2017 IEEE 19th International Conference on e-Health Networking, Applications and Services (Healthcom)

A Survey of Data Mining Technology on Electronic Medical Records

Wencheng Sun1 , Zhiping Cai1 , Fang Liu1 , Shengqun Fang1 , Guoyan Wang2
1 College of Computer, National University of Defense Technology, Changsha 410073, China
2 SysCan Biotechnology Company Limited, Suzhou215000, China
Corresponding author: Zhiping Cai (zpcai@nudt.edu.cn)
Abstract—Medical institutes use Electronic Medical Record importance of medical health and the growing social value
(EMR) to record a series of medical events, including it creates, EMR data min ing has become a hot topic in the
diagnostic information (diagnosis codes), procedures academia and industry circle.
performed (procedure codes) and admission details. Plenty of
II. RESEARCH PROGRESS OF DAT A M INING
data mining technologies are applied in the EMR data set for
TECHNOLOGY ON EMR
knowledge discovery, which is precious to medical practice.
The knowledge found is conducive to develop treatment plans, Data mining (DM), also known as Knowledge
improve health care and reduce medical expenses, moreover, it Discovery and Data M ining (KDD), refers to the process of
could also provide further assistance to predict and control discovering implicit and valuable patterns fro m data sets.

outbreaks of epidemic disease. The growing social value it Data mining techniques can be divided into two main

creates has made it a hot spot for experts and scholars. In this categories: descriptive (unsupervised) learning and

paper, we will summarize the research status of data mining predictive (supervised) learning [2]. Descriptive data
technologies on EMR, and analyze the challenges that EMR mining, a kind of exp loratory analysis methods, attempts to

research is confronting currently.

measure the similarity between records and discover
worthy patterns and relationships. The most important
Keywords—EMR; data mining; classification; clustering; techniques applied in descriptive data min ing are
regression Clustering and Association Rules Mining. Pred ictive data
mining attempts to classify data based on specific targets
I. INT RODUCT ION
(or tags) to construct predictive models and generate
EM R contains many kinds of health-care data, wh ich
predictive ru les. Classification algorith m plays a great role
can be divided into three kinds: structured data,
both in predictive learning and data min ing technologies
semi-structured data and unstructured data. Structured data,
used in EM R. Table 1 shows the current research progress
which is generally stored in fixed -mode databases,
of data mining technology on EMR.
including basic information (age, height, weight, blood type,
etc), drugs taken and allergies.Semi-structured data has the A. Classification Technology

flow chart fo rmat, similar to Resource Description Files
(RDF), including name, value and time-stamp. The
unstructured text [1] is one kind of narrat ive data, such as
clin ical notes, surgical records, and pathology reports. The
unstructured text is a treasure trove for data min ing, but
lacks a co mmon structural framework, and there are many
errors, such as improper grammatical use, spelling errors
and semantic ambiguities, which increase complexity.
EM R data are diverse and rich, and each source data or
feature-subset can provide different insights. Owing to the
Classification process can be divided into t wo stages :
the learning stage and the classification stage.
Classification model is generally constructed in the
learning stage, and the model’s accuracy would be
estimated in the classification stage. Before seeking
med ical care, patients are normally expected to know how
their condition is, serious or mild, early or late. For doctors
and nurses, they may wish to know wh ich treat ment
patients should receive, plan A or plan B. So mething
similar is very suitable for classification technology to

