Machine learning and clinical insights: Building the best model

AI is helping clinicians better predict and treat conditions such as surgical hypotension, and at HIMSS20 experts will show how more sophisticated future models could have even broader healthcare applications.
By Nathan Eddy
10:53 AM

Update: HIMSS20 has been canceled due to the coronavirus. Read more here.

At HIMSS20 next month, two machine learning experts will show how machine learning algorithms are evolving to handle complex physiological data and drive more detailed clinical insights.

During surgery and other critical care procedures, continuous monitoring of blood pressure to detect and avoid the onset of arterial hypotension is crucial. New machine learning technology developed by Edwards Lifesciences has proven to be an effective means of doing this.

In the prodromal stage of hemodynamic instability, which is characterized by subtle, complex changes in different physiologic variables unique dynamic arterial waveform "signatures" are formed, which require machine learning and complex feature extraction techniques to be utilized.

Feras Hatib, director of research and development for algorithms and signal processing at Edwards Lifesciences, explained his team developed a technology that could predict, in real-time and continuously, upcoming hypotension in acute-care patients, using an arterial pressure waveforms.

“We used an arterial pressure signal to create hemodynamic features from that waveform, and we try to assess the state of the patient by analyzing those signals,” said Hatib, who is scheduled to speak about his work at HIMSS20.

His team’s success offers real-world evidence as to how advanced analytics can be used to inform clinical practice by training and validating machine learning algorithms using complex physiological data.

Machine learning approaches were applied to arterial waveforms to develop an algorithm that observes subtle signs to predict hypotension episodes.

In addition, real-world evidence and advanced data analytics were leveraged to quantify the association between hypotension exposure duration for various thresholds and critically ill sepsis patient morbidity and mortality outcomes.

"This technology has been in Europe for at least three years, and it has been used on thousands of patients, and has been available in the US for about a year now," he noted.

Hatib noted similar machine learning models could provide physicians and specialists with information that will help prevent re-admissions or other treatment options, or help prevent things like delirium – current areas of active development.

"In addition to blood pressure, machine learning could find a great use in the ICU, in predicting sepsis, which is critical for patient survival," he noted. "Being able to process that data in the ICU or in the emergency department, that would be a critical area to use these machine learning analytics models."

Hatib pointed out the way in which data is annotated – in his case, defining what is hypotension and what is not – is essential in building the machine learning model.

"The way you label the data, and what data you include in the training is critical," he said. "Even if you have thousands of patients and include the wrong data, that isn’t going to help – it’s a little bit of an art to finding the right data to put into the model."

On the clinical side, it’s important to tell the clinician what the issue is – in this case what is causing hypotension.

"You need to provide to them the reasons that could be causing the hypotension – this is why we complimented the technology with a secondary screen telling the clinician what is physiologically is causing hypotension," he explained. "Helping them decide what do to about it was a critical factor."

Hatib said in the future machine learning will be everywhere, because scientists and universities across the globe are hard at work developing machine learning models to predict clinical conditions.

"The next big step I see is going toward using this ML techniques where the machine takes care of the patient and the clinician is only an observer," he said.

Feras Hatib, along with Sibyl Munson of Boston Strategic Partners, will share some machine learning best practices during his HIMSS20 in a session, "Building a Machine Learning Model to Drive Clinical Insights." It's scheduled for Wednesday, March 11, from 8:30-9:30 a.m. in room W304A.