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Electronic Medical Record Context Signatures Improve Diagnostic Classification using Medical Image Computing

DOI:10.1109/JBHI.2018.2890084 期刊:IEEE Journal of Biomedical and Health Informatics 出版年份:2019 更新时间:2025-09-23 15:22:29
摘要: Composite models that combine medical imaging with electronic medical records (EMR) improve predictive power when compared to traditional models that use imaging alone. The digitization of EMR provides potential access to a wealth of medical information, but presents new challenges in algorithm design and inference. Previous studies, such as PheWAS (Phenome Wide Association Study), have shown that EMR data can be used to investigate the relationship between genotypes and clinical conditions. Here, we introduce PheDAS (Phenome-Disease Association Study) to extend the statistical capabilities of the PheWAS software through a custom Python package which creates diagnostic EMR signatures to capture system-wide co-morbidities for a disease population within a given time interval. We investigate the effect of integrating these EMR signatures with radiological data to improve diagnostic classification in disease domains known to have confounding factors because of variable and complex clinical presentation. Specifically, we focus on two studies: (1) a study of four major optic nerve related conditions and (2) a study of diabetes. Addition of EMR signature vectors to radiologically-derived structural metrics improves the area under the curve (AUC) for diagnostic classification using elastic net regression, for diseases of the optic nerve. For glaucoma, the AUC improves from 0.71 to 0.83, for intrinsic optic nerve disease it increases from 0.72 to 0.91, for optic nerve edema it increases from 0.95 to 0.96, and for thyroid eye disease from 0.79 to 0.89. The EMR signatures recapitulate known comorbidities with diabetes, such as abnormal glucose but do not significantly modulate image-derived features. In summary, EMR signatures present a scalable and readily applicable approach for using EMR context to increase the statistical power of image derived features.
作者: Shikha Chaganti,Louise A. Mawn,Hakmook Kang,Josephine Egan,Susan M. Resnick,Lori L. Beason-Held,Bennett A. Landman,Thomas A. Lasko
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To improve diagnostic classification by integrating electronic medical record (EMR) context signatures with medical imaging data, specifically for optic nerve diseases and diabetes.

The integration of EMR context signatures with medical imaging data significantly improves diagnostic classification accuracy for optic nerve diseases, as evidenced by increased AUC values. For diabetes, EMR signatures alone are highly predictive, but imaging features do not add significant value. The PheDAS approach is scalable and effective for leveraging EMR data in medical image computing, aligning with known medical comorbidities and providing a foundation for clinical decision support systems.

The study relies on ICD-9 codes from EMR, which may have inconsistencies in coding practices. Imaging data was acquired under varied settings and scanners, potentially introducing variability. The sample sizes for some disease groups are small, and the methods may not generalize to all medical conditions. Future work could incorporate other EMR data like procedure codes and lab results.

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