978-1-5090-6704-6/17/$31.00 ©2017 IEEE

 2017 IEEE 19th International Conference on e-Health Networking, Applications and Services (Healthcom)
solve. As can be seen from thes e examp les above, it is
necessary to provide tag of training sets when building
classifier. That is, the class label of training sets is known,
so classification is a kind of supervising learning methods.
Lo H Z et al. [3] p resented an algorith m, based on
Naive Bayesian, which allow existing ADR(Adverse Drug
Reactions) detection methods, which were developed for
spontaneous reporting systems, to be applied d irectly to the
longitudinal EHR data. Hannan B et al. [5] constructed a
system called iHANDs using a Bayesian in ference
mechanis m to identify the level of confidence for each
possible cause. Li C et al. [6] proposed a novel hierarchical
Bayesian non-parametric model, the word
dependent Chinese restaurant franchise (wddCRF), wh ich
incorporates word-to-word distances to
semantically-coherent disease topics. Somanchi S et al. [ 7]
used the SVM (Support Vector Machine) method to predict
the Code Blue to reduce mortality. Rav indranath K R [ 8]
constructed a CDSS (Clinical Decision Decision System)
using decision tree techniques and proposed an extended
sub-tree strategy to handle continuous values. Chen Z et al.
[9] proposed two novel modifications to standard neural net
training to discover and detect characteristic patterns of
physiology in clin ical t ime series data. Baba Y et al. [11]
used the multi-classifier method to construct low-cost
preventive approaches to deal with non-communicable
diseases, by predicting subjective risk,
recommendation and future risk.
B. Clustering Technology
Clustering is a process of dividing a data set into
different subsets (also known as groups or clusters), and
ensuring that data objects within the same subset are highly
similar, and the data objects between different subsets are
very dissimilar. In the med ical field, there are many areas
we actually have little knowledge about, such as super
bacteria and new influenza, so their accumu lated data is
difficult to be classified into different types. At this point,
clustering technology is needed, and different clustering
technologies will generate different subsets.
Rabbi K et al. [12] proposed a clustering algorith m for
sensory data in health-care organizat ion based on dynamic
feature selection known as PCEHRClust, which is to
improve the quality of medical services. Canino G et al. [13]
proposed a methodology to analyze Diagnosis Related
Group(DRG) records and used a semantics -based clustering
procedure to look for similar patterns of diseases.
Toddenroth D et al. [14] proposed strategies to adapt heat
maps for the search for associations and causal effects
within routine EM R data. The use of measures of
association as a clustering input proved to be valid, has
been taken as a trigger to apply transformations. Maya S et
al. [15] proposed a bottom-up hierarchical clustering
method to cluster the spacial patterns of the visual field in
distance glaucoma patients to analyze the progression patterns of
glaucoma.
discover
C. Frequent Pattern Mining
Frequent pattern represents a tread in the data set. The
med ical entity names wh ich occur frequently must have a
certain relevance, which is of help to next treat ment. For
example, adverse drug reactions and changes in nursing
methods will lead to deteriorat ion or imp rovement of
condition.
Huang et al. [16] used a combination of two
semantic-driven frequent pattern mining algorith ms to
analyze adverse drug events and optimize drug alert
methods. Zhang L et al. [17] p ropose a topic-model-based
SPM(Sequential Pattern M ining) approach to find disease
drug
progression patterns. Peter A et al. [18] co mbined frequent
sequence mining techniques with advanced visualizat ions
to support the integration of data-driven insights into care
pathway discovery.
D. Association Rule Mining
Association Rule Min ing is usually used after Frequent
Pattern Mining, and sometimes these two mining methods
are unified as Frequent Pattern Mining. Association Rule
Mining can help d iscover the rule relat ions between
med ical entit ies in data set, such as drugs and symptoms,
disease and condition, and help confirm the confidence of
these relations.
Chute C G et al. [19] co mb ined semantic web with
association rule mining technology to identify potential
 2017 IEEE 19th International Conference on e-Health Networking, Applications and Services (Healthcom)
drug-drug interactions to provide guidance for drug therapy
and post-treatment interventions. Simon et al. [20] aimed to
apply association rule min ing to EM R to discover sets of
risk factors and their corresponding sub-populations that
represent patients at particularly high risk of developing
diabetes. Chen J H et al. [21] used association methods to
improve the accuracy of sequential predict ion and to build
a medical decision support system to predict ICU mortality.
E. Time Series Mining
For patients, imp rovement o r deterioration of their
condition is time-vary ing. If doctors master the evolution in
advance, they can conduct risk predict ion. Fu rthermore, for
those treatment plans closely related to time, such as
emergency treatment of heart-failure and advanced cancer
treatment, time series mining technology is more effective.
Moskovitch R et al. [23] presented Maitreya, a
framework for the predict ion of outcome events, to learn
predictive models based on the temporal patterns . Yin C et
al. [25] used relevance feedback for retrieving time series
data to provide decision support. Kop R et al. [26] studied
the benefit of using advanced data mining techniques for
Colo Rectal Cancer (CRC), and d iscovered
state-of-the-art data min ing techniques, such as temporal
data mining, are able to generate better predictive models.
Zhou Z et al. [27] proposed a predictive method using
spatio-temporal kernel density estimat ion (stKDE), and
provide spatial density predictions for ambulance demand
in Toronto. Liu C er al. [29] developed a novel
representation, namely the temporal g raph, for the
longitudinal and heterogeneous properties in EMR.
F. Regression Algorithm
This method is to discover mathematical relat ions
between medical data with relevant mathematical tools
applied. Regression algorithms are generally used to
identify relationships between variables, such as the extent
to which variable A affects the variable B, or predict the
future trend of variables.
TABLE I. T ABLE T YP E STYLES SUMMARY OF DATA MINING TECHNOLOGIES ON EMR
DM T YPE MET HODS
Vin zamu ri B et al. [31] proposed an algorith m,
combined with two unique correlation based regularizers
with co x regression, which has been proved to be valid in
several synthetic data sets and EHR data about heart failure .
Ftoerper et al. [32] developd a web-based tool that forecasts
the daily bed need for admissions using routinely available
clin ical data within EM R. Tran T et al. [33] constructed a
novel ordinal regression framework for p redicting med ical
risk stratification fro m EM R, to solve a large short-term
suicide risk predict ion problem. Wang Z et al. [35]
developed a dynamic Poisson auto-regressive model with
exogenous inputs variables (DPA RX) for flu forecasting, to
predict short-term ILI (Influenza-like-illness) case count.
G. Hybrid Model
A hybrid model is the one built after co mprehensive
consideration of advantages and disadvantages of various
mining technologies. Thus, it can be said that, after
reasonable deliberation, hybrid models have better
performance than those models built with a single
technology. When we use clustering technology to predict
suicidal behaviors of people with mental illness, if the
that target data set could be preprocessed ahead of time, it is
believed that the results will be improved.
Liu M et al. [37] used different methods such as neural
networks, Bayesian and so on, to test adverse drug
reactions. David M et al. [38] classified laboratory data and
physiologic data using decision trees and naive Bayes
classifiers, to evaluate six d iscretization strategies, both
supervised and unsupervised. Chen Y et al. [39] proposed
an approach based on bi-clustering and neural network for
classification of lesions in breast ultrasound. Amin S et al.
[40] proposed a hybrid system, for pred iction of heart
disease using major risk factors, involved with neural
networks and genetic algorithms.
APPLICAT ION REFERENCE YEAR
 2017 IEEE 19th International Conference on e-Health Networking, Applications and Services (Healthcom)

