BBT.HTI.

509 / NBE-E4080
Decision Support in Healthcare

Lecture 1 – Introduction
Mark van Gils (mark.vangils@tuni.fi), Ivan Radevici (ivan.radevici@aalto.fi),
Pedro Moreno-Sanchez (pedro.morenosanchez@tuni.fi),
Saana Seppälä (saana.seppala@tuni.fi)
 What is this course about? What
do we mean with “Decision
Support in Healthcare”?
• Assist users in complex decision making by
providing tools to process personal health &
illness information in an actionable manner.

• The aim is not automate diagnoses, or ‘take over’ the

work of doctors, but rather make their life easier, e.g.,
• Faster, earlier, easier decision making
• More accurate decision making
• More confidence in decision making

• The tools in this case include biomedical signals

analysis, AI/ML, statistics, data visualisation,
interactive software for clinicians, mobile phone
apps…..
2
 Aim of the course
With successfully passing the course, you
• Understand and can independently formulate data-analysis requirements associated with
different healthcare decision making tasks (risk assessment, early diagnosis, differential
diagnosis, treatment planning, and treatment follow-up)

• Can recognize what kind of approaches (data-driven, rule-based, mechanistic models etc) are
most appropriate for what decision-making challenge

• Have knowledge of, and know how to select and apply methods for data curation and quality
assurance

• Have an understanding of the most common feature extraction and feature selection methods

• Have gained knowledge of the most common AI/ML methods for advanced decision support

• Understand how to objectively assess the performance of AI/ML methods in common healthcare
decision support settings

• Understand considerations such as explainability, privacy-preservation, bias and ethics in

computer-based decision support in health and know which tools are available to address these.
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 Implementation – Lectures and Exercises
• Tampere University and Aalto University co-operation
• Both have their own implementation in each university’s curriculum, with
own Sisu and EXAM implementation
• Course workspaces
• Tampere: Moodle https://moodle.tuni.fi/course/view.php?id=34361
• Aalto: MyCourses https://mycourses.aalto.fi/course/view.php?id=41445

• Courses are given on-site in Tampere and streamed via Zoom, and will
be made available via Panopto (link in the course workspace)

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Who

Mark van Gils, mark.vangils@tuni.fi, overall

responsible for courses both at TAU and Aalto Ivan Radevici, ivan.radevici@aalto.fi ,
course assistant and exercise sessions
at Aalto

Pedro Moreno Sanchez, Saana Seppälä,

pedro.morenosanchez@tuni.fi, saana.seppala@tuni.fi,
course assistant and exercise course assistant at
sessions at TAU TAU

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 Lectures
Lecture Date Time Title Where TAU Where Aalto

1 25.10.2023 Wed 8:30-10:00 Introduction to Decision Support for Healthcare SJ204 zoom

2 27.10.2023 Fri 12:15-14:00 Research and Real-life Decision Support examples SM207 zoom

3 1.11.2023 Wed 8:30-10:00 Considerations regarding inputs and outputs SJ204 zoom

