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Background  The main goal of this study is to explore the use of features representing patient-level electronic health record (EHR) data, generated by the unsupervised deep learning algorithm autoencoder, in predictive modeling. Since autoencoder features are unsupervised, this paper focuses on their general lower-dimensional representation of EHR information in a wide variety of predictive tasks.    Methods  We compare the model with autoencoder features to traditional models: logistic model with least absolute shrinkage and selection operator (LASSO) and Random Forest algorithm. In addition, we include a predictive model using a small subset of response-specific variables (Simple Reg) and a model combining these variables with features from autoencoder (Enhanced Reg). We performed the study first on simulated data that mimics real world EHR data and then on actual EHR data from eight Advocate hospitals.    Results  On simulated data with incorrect categories and missing data, the precision for autoencoder is 24.16% when fixing recall at 0.7, which is higher than Random Forest (23.61%) and lower than LASSO (25.32%). The precision is 20.92% in Simple Reg and improves to 24.89% in Enhanced Reg. When using real EHR data to predict the 30-day readmission rate, the precision of autoencoder is 19.04%, which again is higher than Random Forest (18.48%) and lower than LASSO (19.70%). The precisions for Simple Reg and Enhanced Reg are 18.70 and 19.69% respectively. That is, Enhanced Reg can have competitive prediction performance compared to LASSO. In addition, results show that Enhanced Reg usually relies on fewer features under the setting of simulations of this paper.    Conclusions  We conclude that autoencoder can create useful features representing the entire space of EHR data and which are applicable to a wide array of predictive tasks. Together with important response-specific predictors, we can derive efficient and robust predictive models with less labor in data extraction and model training.

The application of unsupervised deep learning in predictive models using electronic health records