A Domain Incremental Continual Learning Benchmark for ICU Time Series Model Transportability
Authors: Ryan King, Conrad Krueger, Ethan Veselka, Tianbao Yang, Bobak J. Mortazavi
Organizations: Computer Science & Engineering, Texas A&M University, College Station, United States
Abstract
In recent years, machine learning has made significant progress in clinical outcome prediction, demonstrating increasingly accurate results. However, the substantial resources required for hospitals to train these models, such as data collection, labeling, and computational power, limit the feasibility for smaller hospitals to develop their own models. An alternative approach involves transferring a machine learning model trained by a large hospital to smaller hospitals, allowing them to fine-tune the model on their specific patient data. However, these models are often trained and validated on data from a single hospital, raising concerns about their generalizability to new data. Our research shows that there are notable differences in measurement distributions and frequencies across various regions in the United States. To address this, we propose a benchmark that tests a machine learning model's ability to transfer from a source domain to different regions across the country. This benchmark assesses a model's capacity to learn meaningful information about each new domain while retaining key features from the original domain. Using this benchmark, we frame the transfer of a machine learning model from one region to another as a domain incremental learning problem. While the task of patient outcome prediction remains the same, the input data distribution varies, necessitating a model that can effectively manage these shifts. We evaluate two popular domain incremental learning methods: data replay, which stores examples from previous data sources for fine-tuning on the current source, and Elastic Weight Consolidation (EWC), a model parameter regularization method that maintains features important for both data sources.
Deploying clinical prediction models across healthcare systems often fails when key training covariates are unavailable at deployment and labeled outcomes are limited in the target domain. For example, high-performing models for out-of-hospital cardiac arrest (OHCA) rely on detailed prehospital measurements routinely collected in high-resource settings but unavailable in many international registries. Existing methods either discard missing covariates, sacrificing predictive information, or rely on untestable assumptions about their target distribution. We propose DRUM (\underline{D}istributionally \underline{R}obust \underline{U}nsupervised transfer learning with structurally \underline{M}issing covariates), a framework that transfers prediction models to target populations where certain covariates are structurally absent and outcome labels are unavailable. DRUM partitions covariates into shared components (X), observed across all settings, and missing components (A), observed only in the source. Rather than imputing missing covariates, DRUM optimizes worst-case predictive performance over the unknown target distribution of A∣X using a neural network generator, with a robustness parameter controlling allowable deviation from the source conditional. We further develop a bias correction procedure that reduces sensitivity to nuisance estimation error. Simulations show substantial improvements in both mean and worst-case prediction error under distribution shift. Applied to cross-national OHCA prediction, transferring models from a US registry to multiple Asian registries where prehospital variables are unrecorded, DRUM yields better-calibrated predictions and improved clinical classification performance across sites.
Deep learning models achieved high accuracy in pneumonia detection from chest X-rays. However, their generalization across clinical domains remains limited due to variations in imaging devices, acquisition protocols, and institutional conditions. This study introduces a replay-based domain-incremental continual learning designed to enable continual adaptation to cross-domain variations without catastrophic forgetting. The proposed method incorporates a class-aware balanced replay to maintain balanced class representation within a constrained memory and a class-aware loss to dynamically reweight class imbalance during training. Experiments conducted on a domain-shifted PneumoniaMNIST dataset consisting of five simulated domains demonstrate that the proposed method achieves an average accuracy of 88.66%, outperforming Experience Replay, Fine-Tuning, and Joint Training baselines. These findings highlight the efficacy of the proposed approach in achieving robust and consistent pneumonia detection across clinical environment variations.
Modern machine learning pipelines increasingly rely on reusing pretrained and foundation models across downstream tasks. These pretrained models can differ not only in performance but also in how they can be used: some only provide black-box predictions, while others may permit white-box access to internal representations that can be probed or fine-tuned. When deployed to the target domain in the presence of distribution shift, no single strategy, including zero-shot application, fine-tuning, or directly training a target-specific model, is uniformly the best. In this work, we propose Frontier Learning, a framework that treats a library of candidate models spanning different training histories and access regimes as complementary sources of information rather than mutually exclusive alternatives. Frontier Learning constructs a unified target-domain feature by concatenating internal representations from white-box candidates as well as prediction outputs from black-box candidates, then fits a lightweight, regularized supervised learner on this concatenated representation using labeled target data. Because the resulting hypothesis class contains predictors obtained by zero-shot reuse, fine-tuning, and direct training as special cases, empirical risk minimization over the frontier learner is guaranteed to be no worse, on the training sample, than any individual baseline. We evaluate the framework in simulations spanning varying degrees of source-target compatibility and in two real-world distribution-shift settings: visual domain adaptation on DomainNet/VisDA and clinical mortality prediction across intensive care unit domains using MIMIC-IV-Notes. Across all settings, Frontier Learning matches or outperforms the strongest individual reuse strategy, with the largest gains arising precisely when no single baseline is reliable across the range of shift considered.