VBridge: Connecting the Dots Between Features and Data to Explain Healthcare Models

TrajVis: a visual clinical decision support system to translate artificial intelligence trajectory models in the precision management of chronic kidney disease

OBJECTIVE

Our objective is to develop and validate TrajVis, an interactive tool that assists clinicians in using artificial intelligence (AI) models to leverage patients' longitudinal electronic medical records (EMRs) for personalized precision management of chronic disease progression.

MATERIALS AND METHODS

We first perform requirement analysis with clinicians and data scientists to determine the visual analytics tasks of the TrajVis system as well as its design and functionalities. A graph AI model for chronic kidney disease (CKD) trajectory inference named DisEase PrOgression Trajectory (DEPOT) is used for system development and demonstration. TrajVis is implemented as a full-stack web application with synthetic EMR data derived from the Atrium Health Wake Forest Baptist Translational Data Warehouse and the Indiana Network for Patient Care research database. A case study with a nephrologist and a user experience survey of clinicians and data scientists are conducted to evaluate the TrajVis system.

RESULTS

The TrajVis clinical information system is composed of 4 panels: the Patient View for demographic and clinical information, the Trajectory View to visualize the DEPOT-derived CKD trajectories in latent space, the Clinical Indicator View to elucidate longitudinal patterns of clinical features and interpret DEPOT predictions, and the Analysis View to demonstrate personal CKD progression trajectories. System evaluations suggest that TrajVis supports clinicians in summarizing clinical data, identifying individualized risk predictors, and visualizing patient disease progression trajectories, overcoming the barriers of AI implementation in healthcare.

DISCUSSION

The TrajVis system provides a novel visualization solution which is complimentary to other risk estimators such as the Kidney Failure Risk Equations.

CONCLUSION

TrajVis bridges the gap between the fast-growing AI/ML modeling and the clinical use of such models for personalized and precision management of chronic diseases.

Recent Applications of Explainable AI (XAI): A Systematic Literature Review

This systematic literature review employs the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to investigate recent applications of explainable AI (XAI) over the past three years. From an initial pool of 664 articles identified through the Web of Science database, 512 peer-reviewed journal articles met the inclusion criteria—namely, being recent, high-quality XAI application articles published in English—and were analyzed in detail. Both qualitative and quantitative statistical techniques were used to analyze the identified articles: qualitatively by summarizing the characteristics of the included studies based on predefined codes, and quantitatively through statistical analysis of the data. These articles were categorized according to their application domains, techniques, and evaluation methods. Health-related applications were particularly prevalent, with a strong focus on cancer diagnosis, COVID-19 management, and medical imaging. Other significant areas of application included environmental and agricultural management, industrial optimization, cybersecurity, finance, transportation, and entertainment. Additionally, emerging applications in law, education, and social care highlight XAI’s expanding impact. The review reveals a predominant use of local explanation methods, particularly SHAP and LIME, with SHAP being favored for its stability and mathematical guarantees. However, a critical gap in the evaluation of XAI results is identified, as most studies rely on anecdotal evidence or expert opinion rather than robust quantitative metrics. This underscores the urgent need for standardized evaluation frameworks to ensure the reliability and effectiveness of XAI applications. Future research should focus on developing comprehensive evaluation standards and improving the interpretability and stability of explanations. These advancements are essential for addressing the diverse demands of various application domains while ensuring trust and transparency in AI systems.

Intelligent systems in healthcare: A systematic survey of explainable user interfaces

With radiology shortages affecting over half of the global population, the potential of artificial intelligence to revolutionize medical diagnosis and treatment is ever more important. However, lacking trust from medical professionals hinders the widespread adoption of AI models in health sciences. Explainable AI (XAI) aims to increase trust and understanding of black box models by identifying biases and providing transparent explanations. This is the first survey that explores explainable user interfaces (XUI) from a medical domain perspective, analysing the visualization and interaction methods employed in current medical XAI systems. We analysed 42 explainable interfaces following the PRISMA methodology, emphasizing the critical role of effectively conveying information to users as part of the explanation process. We contribute a taxonomy of interface design properties and identify five distinct clusters of research papers. Future research directions include contestability in medical decision support, counterfactual explanations for images, and leveraging Large Language Models to enhance XAI interfaces in healthcare.

A Patient Similarity Network (CHDmap) to Predict Outcomes After Congenital Heart Surgery: Development and Validation Study

Background

Although evidence-based medicine proposes personalized care that considers the best evidence, it still fails to address personal treatment in many real clinical scenarios where the complexity of the situation makes none of the available evidence applicable. "Medicine-based evidence" (MBE), in which big data and machine learning techniques are embraced to derive treatment responses from appropriately matched patients in real-world clinical practice, was proposed. However, many challenges remain in translating this conceptual framework into practice.

Objective

This study aimed to technically translate the MBE conceptual framework into practice and evaluate its performance in providing general decision support services for outcomes after congenital heart disease (CHD) surgery.

Methods

Data from 4774 CHD surgeries were collected. A total of 66 indicators and all diagnoses were extracted from each echocardiographic report using natural language processing technology. Combined with some basic clinical and surgical information, the distances between each patient were measured by a series of calculation formulas. Inspired by structure-mapping theory, the fusion of distances between different dimensions can be modulated by clinical experts. In addition to supporting direct analogical reasoning, a machine learning model can be constructed based on similar patients to provide personalized prediction. A user-operable patient similarity network (PSN) of CHD called CHDmap was proposed and developed to provide general decision support services based on the MBE approach.

