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The importance of domain knowledge – A healthcare data science perspective

Data scientists have (and need) many skills. They are frequently either former academic researchers or software engineers, with knowledge and skills in statistics, programming, machine learning, and many other domains of mathematics and computer science. These skills are general and allow data scientists to offer valuable services to almost any field. However, data scientists in some cases find themselves in industries they have relatively little knowledge of.

This is especially true in the healthcare field. In healthcare, there is an enormous amount of important clinical knowledge that might be relevant to a data scientist. It is unreasonable to expect a data scientist to not only have all of the skills typically required of a data scientist, but to also have all of the knowledge a medical professional may have.

Why is domain knowledge necessary?

This lack of domain knowledge, while perfectly understandable, can be a major barrier to healthcare data scientists. For one thing, it’s difficult to come up with project ideas in a domain that you don’t know much about. It can also be difficult to determine the type of data that may be helpful for a project – if you want to build a model to predict a health outcome (for example, whether a patient has or is likely to develop a gastrointestinal bleed), you need to know what types of variables might be related to this outcome so you can make sure to gather the right data.

Knowing the domain is useful not only for figuring out projects and how to approach them, but also for having rules of thumb for sanity checks on the data. Knowing how data is captured (is it hand-entered? Is it from machines that can give false readings for any number of reasons?) can help a data scientist with data cleaning and from going too far down the wrong path. It can also inform what true outliers are and which values might just be due to measurement error.

Often the most challenging part of building a machine learning model is feature engineering. Understanding clinical variables and how they relate to a health outcome is extremely important for this. Is a long history of high blood pressure important for predicting heart problems, or is only very recent history? How long a time horizon is considered ‘long’ or ‘short’ in this context? What other variables might be related to this health outcome? Knowing the domain can help direct the data exploration and greatly speed (and enhance) the feature engineering process.

Once features are generated, knowing what relationships between variables are plausible helps for basic sanity checks. If you’re finding the best predictor of hospitalization is the patient’s eye color, this might indicate an issue with your code. Being able to glance at the outcome of a model and determine if they make sense goes a long way for quality assurance of any analytical work.

Finally, one of the biggest reasons a strong understanding of the data is important is because you have to interpret the results of analyses and modeling work. Knowing what results are important and which are trivial is important for the presentation and communication of results. An analysis that determines there is a strong relationship between age and mortality is probably well-known to clinicians, while weaker but more surprising associations may be of more use. It’s also important to know what results are actionable. An analysis that finds that patients who are elderly are likely to end up hospitalized is less useful for trying to determine the best way to reduce hospitalizations (at least, without further context).

How do you get domain knowledge?

In some industries, such as tech, it’s fairly easy and straightforward to see an end-user’s prospective. By simply viewing a website or piece of software from the user’s point of view, a data scientist can gain a lot of the needed context and background knowledge needed to understand where their data is coming from and how their model output is being used. In the healthcare industry, it’s more difficult. A data scientist can’t easily choose to go through med school or the experience of being treated for a chronic illness. This means there is no easy single answer to where to gain domain knowledge. However, there are many avenues available.

Reading literature and attending presentations can boost one’s domain knowledge. However, it’s often difficult to find resources that are penetrable for someone who is not already a clinician. To gain deep knowledge, one needs to be steeped in the topic. One important avenue to doing this is through the establishment of good relationships with clinicians. Clinicians can be powerful allies that can help point you in the right direction for understanding your data, and simply by chatting with them you can gain important insights. They can also help you visit the clinics or practices to interact with the people that perform the procedures or even watch the procedures being done. At Fresenius Medical Care, where I work, members of my team regularly visit clinics. I have in the last year visited one of our dialysis clinics, a nephrology practice, and a vascular care unit. These experiences have been invaluable to me in developing my knowledge of the treatment of chronic illnesses.

In conclusion, it is crucial for data scientists to acquire basic familiarity in the field they are working in and in being part of collaborative teams that include people who are technically knowledgeable in the field they work in. This said, acquiring even an essential understanding (such as “Medicine 101”) may go a long way for the data scientists in being able to become self-sufficient in essential feature selection and design.

