Counterfactual Supporting Facts Extraction for Explainable Medical Record Based Diagnosis with Graph Network

Providing a reliable explanation for clinical diagnosis based on the Electronic Medical Record (EMR) is fundamental to the application of Artificial Intelligence in the medical field. Current methods mostly treat the EMR as a text sequence and provide explanations based on a precise medical knowledge base, which is disease-specific and difficult to obtain for experts in reality. Therefore, we propose a counterfactual multi-granularity graph supporting facts extraction (CMGE) method to extract supporting facts from irregular EMR itself without external knowledge bases in this paper. Specifically, we first structure the sequence of EMR into a hierarchical graph network and then obtain the causal relationship between multi-granularity features and diagnosis results through counterfactual intervention on the graph. Features having the strongest causal connection with the results provide interpretive support for the diagnosis. Experimental results on real Chinese EMR of the lymphedema demonstrate that our method can diagnose four types of EMR correctly, and can provide accurate supporting facts for the results. More importantly, the results on different diseases demonstrate the robustness of our approach, which represents the potential application in the medical field.

[1]  Fenglong Ma,et al.  KAME: Knowledge-based Attention Model for Diagnosis Prediction in Healthcare , 2018, CIKM.

[2]  Jason Weston,et al.  Translating Embeddings for Modeling Multi-relational Data , 2013, NIPS.

[3]  Bowen Zhou,et al.  Multi-hop Reading Comprehension across Multiple Documents by Reasoning over Heterogeneous Graphs , 2019, ACL.

[4]  Christopher D. Manning,et al.  Stanza: A Python Natural Language Processing Toolkit for Many Human Languages , 2020, ACL.

[5]  Yoshua Bengio,et al.  Learning Phrase Representations using RNN Encoder–Decoder for Statistical Machine Translation , 2014, EMNLP.

[6]  Rongzhong Lian,et al.  Learning to Select Knowledge for Response Generation in Dialog Systems , 2019, IJCAI.

[7]  Yu Cao,et al.  BAG: Bi-directional Attention Entity Graph Convolutional Network for Multi-hop Reasoning Question Answering , 2019, NAACL.

[8]  Yuan Luo,et al.  Graph Convolutional Networks for Text Classification , 2018, AAAI.

[9]  Pengtao Xie,et al.  Multimodal Machine Learning for Automated ICD Coding , 2018, MLHC.

[10]  Christopher D. Manning,et al.  Biomedical and Clinical English Model Packages in the Stanza Python NLP Library , 2020, ArXiv.

[11]  Yongfeng Huang,et al.  Clinical Assistant Diagnosis for Electronic Medical Record Based on Convolutional Neural Network , 2018, Scientific Reports.

[12]  Keith A. Markus,et al.  Making Things Happen: A Theory of Causal Explanation , 2007 .

[13]  Jure Leskovec,et al.  GNNExplainer: Generating Explanations for Graph Neural Networks , 2019, NeurIPS.

[14]  Brian Peasland Diagnostics , 2019, Oracle DBA Mentor.

[15]  Wanxiang Che,et al.  Document Modeling with Graph Attention Networks for Multi-grained Machine Reading Comprehension , 2020, ACL.

[16]  John P. Dickerson,et al.  Counterfactual Explanations for Machine Learning: A Review , 2020, ArXiv.

[17]  Natalia Gimelshein,et al.  PyTorch: An Imperative Style, High-Performance Deep Learning Library , 2019, NeurIPS.

[18]  Honghan Wu,et al.  Explainable Automated Coding of Clinical Notes using Hierarchical Label-wise Attention Networks and Label Embedding Initialisation , 2021, J. Biomed. Informatics.

[19]  Zhe Gan,et al.  Hierarchical Graph Network for Multi-hop Question Answering , 2020, EMNLP.

[20]  S. LeVine Lymphedema: Complete Medical and Surgical Management. , 2017, Plastic and reconstructive surgery.

[21]  Yasha Wang,et al.  ConCare: Personalized Clinical Feature Embedding via Capturing the Healthcare Context , 2019, AAAI.

[22]  Pietro Liò,et al.  Graph Attention Networks , 2017, ICLR.

[23]  Katja Bühler,et al.  Domain aware medical image classifier interpretation by counterfactual impact analysis , 2020, MICCAI.

[24]  Nora Hollenstein,et al.  Patient Risk Assessment and Warning Symptom Detection Using Deep Attention-Based Neural Networks , 2018, Louhi@EMNLP.

[25]  Jimmy Ba,et al.  Adam: A Method for Stochastic Optimization , 2014, ICLR.

[26]  Jimeng Sun,et al.  Explainable Prediction of Medical Codes from Clinical Text , 2018, NAACL.

[27]  Zhiting Hu,et al.  Learning Hierarchical Representations of Electronic Health Records for Clinical Outcome Prediction , 2019, AMIA.

[28]  Xiaodan Liang,et al.  Learning Reinforced Agents with Counterfactual Simulation for Medical Automatic Diagnosis , 2020, ArXiv.

[29]  Jiangtao Wang,et al.  AdaCare: Explainable Clinical Health Status Representation Learning via Scale-Adaptive Feature Extraction and Recalibration , 2019, AAAI.

[30]  Jimeng Sun,et al.  MiME: Multilevel Medical Embedding of Electronic Health Records for Predictive Healthcare , 2018, NeurIPS.

[31]  Walter F. Stewart,et al.  Doctor AI: Predicting Clinical Events via Recurrent Neural Networks , 2015, MLHC.

[32]  David Sontag,et al.  Counterfactual Off-Policy Evaluation with Gumbel-Max Structural Causal Models , 2019, ICML.

[33]  Yubo Chen,et al.  HyperCore: Hyperbolic and Co-graph Representation for Automatic ICD Coding , 2020, ACL.

[34]  Jun Chen,et al.  The Graph-based Mutual Attentive Network for Automatic Diagnosis , 2020, IJCAI.

[35]  Fei Li,et al.  ICD Coding from Clinical Text Using Multi-Filter Residual Convolutional Neural Network , 2019, AAAI.

[36]  May D. Wang,et al.  Interpretable Predictions of Clinical Outcomes with An Attention-based Recurrent Neural Network , 2017, BCB.

[37]  Ming-Wei Chang,et al.  BERT: Pre-training of Deep Bidirectional Transformers for Language Understanding , 2019, NAACL.

[38]  Pengfei Liu,et al.  Heterogeneous Graph Neural Networks for Extractive Document Summarization , 2020, ACL.

[39]  Lei Li,et al.  Dynamically Fused Graph Network for Multi-hop Reasoning , 2019, ACL.

[40]  Frank Rudzicz,et al.  Explainable Clinical Decision Support from Text , 2020, EMNLP.

[41]  M. Strevens Review of Woodward, Making Things Happen* , 2007 .

[42]  Kuldip K. Paliwal,et al.  Bidirectional recurrent neural networks , 1997, IEEE Trans. Signal Process..

[43]  Adam G. D'Souza,et al.  Enhancing ICD-Code-Based Case Definition for Heart Failure Using Electronic Medical Record Data. , 2020, Journal of cardiac failure.