails to analyse which techniques and applications are relevant to AHRs. AHRs contain uniquely well-structured, categorically encoded records which are distinct from other data-modalities captured by EHRs, and they can provide valuable information pertaining to how patients interact with the healthcare system. This paper systematically reviews AHR-based research, analysing 70 relevant studies and spanning multiple databases. We identify and analyse which machine learning techniques are applied to AHRs and which health informatics applications are pursued in AHR-based research. We also analyse how these techniques are applied in pursuit of each application, and identify the limitations of these approaches. We find that while AHR-based studies are disconnected from each other, the use of AHRs in health informatics research is substantial and accelerating. Our synthesis of these studies highlights the utility of AHRs for pursuing increasingly complex and diverse research objectives despite a number of pervading data- and technique-based limitations. Finally, through our findings, we propose a set of future research directions that can enhance the utility of AHR data and machine learning techniques for health informatics research.

Beyond Topics: Discovering Latent Healthcare Objectives from Event Sequences

A meaningful understanding of clinical protocols and patient pathways helps improve healthcare outcomes. Electronic health records (EHR) reflect real-world treatment behaviours that are used to enhance healthcare management but present challenges; protocols and pathways are often loosely defined and with elements frequently not recorded in EHRs, complicating the enhancement. To solve this challenge, healthcare objectives associated with healthcare management activities can be indirectly observed in EHRs as latent topics. Topic models, such as Latent Dirichlet Allocation (LDA), are used to identify latent patterns in EHR data. However, they do not examine the ordered nature of EHR sequences, nor do they appraise individual events in isolation. Our novel approach, the Categorical Sequence Encoder (CaSE) addresses these shortcomings. The sequential nature of EHRs is captured by CaSE's event-level representations, revealing latent healthcare objectives. In synthetic EHR sequences, CaSE outperforms LDA by up to 37% at identifying healthcare objectives. In the real-world MIMIC-III dataset, CaSE identifies meaningful representations that could critically enhance protocol and pathway development.