Adversarial Robust Federated Learning for Secure Mortality Risk Prediction using Multi-Institutional Electronic Health Records (EHRs)

Electronic Health Records (EHRs) are the main source of data that enable data-driven clinical decision-making. However, the sensitive character of EHRs and the strict privacy policies in the healthcare sector make centralized model training difficult or impossible. An Adversarially Robust Federated Learning (AR-FL) model is proposed to predict patient mortality risk across different institutions without sharing the original EHR data. The primary aim of this study is to introduce a secure, reproducible, and scalable procedure for training privacy-preserving, adversarially resilient predictive models across diverse clinical settings. This study employs a min-max adversarial training approach at each institution to improve robustness against worst-case perturbations. A domain-aware attention mechanism is also employed to dynamically adapt to differences in clinical feature distributions within the institution. For confidentiality, the model updates are pooled using privacy-protecting methods that block the revealing of sensitive patient data during federated communication. This study specifies the entire process from data preprocessing and adversarial example generation to local training, secure aggregation, and global model evaluation, allowing for a consistent implementation across various healthcare environments. Experimental validations demonstrate that the AR-FL model achieves superior predictive performance, adversarial robustness, and cross-institutional generalization. By establishing a standardized training and evaluation pipeline, this study supports the development of reliable and ethically compliant clinical decision-support systems.