Development of integrated informatics analytics for improved evidence-based, personalized, and predictive health
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Advanced information technologies promise a massive influx of individual-specific medical data. These rich sources offer great potential for an increased understanding of disease mechanisms and for providing evidence-based and personalized clinical decision support. However, the size, complexity, and biases of the data pose new challenges, which make it difficult to transform the data to useful and actionable knowledge using conventional statistical analysis. The so-called “Big Data” era has created an emerging and urgent need for scalable, computer-based data mining methods that can turn data into useful, personalized decision support knowledge in a flexible, cost-effective, and productive way. The goal of my Ph.D. research is to address some key challenges in current clinical deci-sion support, including (1) the lack of a flexible, evidence-based, and personalized data mining tool, (2) the need for interactive interfaces and visualization to deliver the decision support knowledge in an accurate and effective way, (3) the ability to generate temporal rules based on patient-centric chronological events, and (4) the need for quantitative and progressive clinical predictions to investigate the causality of targeted clinical outcomes. The problem statement of this dissertation is that the size, complexity, and biases of the current clinical data make it very difficult for current informatics technologies to extract individual-specific knowledge for clinical decision support. This dissertation addresses these challenges with four overall specific aims: Evidence-Based and Personalized Decision Support: To develop clinical decision support systems that can generate evidence-based rules based on personalized clinical conditions. The systems should also show flexibility by using data from different clinical settings. Interactive Knowledge Delivery: To develop an interactive graphical user interface that expedites the delivery of discovered decision support knowledge and to propose a new visualiza-tion technique to improve the accuracy and efficiency of knowledge search. Temporal Knowledge Discovery: To improve conventional rule mining techniques for the discovery of relationships among temporal clinical events and to use case-based reasoning to evaluate the quality of discovered rules. Clinical Casual Analysis: To expand temporal rules with casual and time-after-cause analyses to provide progressive clinical prognostications without prediction time constraints. The research of this dissertation was conducted with frequent collaboration with Children’s Healthcare of Atlanta, Emory Hospital, and Georgia Institute of Technology. It resulted in the development and adoption of concrete application deliverables in different medical settings, including: the neuroARM system in pediatric neuropsychology, the PHARM system in predictive health, and the icuARM, icuARM-II, and icuARM-KM systems in intensive care. The case studies for the evaluation of these systems and the discovered knowledge demonstrate the scope of this research and its potential for future evidence-based and personalized clinical decision support.