Naive Bayesian Adverse drug reactions [3] 2013

Bayesian grading framework Infectious disease [4] 2015

Bayesian reasoning mechanism Personal health decision making system [5] 2014
Stratified Bayesian model Disease risk prediction [6] 2016
Classification
Support Vector Machines ICU risk prediction [7] 2015
Technology
Decision tree Decision Support Systems [8] 2015
Neural network EMR data processing [9] 2015

Dynamic classification and hierarchical model Re - hospitalization risk prediction [10] 2015
Multi-classifier method Noncommunicable disease prediction [11] 2015

Dynamic feature selection Quality of medical service [12] 2015

Clustering A semantic - based clustering method Disease patterns [13] 2015

Technology Correlation measurement EMR data processing [14] 2014
A bottom-up hierarchical clustering method Glaucoma treatment [15] 2015

Frequent Frequent pattern mining Adverse drug reactions [16] 2013

Pattern Clinical subject sequence pattern mining Clinical patterns [17] 2016
Mining Frequent pattern mining and visualization Nursing path [18] 2015
Semantic web and association rule mining Potential drug-drug interactions [19] 2013

Association Association rule mining Diabetes risk prediction [20] 2015

Rule Mining Association rule mining Recommendation systems [21] 2016

Association methods ICU mortality prediction [22] 2014

T ime series mining Risk prediction [23] 2016
T ime series mining Personalized medical care [24] 2015

