Mining Electronic Health Records to Investigate Effectiveness of Ensemble Deep Clustering

Effective sub-typing (also known as grouping or clustering) of patients using their electronic health record (EHR) data can greatly inform precision medicine efforts. However, subtyping temporal EHR datasets is known to be challenging due to inherent EHR issues, including complexity and irregularity. In this study, we propose a self-supervised Mamba-based model that learns effective EHR representations and enables enhanced patient subtyping. We evaluate the proposed model on public and private real-world EHR datasets to classify the data based on the available labels and subtype patients based on the representations learned from the model. Through an extensive set of experiments, we demonstrate that our model's design choices lead to better performance compared to competitive baseline models for prediction. Moreover, we evaluate several clustering techniques to demonstrate that our findings offer valuable insights into subtyping patients based on temporal records from EHR models\footnote{Our implementations are available at https://github.com/healthylaife/triplet_mamba.

Data imbalance poses a major challenge in supervised classification, where the majority-class bias contributes to false negatives and overestimates classification accuracy. Unsupervised deep clustering can be immune to class imbalance because representation learning for clustering is performed without class labels. Deep clustering has been proposed for images, languages, and graphs, while its application to tabular data has only emerged recently. This paper is among the first to examine the performance of state-of-the-art deep clustering methods under varying levels of data imbalance. We introduce two novel cluster ensemble approaches: one aggregates deep clustering assignments across different embedding dimensions, and the other applies majority voting to the best-performing clustering algorithms. Experiments on 16 binary tabular datasets with varying and artificially induced levels of imbalance reveal distinct strengths of different deep clustering methods. On average, our ensemble methods outperform individual clustering methods in ACC, NMI, and ARI scores, offering greater resilience to data imbalance when identifying ground-truth classes without supervision. Therefore, in an imbalanced data scenario, deep clustering can serve as a strong alternative to supervised classification.

Learning from Electronic Health Records (EHRs) has gained significant attention due to its potential to improve clinical prediction. However, effective learning remains challenging because EHRs encode heterogeneous, temporally ordered clinical interactions. In particular, EHRs contain: (i) heterogeneous clinical entities, including patients, visits, diagnoses, prescriptions, and procedures, together with their heterogeneous interactions, (ii) longitudinal patient trajectories across hospital visits and (iii) shared statistical dependencies across related clinical prediction tasks. Existing EHR learning methods capture only a subset of these properties. To bridge this gap, we propose Multi-task Graph transformer for Heterogeneous Temporal EHRs (MiGHT-EHR), which jointly models all three within a unified representation learning method. MiGHT-EHR constructs a heterogeneous graph from EHRs in which nodes represent clinical entities and edges connect statistically associated entities identified via normalized point-wise mutual information. Across MIMIC-III and MIMIC-IV datasets, MiGHT-EHR outperforms state-of-the-art methods on average across four tasks: drug recommendation, prediction of length-of-stay, mortality, and readmission, with particularly strong improvements in mortality and readmission prediction. Furthermore, a post-hoc analysis of the learned representations reveals that patient neighborhoods are organized by clinical outcomes, salient medical concepts are recoverable as linear directions in the representation space, and task probabilities are well calibrated. Collectively, these findings demonstrate that MiGHT-EHR representations support diverse prediction tasks while preserving clinically interpretable structure.