Results

Using 256 CHD cases, CHDmap was evaluated on 2 different types of postoperative prognostic prediction tasks: a binary classification task to predict postoperative complications and a multiple classification task to predict mechanical ventilation duration. A simple poll of the k-most similar patients provided by the PSN can achieve better prediction results than the average performance of 3 clinicians. Constructing logistic regression models for prediction using similar patients obtained from the PSN can further improve the performance of the 2 tasks (best area under the receiver operating characteristic curve=0.810 and 0.926, respectively). With the support of CHDmap, clinicians substantially improved their predictive capabilities.

Conclusions

Without individual optimization, CHDmap demonstrates competitive performance compared to clinical experts. In addition, CHDmap has the advantage of enabling clinicians to use their superior cognitive abilities in conjunction with it to make decisions that are sometimes even superior to those made using artificial intelligence models. The MBE approach can be embraced in clinical practice, and its full potential can be realized.

DASS Good: Explainable Data Mining of Spatial Cohort Data

Developing applicable clinical machine learning models is a difficult task when the data includes spatial information, for example, radiation dose distributions across adjacent organs at risk. We describe the co-design of a modeling system, DASS, to support the hybrid human-machine development and validation of predictive models for estimating long-term toxicities related to radiotherapy doses in head and neck cancer patients. Developed in collaboration with domain experts in oncology and data mining, DASS incorporates human-in-the-loop visual steering, spatial data, and explainable AI to augment domain knowledge with automatic data mining. We demonstrate DASS with the development of two practical clinical stratification models and report feedback from domain experts. Finally, we describe the design lessons learned from this collaborative experience.

Solving the explainable AI conundrum by bridging clinicians' needs and developers' goals

Explainable artificial intelligence (XAI) has emerged as a promising solution for addressing the implementation challenges of AI/ML in healthcare. However, little is known about how developers and clinicians interpret XAI and what conflicting goals and requirements they may have. This paper presents the findings of a longitudinal multi-method study involving 112 developers and clinicians co-designing an XAI solution for a clinical decision support system. Our study identifies three key differences between developer and clinician mental models of XAI, including opposing goals (model interpretability vs. clinical plausibility), different sources of truth (data vs. patient), and the role of exploring new vs. exploiting old knowledge. Based on our findings, we propose design solutions that can help address the XAI conundrum in healthcare, including the use of causal inference models, personalized explanations, and ambidexterity between exploration and exploitation mindsets. Our study highlights the importance of considering the perspectives of both developers and clinicians in the design of XAI systems and provides practical recommendations for improving the effectiveness and usability of XAI in healthcare.

CohortVA: A Visual Analytic System for Interactive Exploration of Cohorts based on Historical Data

In history research, cohort analysis seeks to identify social structures and figure mobilities by studying the group-based behavior of historical figures. Prior works mainly employ automatic data mining approaches, lacking effective visual explanation. In this paper, we present CohortVA, an interactive visual analytic approach that enables historians to incorporate expertise and insight into the iterative exploration process. The kernel of CohortVA is a novel identification model that generates candidate cohorts and constructs cohort features by means of pre-built knowledge graphs constructed from large-scale history databases. We propose a set of coordinated views to illustrate identified cohorts and features coupled with historical events and figure profiles. Two case studies and interviews with historians demonstrate that CohortVA can greatly enhance the capabilities of cohort identifications, figure authentications, and hypothesis generation.

In Defence of Visual Analytics Systems: Replies to Critics

The last decade has witnessed many visual analytics (VA) systems that make successful applications to wide-ranging domains like urban analytics and explainable AI. However, their research rigor and contributions have been extensively challenged within the visualization community. We come in defence of VA systems by contributing two interview studies for gathering critics and responses to those criticisms. First, we interview 24 researchers to collect criticisms the review comments on their VA work. Through an iterative coding and refinement process, the interview feedback is summarized into a list of 36 common criticisms. Second, we interview 17 researchers to validate our list and collect their responses, thereby discussing implications for defending and improving the scientific values and rigor of VA systems. We highlight that the presented knowledge is deep, extensive, but also imperfect, provocative, and controversial, and thus recommend reading with an inclusive and critical eye. We hope our work can provide thoughts and foundations for conducting VA research and spark discussions to promote the research field forward more rigorously and vibrantly.

Explainable AI for clinical and remote health applications: a survey on tabular and time series data

Nowadays Artificial Intelligence (AI) has become a fundamental component of healthcare applications, both clinical and remote, but the best performing AI systems are often too complex to be self-explaining. Explainable AI (XAI) techniques are defined to unveil the reasoning behind the system’s predictions and decisions, and they become even more critical when dealing with sensitive and personal health data. It is worth noting that XAI has not gathered the same attention across different research areas and data types, especially in healthcare. In particular, many clinical and remote health applications are based on tabular and time series data, respectively, and XAI is not commonly analysed on these data types, while computer vision and Natural Language Processing (NLP) are the reference applications. To provide an overview of XAI methods that are most suitable for tabular and time series data in the healthcare domain, this paper provides a review of the literature in the last 5 years, illustrating the type of generated explanations and the efforts provided to evaluate their relevance and quality. Specifically, we identify clinical validation, consistency assessment, objective and standardised quality evaluation, and human-centered quality assessment as key features to ensure effective explanations for the end users. Finally, we highlight the main research challenges in the field as well as the limitations of existing XAI methods.