Objective Recent studies on electronic health records (EHRs) started to learn deep generative models and synthesize a huge amount of realistic records, in order to address significant privacy issues surrounding the EHR. However, most of them only focus on structured records about patients’ independent visits, rather than on chronological clinical records. In this article, we aim to learn and synthesize realistic sequences of EHRs based on the generative autoencoder. Materials and Methods We propose a dual adversarial autoencoder (DAAE), which learns set-valued sequences of medical entities, by combining a recurrent autoencoder with 2 generative adversarial networks (GANs). DAAE improves the mode coverage and quality of generated sequences by adversarially learning both the continuous latent distribution and the discrete data distribution. Using the MIMIC-III (Medical Information Mart for Intensive Care-III) and UT Physicians clinical databases, we evaluated the performances of DAAE in terms of predictive modeling, plausibility, and privacy preservation. Results Our generated sequences of EHRs showed the comparable performances to real data for a predictive modeling task, and achieved the best score in plausibility evaluation conducted by medical experts among all baseline models. In addition, differentially private optimization of our model enables to generate synthetic sequences without increasing the privacy leakage of patients’ data. Conclusions DAAE can effectively synthesize sequential EHRs by addressing its main challenges: the synthetic records should be realistic enough not to be distinguished from the real records, and they should cover all the training patients to reproduce the performance of specific downstream tasks.

Tensor factorization has been demonstrated as an e cient approach for computational phenotyping, where massive electronic health records (EHRs) are converted to concise and meaningful clinical concepts. While distributing the tensor factorization tasks to local sites can avoid direct data sharing, it still requires the exchange of intermediary results which could reveal sensitive patient information. erefore, the challenge is how to jointly decompose the tensor under rigorous and principled privacy constraints, while still support the model's interpretability.We propose DPFact, a privacy-preserving collaborative tensor factorization method for computational phenotyping using EHR. It embeds advanced privacy-preserving mechanisms with collaborative learning. Hospitals can keep their EHR database private but also collaboratively learn meaningful clinical concepts by sharing di erentially private intermediary results. Moreover, DPFact solves the heterogeneous patient population using a structured sparsity term. In our framework, each hospital decomposes its local tensors, and sends the updated intermediary results with output perturbation every several iterations to a semi-trusted server which generates the phenotypes. e evaluation on both real-world and synthetic datasets demonstrated that under strict privacy constraints, our method is more accurate and communication-e cient than stateof-the-art baseline methods.

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Modern healthcare systems knitted by a web of entities (e.g., hospitals, clinics, pharmacy companies) are collecting a huge volume of healthcare data from a large number of individuals with various medical procedures, medications, diagnosis, and lab tests. To extract meaningful medical concepts (i.e., phenotypes) from such higher-arity relational healthcare data, tensor factorization has been proven to be an effective approach and received increasing research attention, due to their intrinsic capability to represent the high-dimensional data. Recently, federated learning offers a privacy-preserving paradigm for collaborative learning among different entities, which seemingly provides an ideal potential to further enhance the tensor factorization-based collaborative phenotyping to handle sensitive personal health data. However, existing attempts to federated tensor factorization come with various limitations, including restrictions to the classic tensor factorization, high communication cost and reduced accuracy. We propose a communication efficient federated generalized tensor factorization, which is flexible enough to choose from a variate of losses to best suit different types of data in practice. We design a three-level communication reduction strategy tailored to the generalized tensor factorization, which is able to reduce the uplink communication cost up to 99.90%. In addition, we theoretically prove that our algorithm does not compromise convergence speed despite the aggressive communication compression. Extensive experiments on two real-world electronics health record datasets demonstrate the efficiency improvements in terms of computation and communication cost.