Jillian H. Hurst

Feier Chang, Jay Krishnan, Jillian H Hurst et al.

To identify patients who are hospitalized because of COVID-19 as opposed to those who were admitted for other indications, we compared the performance of different computable phenotype definitions for COVID-19 hospitalizations that use different types of data from the electronic health records (EHR), including structured EHR data elements, provider notes, or a combination of both data types. And conduct a retrospective data analysis utilizing chart review-based validation. Participants are 586 hospitalized individuals who tested positive for SARS-CoV-2 during January 2022. We used natural language processing to incorporate data from provider notes and LASSO regression and Random Forests to fit classification algorithms that incorporated structured EHR data elements, provider notes, or a combination of structured data and provider notes. Results: Based on a chart review, 38% of 586 patients were determined to be hospitalized for reasons other than COVID-19 despite having tested positive for SARS-CoV-2. A classification algorithm that used provider notes had significantly better discrimination than one that used structured EHR data elements (AUROC: 0.894 vs 0.841, p < 0.001), and performed similarly to a model that combined provider notes with structured data elements (AUROC: 0.894 vs 0.893). Assessments of hospital outcome metrics significantly differed based on whether the population included all hospitalized patients who tested positive for SARS-CoV-2 versus those who were determined to have been hospitalized due to COVID-19. This work demonstrates the utility of natural language processing approaches to derive information related to patient hospitalizations in cases where there may be multiple conditions that could serve as the primary indication for hospitalization.

Minghui Sun, Haoyu Gong, Xingyu You et al.

Event stream data often exhibit hierarchical structure in which multiple events co-occur, resulting in a sequence of multisets (i.e., bags of events). In electronic health records (EHRs), for example, medical events are grouped into a sequence of clinical encounters with well-defined temporal structure, but the order and timing of events within each encounter may be unknown or unreliable. Most existing foundation models (FMs) for event stream data flatten this hierarchy into a one-dimensional sequence, leading to (i) computational inefficiency associated with dense attention and learning spurious within-set relationships, and (ii) lower-quality set-level representations from heuristic post-training pooling for downstream tasks. Here, we show that preserving the original hierarchy in the FM architecture provides a useful inductive bias that improves both computational efficiency and representation quality. We then introduce Nested Event Stream Transformer (NEST), a FM for event streams comprised of sequences of multisets. Building on this architecture, we formulate Masked Set Modeling (MSM), an efficient paradigm that promotes improved set-level representation learning. Experiments on real-world multiset sequence data show that NEST captures real-world dynamics while improving both pretraining efficiency and downstream performance.