 

Data Science and Predictive Analytics in Healthcare

Doing data science in a healthcare company can save lives. Whether it’s by predicting which patients have a tumor on an MRI, are at risk of re-admission, or have misclassified diagnoses in electronic medical records are all examples of how predictive models can lead to better health outcomes and improve the quality of life of patients.  Nevertheless, the healthcare industry presents many unique challenges and opportunities for data scientists.

The impact of data science in healthcare

Healthcare providers have a plethora of important but sensitive data. Medical records include a diverse set of data such as basic demographics, diagnosed illnesses, and a wealth of clinical information such as lab test results. For patients with chronic diseases, there could be a long and detailed history of data available on a number of health indicators due to the frequency of visits to a healthcare provider. Information from medical records can often be combined with outside data as well. For example, a patient’s address can be combined with other publicly available information to determine the number of surgeons that practice near a patient or other relevant information about the type of area that patients reside in.

With this rich data about a patient as well as their surroundings, models can be built and trained to predict many outcomes of interest. One important area of interest is models predicting disease progression, which can be used for disease management and planning. For example, at Fresenius Medical Care (where we primarily care for patients with chronic conditions such as kidney disease), we use a Chronic Kidney Disease progression model that can predict the trajectory of a patient’s condition to help clinicians decide whether and when to proceed to the next stage in their medical care. Predictive models can also notify clinicians about patients who may require interventions to reduce risk of negative outcomes. For instance, we use models to predict which patients are at risk for hospitalization or missing a dialysis treatment. These predictions, along with the key factors driving the prediction, are presented to clinicians who can decide if certain interventions might help reduce the patient’s risk.

Challenges of data science in healthcare

One challenge is that the healthcare industry is far behind other sectors in terms of adopting the latest technology and analytics tools. This does present some challenges, and data scientists should be aware that the data infrastructure and development environment at many healthcare companies will not be at the bleeding edge of the field. However it also means there are a lot of opportunities for improvement, and even small simple models can yield vast improvements over current methods.

Another challenge in the healthcare sector arises from the sensitive nature of medical information. Due to concerns over data privacy, it can often be difficult to obtain access to data that the company has. For this reason, data scientists considering a position at a healthcare company should be aware of whether there is already an established protocol for data professionals to get access to the data. If there isn’t, be aware that simply getting access to the data may be a major effort in itself.

Finally, it is important to keep in mind the end-use of any predictive model. In many cases, there are very different costs to false-negatives and false-positives. A false-negative may be detrimental to a patient’s health, while too many false-positives may lead to many costly and unnecessary treatments (also to the detriment of patients’ health for certain treatments as well as economy overall). Education about the proper use of predictive models and their limitations is essential for end-users. Finally, making sure the output of a predictive model is actionable is important. Predicting that a patient is at high-risk is only useful if the model outputs is interpretable enough to explain what factors are putting that patient at risk. Furthermore, if the model is being used to plan interventions, the factors that can be changed need to be highlighted in some way – telling a clinician that a patient is at risk because of their age is not useful if the point of the prediction is to lower risk through intervention.

The future of data science in the healthcare sector

The future holds a lot of promise for data science in healthcare. Wearable devices that track all kinds of activity and biometric data are becoming more sophisticated and more common. Streaming data coming from either wearables or devices providing treatment (such as dialysis machines) could eventually be used to provide real-time alerts to patients or clinicians about health events outside of the hospital.

Currently, a major issue facing medical providers is that patients’ data tends to exist in silos. There is little integration across electronic medical record systems (both between and within medical providers), which can lead to fragmented care. This can lead to clinicians receiving out of date or incomplete information about a patient, or to duplication of treatments. Through a major data engineering effort, these systems could (and should) be integrated. This would vastly increase the potential of data scientists and data engineers, who could then provide analytics services that took into account the whole patients’ history to provide a level of consistency across care providers. Data workers could use such an integrated record to alert clinicians to duplications of procedures or dangerous prescription drug combinations.

Data scientists have a lot to offer in the healthcare industry. The advances of machine learning and data science can and should be adopted in a space where the health of individuals can be improved. The opportunities for data scientists in this sector are nearly endless, and the potential for good is enormous.