PMID- 35927974
OWN - NLM
STAT- MEDLINE
DCOM- 20221012
LR  - 20230805
IS  - 1527-974X (Electronic)
IS  - 1067-5027 (Print)
IS  - 1067-5027 (Linking)
VI  - 29
IP  - 11
DP  - 2022 Oct 7
TI  - Keeping synthetic patients on track: feedback mechanisms to mitigate performance 
      drift in longitudinal health data simulation.
PG  - 1890-1898
LID - 10.1093/jamia/ocac131 [doi]
AB  - OBJECTIVE: Synthetic data are increasingly relied upon to share electronic health 
      record (EHR) data while maintaining patient privacy. Current simulation methods 
      can generate longitudinal data, but the results are unreliable for several 
      reasons. First, the synthetic data drifts from the real data distribution over 
      time. Second, the typical approach to quality assessment, which is based on the 
      extent to which real records can be distinguished from synthetic records using a 
      critic model, often fails to recognize poor simulation results. In this article, 
      we introduce a longitudinal simulation framework, called LS-EHR, which addresses 
      these issues. MATERIALS AND METHODS: LS-EHR enhances simulation through 
      conditional fuzzing and regularization, rejection sampling, and prior knowledge 
      embedding. We compare LS-EHR to the state-of-the-art using data from 60 000 EHRs 
      from Vanderbilt University Medical Center (VUMC) and the All of Us Research 
      Program. We assess discrimination between real and synthetic data over time. We 
      evaluate the generation process and critic model using the area under the 
      receiver operating characteristic curve (AUROC). For the critic, a higher value 
      indicates a more robust model for quality assessment. For the generation process, 
      a lower value indicates better synthetic data quality. RESULTS: The LS-EHR critic 
      improves discrimination AUROC from 0.655 to 0.909 and 0.692 to 0.918 for VUMC and 
      All of Us data, respectively. By using the new critic, the LS-EHR generation 
      model reduces the AUROC from 0.909 to 0.758 and 0.918 to 0.806. CONCLUSION: 
      LS-EHR can substantially improve the usability of simulated longitudinal EHR 
      data.
CI  - (c) The Author(s) 2022. Published by Oxford University Press on behalf of the 
      American Medical Informatics Association. All rights reserved. For permissions, 
      please email: journals.permissions@oup.com.
FAU - Zhang, Ziqi
AU  - Zhang Z
AD  - Department of Computer Science, Vanderbilt University, Nashville, Tennessee, USA.
FAU - Yan, Chao
AU  - Yan C
AUID- ORCID: 0000-0002-6719-1388
AD  - Department of Biomedical Informatics, Vanderbilt University Medical Center, 
      Nashville, Tennessee, USA.
FAU - Malin, Bradley A
AU  - Malin BA
AD  - Department of Computer Science, Vanderbilt University, Nashville, Tennessee, USA.
AD  - Department of Biomedical Informatics, Vanderbilt University Medical Center, 
      Nashville, Tennessee, USA.
AD  - Department of Biostatistics, Vanderbilt University Medical Center, Nashville, 
      Tennessee, USA.
LA  - eng
GR  - UL1 TR002243/TR/NCATS NIH HHS/United States
GR  - U2COD023196/GF/NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - England
TA  - J Am Med Inform Assoc
JT  - Journal of the American Medical Informatics Association : JAMIA
JID - 9430800
SB  - IM
MH  - Computer Simulation
MH  - Electronic Health Records
MH  - Feedback
MH  - Humans
MH  - *Population Health
PMC - PMC9552284
OTO - NOTNLM
OT  - electronic health records (EHRs)
OT  - generative adversarial networks (GANs)
OT  - longitudinal simulation
OT  - privacy
OT  - synthetic data
EDAT- 2022/08/06 06:00
MHDA- 2022/10/13 06:00
PMCR- 2023/08/04
CRDT- 2022/08/05 01:53
PHST- 2022/05/13 00:00 [received]
PHST- 2022/06/25 00:00 [revised]
PHST- 2022/07/22 00:00 [accepted]
PHST- 2022/08/06 06:00 [pubmed]
PHST- 2022/10/13 06:00 [medline]
PHST- 2022/08/05 01:53 [entrez]
PHST- 2023/08/04 00:00 [pmc-release]
AID - 6655786 [pii]
AID - ocac131 [pii]
AID - 10.1093/jamia/ocac131 [doi]
PST - ppublish
SO  - J Am Med Inform Assoc. 2022 Oct 7;29(11):1890-1898. doi: 10.1093/jamia/ocac131.