Relevance feedback Decision-making support [25] 2014

T ime Series T ime series mining Risk prediction of colorectal cancer [26] 2015

Mining Space-time series technology Ambulance positioning [27] 2015

T ime series mining Risk prediction of heart disease [28] 2014

Phenotyping framework Risk prediction of heart failure [29] 2015

T ime series mining Disease risk prediction [30] 2014

Cox regression Heart failure treatment [31] 2013

Multivariate logistic regression Analysis of Cardiac Surgical Bed Demand [32] 2016
Regression Ordinal regression framework Suicide risk prediction [33] 2015
Algorithm Generalized linear dynamic model Death probability risk prediction [34] 2015

Dynamic Poisson Auto-regressive Model Influenza prediction [35] 2015

Sparse logistic regression Disease risk prediction [36] 2014

Neural networks and Bayesian Adverse drug reactions [37] 2013

Decision trees and naive Bayes classifiers ICU data classification [38] 2013
Hybrid Model Bi-clustering and neural network Breast cancer treatment [39] 2016

Neural networks and genetic algorithms Heart disease risk prediction [40] 2013
K-means and clustering technologies EMR data processing [41] 2014
 2017 IEEE 19th International Conference on e-Health Networking, Applications and Services (Healthcom)
III. CONCLUSION
As a new research field, EM R data min ing is highly
valued. Ho wever, there are some challenges that constrain
its development.
1. Data Quality. EM R data itself has incompleteness,
redundancy and diversity, therefore, it can not be directly
applied in data min ing. Data pre-processing is a must, and
different data sets need different methods, according to
their own data characteristics. In addit ion, as narrat ive data,
unstructured text doesn’t have an unified framework, and
are generally processed with NLP(Natural Language
Processing) and text mining methods.
2. Data Sharing and Privacy. At present, many patients
suffer fro m social mo rality and ethical stress, and worse
still, they are unwilling or afraid to receive med ical
treatment, because of their illness or symptoms, such as
unmarried pregnancy, HIV o r other private issues. In the
future, EMR will be circulated as a commercial product or
public goods, which would pro mote the develop ment of
med ical career, but at the same time cause great pressure to
privacy protection.
3. EM R Management. The way to manage EM R and the
standard of EMR varies according to the HIS in each
med ical institutes, which makes numerous applications
with EM R as the core, such as medical decision support
system , mobile medical and other, difficult to pro mote.
Moreover, the cloud technology will play a larger ro le in
EMR storage, transmission and management.
The healthcare industry is predominantly moving
towards accessible and quality health services, and EM R
data mining will continue to evolve fast, leading to
impactful and positive changes
to the way people work and live.
REFERENCES
[1] Feldman, K., Hazekamp, N., & Chawla, N. V. (2016). Mining the
Clinical Narrative: All T ext are Not Equal. IEEE International
Conference on Healthcare Informatics (pp.271-280). IEEE.
[2] Fayyad, U., Piatetsky-Shapiro, G., & Smyth, P. (1996). The KDD
process for extracting useful knowledge from volumes of data.
ACM.
[3] Lo, H. Z., Ding, W., & Nazeri, Z. (2013). Mining Adverse Drug
Reactions from Electronic Health Records. IEEE, International
Conference on Data Mining Workshops (Vol.309, pp.1137-1140).
IEEE.
[4] Fan, K., Eisenberg, M., Walsh, A., Aiello, A., & Heller, K. (2015).
Hierarchical Graph-Coupled HMMs for Heterogeneous
Personalized Health Data. The, ACM SIGKDD International
Conference (pp.239-248). ACM.
[5] Hannan, B., Zhang, X., & Sethares, K. (2014). iHANDs:Intelligent
Health Advising and Decision-Support Agent. Ieee/wic/acm
International Joint Conferences on Web Intelligence (Vol.3,
pp.294-301). ACM.
[6] Li, C., Rana, S., Phung, D., & Venkatesh, S. (2016). Hierarchical
