AdaDiag: Adversarial Domain Adaptation of Diagnostic Prediction with Clinical Event Sequences

Early detection of heart failure (HF) can provide patients with the opportunity for more timely intervention and better disease management, as well as efficient use of healthcare resources. Recent machine learning (ML) methods have shown promising performance on diagnostic prediction using temporal sequences from electronic health records (EHRs). In practice, however, these models may not generalize to other populations due to dataset shift. Shifts in datasets can be attributed to a range of factors such as variations in demographics, data management methods, and healthcare delivery patterns. In this paper, we use unsupervised adversarial domain adaptation methods to adaptively reduce the impact of dataset shift on cross-institutional transfer performance. The proposed framework is validated on a next-visit HF onset prediction task using a BERT-style Transformer-based language model pre-trained with a masked language modeling (MLM) task. Our model empirically demonstrates superior prediction performance relative to non-adversarial baselines in both transfer directions on two different clinical event sequence data sources.