4 3.11.2023 Fri 12:15-14:00 Rule- and model-based approaches SM207 zoom

5 8.11.2023 Wed 8:30-10:00 Data-driven approaches SJ204 zoom

6 10.11.2023 Fri 12:15-14:00 Decision support method development 1 SM207 zoom

7 15.11.2023 Wed 8:30-10:00 Decision support method development 2 SJ204 zoom

8 17.11.2023 Fri 12:15-14:00 Validation, performance assessment SM207 zoom

9 22.11.2023 Wed 8:30-10:00 Ethical, Legal, Societal and other Apects SJ204 zoom

10 24.11.2023 Fri 12:15-14:00 Data - complications SM207 zoom

11 29.11.2023 Wed 8:30-10:00 Uptake and Impact SJ204 zoom

12 1.12.2023 Fri 12:15-14:00 Explainable AI SM207 zoom

6.12.2023 NO LECTURES

13 8.12.2023 Fri 12:15-14:00 Conclusions and outlook SM207 zoom

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Exercise sessions
0 TAU 30.10.2023 Mon 10:15-12:00 Intro to tools and methods in Python SE211 Pedro
Aalto 30.10.2023 Mon 8:15-10:00 Y313 (Otakaari 1) Ivan
1 TAU 6.11.2023 Mon 10:15-12:00 Preprocessing, artefacts and noise SE211 Pedro
Aalto 6.11.2023 Mon 8:15-10:00 Y313 (Otakaari 1) Ivan
2 TAU 13.11.2023 Mon 10:15-12:00 Rule-based and data-driven examples SE211 Pedro
Aalto 13.11.2023 Mon 8:15-10:00 Y313 (Otakaari 1) Ivan
3 TAU 20.11.2023 Mon 10:15-12:00 Feature extraction and selection, simple classifier SE211 Pedro
Aalto 20.11.2023 Mon 8:15-10:00 Y313 (Otakaari 1) Ivan
Classifier examples, Performance estimation, ROC,
4 TAU 27.11.2023 Mon 10:15-12:00 visualisation SE211 Pedro
Aalto 27.11.2023 Mon 8:15-10:00 Y313 (Otakaari 1) Ivan
5 AND 6 TAU 4.12.2023 Mon 10:15-12:00 Explainable AI & Trustworthy AI SE211 Pedro
Aalto 4.12.2023 Mon 8:15-10:00 Y313 (Otakaari 1) Ivan

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Feedback…
•Please feel free to give feedback at any moment (during
lectures, exercises, or afterwards) about practical
implementation and contents
•Hybrid teaching is tricky as there are two different
audiences at the same time. Please notify if someone
makes a comment in zoom that the lecturer doesn’t see,
sound is poor etc etc.

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Study material
•Handouts/slides will form main material -> they cover
the topics that will be asked in the exam

•Additional reading material in Moodle/MyCourses –

articles, books, and links – they are not obligatory but
are useful documents to gain further insight.

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How to pass the course
• Exam via local electronic EXAM implementation. Pick a date in
the period from 11.12 onwards to end December for first
opportunity. Check rules at local website.

• Exercises
• points from submitted answers
• self-assessment

• Points calculation: Exam is max 30 points (5 questions * 6

points). Doing exercises can give you max 6 points already.

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What do you need as background
•Basic understanding of
• (biomedical) data analysis and statistics principles.

•Basic Python knowledge is useful. The very first

“exercise” will help with getting acquainted with it if
needed. (off-line instructions in Tampere, on-site in
Otaniemi)

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Main knowledge to gain from the course
• Understanding the practical issues and differences between
real-life requirements and theoretical research for decision
support in health care

• Getting an understanding of the different approaches that exist,

together with their pros and cons

• Understand how to assess performance critically

• Get an update on current trends and challenges

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Decision Support for
Health - aim
• Assist users in complex decision
making by providing tools to process
personal health & illness information
in an actionable manner.

• The aim is not automate diagnoses, or ‘take

over’ the work of doctors or radiologists, but
rather make their life easier, e.g.,
• Faster, earlier, easier decision making
• More accurate decision making
• More confidence in decision making

13
In practice there are
many different users
•A doctor who needs to make difficult
diagnoses for diseases with complex symptoms

•Hospital management who needs to schedule staff,

allocate equipment, rooms etc. efficiently

•Policy makers who need to understand possible effects

of planned legislations, reimbursement policies, nation-,
or region-wide actions
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•Healthy people who want to stay
healthy

•Companies who want to prevent

sickness absences for employees

•Social and healthcare service providers

who want to prevent worsening
problems

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Artificial Intelligence
Success stories
• Deep learning for (medical) image analysis
• Assistive technologies: logistics,
chatbots, natural-language processing

A robot retrieving drugs in the pharmacy of a major EU projects

PredictND,
hospital. Alibaba Health in three major Chinese Hospitals. CENTER-TBI
Photo: Agence France-Presse
 2023

http://cdn.medicalfuturist.com/wp-
content/uploads/2021/09/0915_tmf_hype_cycle_infographic-01.png
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Reality:

Actual uptake of
AI in healthcare is
much slower than in other fields

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 Data
AI/ML Algorithms need
targets
/sigproc

Environment

@mark_van_gils
 Healthcare AI/ML Healthcare
specific data specific targets
/sigproc