bayesian nonparametric models for knowledge discovery from
electronic medical records. Knowledge-Based Systems, 99, 168-182.
[7] Somanchi, S., Adhikari, S., Lin, A., Eneva, E., & Ghani, R. (2015).
Early Prediction of Cardiac Arrest (Code Blue) using Electronic
Medical Records.ACM SIGKDD International Conference on
Knowledge Discovery and Data Mining (pp.2119-2126). ACM.
[8] Ravindranath, K. R. (2015). Clinical Decision Support System for
heart diseases using Extended sub tree. International Conference on
Pervasive Computing (pp.1-5).
[9] Che, Z., Kale, D., Li, W., Bahadori, M. T., & Liu, Y. (2015). Deep
Computational Phenotyping. The, ACM SIGKDD International
Conference(pp.507-516). ACM.
[10] Basu Roy, S., T eredesai, A., Zolfaghar, K., Liu, R., Hazel, D., &
Newman, S., et al. (2015). Dynamic Hierarchical Classification for
Patient Risk-of-Readmission. The, ACM SIGKDD International
Conference (pp.1691-1700). ACM.
[11] Baba, Y., Kashima, H., Nohara, Y., Kai, E., Ghosh, P., & Islam, R.,
et al. (2015). Predictive Approaches for Low-Cost Preventive
Medicine Program in Developing Countries. The, ACM SIGKDD
International Conference(Vol.1, pp.1681-1690). ACM.
[12] Rabbi, K., Mamun, Q., & Islam, M. R. (2015). Dynamic feature
selection (DFS) based Data clustering technique on sensory data
streaming in eHealth record system. Industrial Electronics and
Applications (pp.661-665). IEEE.
[13] Canino, G., Guzzi, P., Tradigo, G., & Zhang, A. (2015). On the
analysis of diseases and their related geographical data. IEEE
Journal of Biomedical & Health Informatics, 1-1.
[14] Toddenroth, D., Ganslandt, T., Castellanos, I., Prokosch, H. U., &
Bürkle, T . (2014). Employing heat maps to mine associations in
structured routine care data. Artificial Intelligence in
Medicine, 60(2), 79.
[15] Maya, S., Morino, K., Murata, H., Asaoka, R., & Yamanishi, K.
(2015). Discovery of Glaucoma Progressive Patterns Using
Hierarchical MDL-Based Clustering. The, ACM SIGKDD
International Conference (pp.1979-1988). ACM.
[16] Huang, J., Huan, J., Tropsha, A., & Dang, J. (2013).
Semantics-driven frequent data pattern mining on electronic health
 2017 IEEE 19th International Conference on e-Health Networking, Applications and Services (Healthcom)
records for effective adverse drug event monitoring. IEEE
International Conference on Bioinformatics and
Biomedicine (pp.608-611). IEEE.
[17] Zhang, L., Zhao, J., Wang, Y., & Xie, B. (2016). Mining patterns of
disease progression: a topic-model-based approach. Studies in
Health Technology & Informatics, 228, 354.
[18] Perer, A., Wang, F., & Hu, J. (2015). Mining and exploring care
pathways from electronic medical records with visual
analytics. Journal of Biomedical Informatics, 56(C), 369.
[19] Pathak, J., Kiefer, R. C., & Chute, C. G. (2013). Mining drug-drug
interaction patterns from linked data: A case study for Warfarin,
Clopidogrel, and Simvastatin. IEEE International Conference on
Bioinformatics and Biomedicine (pp.23-30). IEEE.
[20] Simon, G. J., Caraballo, P. J., Therneau, T. M., & Cha, S. S. (2015).
Extending association rule summarization techniques to assess risk
of diabetes mellitus. Knowledge & Data Engineering IEEE
Transactions on,27(1), 130-141.
[21] Chen, J. H., Podchiyska, T ., & Altman, R. B. (2016). Orderrex:
clinical order decision support and outcome predictions by
data-mining electronic medical records. Journal of the American
Medical Informatics Association,23(2), 339.
[22] Chen, J. H., & Altman, R. B. (2014). Automated physician order
recommendations and outcome predictions by data-mining
electronic medical records. Amia Joint Summits on Translational
Science Proceedings Amia Joint Summits on Translational
Science, 2014, 206-210.
[23] Moskovitch, R., Choi, H., Hripcsak, G., & Tatonetti, N. (2016).
Prognosis of clinical outcomes with temporal patterns and
experiences with one class feature selection. IEEE/ACM
Transactions on Computational Biology & Bioinformatics, PP(99),
1-1.
[24] Yadav, P., Steinbach, M., Pruinelli, L., & Westra, B. (2015).
Forensic Style Analysis with Survival Trajectories. IEEE
International Conference on Data Mining (pp.1069-1074). IEEE.
[25] Yin, C., Ishikawa, H., & Takama, Y. (2014). Proposal of time series
data retrieval with user feedback. IEEE International Conference on
Granular Computing (pp.358-361). IEEE.
[26] Kop, R., Hoogendoorn, M., Moons, L. M. G., Numans, M. E., &
Teije, A. T . (2015). On the advantage of using dedicated data
mining techniques to predict colorectal cancer. Lecture Notes in
Computer Science, 9105(5), 133-142.
[27] Zhou, Z., & Matteson, D. S. (2015). Predicting Ambulance Demand:
a Spatio-Temporal Kernel Approach. ACM SIGKDD International
Conference on Knowledge Discovery and Data
Mining (pp.2297-2303). ACM.
[28] Chia, C. C., & Syed, Z. (2014). Scalable noise mining in long-term
electrocardiographic time-series to predict death following heart
attacks.ACM SIGKDD International Conference on Knowledge
Discovery and Data Mining (pp.125-134). ACM.
[29] Liu, C., Wang, F., Hu, J., & Xiong, H. (2015). Temporal
Phenotyping from Longitudinal Electronic Health Records: A
Graph Based Framework. The, ACM SIGKDD International
Conference (pp.705-714). ACM.
[30] Zhou, J., Wang, F., Hu, J., & Ye, J. (2014). From micro to macro:
data driven phenotyping by densification of longitudinal electronic
medical records. ACM SIGKDD International Conference on
Knowledge Discovery and Data Mining (pp.135-144). ACM.
[31] Vinzamuri, B., & Reddy, C. K. (2013). Cox Regression with
Correlation Based Regularization for Electronic Health
Records. IEEE, International Conference on Data
Mining (pp.757-766). IEEE.
[32] Ftoerper, M., EleniFlanagan, SaulehSiddiqui, JeffAppelbaum,
Kkasper, E., & ScottLevin. (2015). Cardiac catheterization
laboratory inpatient forecast tool: a prospective evaluation. Journal
of the American Medical Informatics Association Jamia, 23(e1).
[33] Tran, T., Phung, D., Luo, W., & Venkatesh, S. (2015). Stabilized
sparse ordinal regression for medical risk stratification. Knowledge
and Information Systems, 43(3), 555-582.
[34] Caballero Barajas, K. L., & Akella, R. (2015). Dynamically
Modeling Patient's Health State from Electronic Medical Records:
A T ime Series Approach. ACM SIGKDD International Conference
on Knowledge Discovery and Data Mining (pp.69-78). ACM.
[35] Wang, Z., Chakraborty, P., Mekaru, S. R., Brownstein, J. S., Ye, J.,
& Ramakrishnan, N. (2015). Dynamic Poisson Autoregression for
Influenza-Like-Illness Case Count Prediction. The, ACM SIGKDD
International Conference (pp.1285-1294). ACM.
[36] Wang, F., Zhang, P., Qian, B., Wang, X., & Davidson, I. (2014).
Clinical risk prediction with multilinear sparse logistic
regression. ACM SIGKDD International Conference on Knowledge
Discovery and Data Mining(pp.145-154). ACM.
[37] Liu, M., McPeek Hinz, E. R., Matheny, M. E., Denny, J. C.,
Schildcrout, J. S., & Miller, R. A., et al. (2013). Comparative
analysis of pharmacovigilance methods in the detection of adverse
drug reactions using electronic medical records. Journal of the
American Medical Informatics Association Jamia, 20(3), 420-6.
[38] David M Maslove, Tanya Podchiyska, Henry J Lowe. (2012).
Discretization of continuous features in clinical datasets. Journal of
the American Medical Informatics Association, 20(3), 544-53.
[39] Chen, Y., & Huang, Q. (2016). An approach based on biclustering
and neural network for classification of lesions in breast
ultrasound.International Conference on Advanced Robotics and
Mechatronics(pp.597-601).
[40] Amin, S. U., Agarwal, K., & Beg, R. (2013). Genetic neural
network based data mining in prediction of heart disease using risk
factors. Information & Communication
Technologies (pp.1227-1231). IEEE.
[41] Sumana, B. V., & Santhanam, T. (2014). Prediction of diseases by
cascading clustering and classification. International Conference on
Advances in Electronics, Computers and Communications (pp.1-8).