Healthcare environment

@mark_van_gils
Decision Support in Healthcare

In this course we will look at the obstacles

• Messy data
• Complex targets
• Challenging environments

and investigate how to tackle them

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 Some research areas
• Study diseases and their mechanisms -> biological research, genetics, -
omics, systems medicine -> in the end help healthcare professionals make
more informed decisions
• Study organs, physiological processes -> modelling, bioinformatics -> in the
end help healthcare professionals make more informed decisions
• Technical research on medical image and signal analysis, patient
monitoring -> help radiologists, doctors, nurses to work more effectively
• Research on health economics, cost-effectiveness, intervention effects ->
help on decisions regarding investments, management paths to take,
legislation
• Healthcare process optimization -> helps eg hospital management in
resource optimisation
• Psychology, behaviour change technologies -> helps motivating people to
reduce risks, or better live with a disease
• Data visualization, user interaction -> helps informed decision making for
different users 23/10/2023 | 23
Some different decisions to support
• Diagnosis – based on symptoms, decide what a patient state is (what
disease, or no disease at all) -> classifiers
• Prediction, risk assessment, prognosis – Predict the patient state in the
future, or likelihood of some event happening (disease occurring, recovery,
death,…) -> time-series analysis, regression, clustering, classifying,
survival analysis
• Intervention planning – what is the best course of action for a current
patient (medication, operation, send home..) -> time-series analysis,
classification/clustering (of earlier data), modelling
• Disease state management – follow the patient state progress and effect
of, e.g., medications, are things get better, or worse? -> time-series
analysis, regression, profiling, prediction
• Resourcing, procurement and investments, legislation….
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 Application view - different care areas
• Primary care: general practitioners, health centres, no specialists, wide scope of cases
• Secondary care: towards specialization (imaging, laboratory)*
• Tertiary care: specialist care, rare diseases, complex cases, expensive tests
• Occupational healthcare: prevent work-related illnesses and accidents, help workplace function
effectively. Often informally considered ‘primary care for employees’**
• Preventive care: risk minimization (eg cardiac, diabetes, burn-out), “non-medicine interventions” (sleep,
exercise, food)
• Worried well, fitness, lifestyle, sports: wanting at least to stay healthy, but also often further improve
performance
• Disease management, Rehabilitation – living with a disease, regularly monitoring, road towards
improvement or symptom management, regaining of functionalities
• Palliative care – optimizing quality of life for people with severe diseases (often, but not always, near
end of life)
* In Finland the border between primary and secondary care is not as clear-cut as in many other countries, primary care may offer services that are
thought to belong to secondary care in other countries
** Occupational healthcare in Finland (and several other ‘north/west European’ countries) is considerably more available and used than in many
other countries. Around 30% of the Finnish population has access to it, and when applicable, is often preferred thanks to faster and easier access.
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Decision Support in Healthcare –
prediction models

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Maarten van Smeden
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But, take into account the modest relative size of
medicine and health.
Compare to e.g., wellness and beauty care!

https://appinventiv.com/blog/wellness-market-statistics-for-future-growth/ 23/10/2023 | 32
Lecture Date Time Title
1 25.10.2023 Wed 8:30-10:00 Introduction to Decision Support for Healthcare
2 27.10.2023 Fri 12:15-14:00 Research and Real-life Decision Support examples
3 1.11.2023 Wed 8:30-10:00 Considerations regarding inputs and outputs
4 3.11.2023 Fri 12:15-14:00 Rule- and model-based approaches
5 8.11.2023 Wed 8:30-10:00 Data-driven approaches
6 10.11.2023 Fri 12:15-14:00 Decision support method development 1
7 15.11.2023 Wed 8:30-10:00 Decision support method development 2
8 17.11.2023 Fri 12:15-14:00 Validation, performance assessment
9 22.11.2023 Wed 8:30-10:00 Ethical, Legal, Societal and other Apects
10 24.11.2023 Fri 12:15-14:00 Data - complications
11 29.11.2023 Wed 8:30-10:00 Uptake and Impact
12 1.12.2023 Fri 12:15-14:00 Explainable AI
6.12.2023 NO LECTURES
13 8.12.2023 Fri 12:15-14:00 Conclusions and outlook

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