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Predicting medical chronic conditions with Machine Learning

Note - Some parts of this post requires some familiarity with basics of Machine Learning. These terms should be understood in a technical form - Binary Classification, Accuracy, AUC, Biased Dataset

TLDR -

It is possible to build a system to predict medical chronic conditions with ML.

The path to actually building an ML system from scratch is long and winding and will probably differ for each company. It’s very messy and undefined in the start - and that's ok.

You do NOT need a huge amount of data to start. Use proxies and try to get some real world data points.

There are plenty of ways to use the initial results in a commercial application - especially for targeting/identifying customer types.

Read the newly released Machine Learning Yearning if you don’t know where to start.

DoctorC has been doing diagnostics for 3 years now. We have gone from running operations on spreadsheet to end to end automated systems which handle everything, from placing an order, to delivery of reports. We also store all reports and some report values for our customers so that they can easily access their medical history from anywhere.

A few months ago, we started an initiative to see if we can apply ML on our data and get some useful applications out of it. We are an extremely small company with very limited amount of resources. So it was basically just me running some experiments and dedicating only a few hours a week.

The first question we asked ourselves before starting was - “How is it going to be useful to us as a business?”. The answer was surprisingly easy.

We have two kinds of customers -

People who undergo some illness/accident etc where they need some medical help - but only one time.

People who have chronic conditions like hypertension, diabetes, cholesterol issues etc.

#1 are transactional and #2 are our repeat customers. #2 use/need our service the most and they are consequently very valuable to us. In Urban India, chronic conditions (non communicable diseases) are on the rise rapidly and the prevalence of diseases vary from 15% all the way to 35% (WHO link - http://www.who.int/choice/publications/Chronic_diseaseIndia.pdf).

These are the customers we are looking for. So the question boiled down to - “How do we identify people with chronic conditions?”. Once we identify them - we can enroll them in a program specifically tailored for people who need medications and diagnostic tests frequently.

The hardest point - Starting

We needed to start with a training set of people who are identified as chronic. We had 0 points of data for this.

So we looked for proxies. “What behaviour indicates if a person has a chronic condition?”. Answer - People who used our services frequently are more likely to be chronic.

We keep track of every test that was bought and their results for every customer. Therefore, we had a (comparatively speaking) rich medical history at our fingertips. On top of that - our in-house proprietary system can “read” a diagnostic report and infer structured medical data for a whole array of tests.

Based on this, we started with an initial training set of a couple of hundred people who were deemed “chronic”. We used another set of infrequent buyers as negative examples for our model.

I explored a whole bunch of options on what platform to use for training ML - Scikit Learn, Tensorflow, AWS Machine Learning and Microsoft Azure. Azure’s ease of use puts it in another league altogether - especially for people who want to just apply existing ML algorithms. Drag and drop, kicking off experiments parallely, easy to construct flows etc. allow you to move really really fast as compared to writing code.

This might become a bottleneck later as we scale or it might become more expensive to run - but the tools they provide save tons of time, especially for prototyping and experimentation. I highly recommend trying out Azure - their free tier gives a good taste of what’s possible on their platform.

Before you start, or while you are playing with your dataset - you need to decide what your “One True Metric™” is. This is the thing you are going to optimize for while evaluating different machine learning models.  By definition, it is very specific to your problem and cannot be purely decided based on a formula.

For us, it was identifying people with chronic conditions with a highly imbalanced data set (we have a lot less people with chronic conditions compared to normal population). It’s a binary classification problem. I chose AUC as a measure and started experiments to optimize that. Why did I not choose Accuracy? That is a post for another day.

We did an initial split of 50/50 of positive and negative samples to ensure we didn’t bias the system with a small initial set. Then i started my experiments. This is the messy part - you have to start from the simplest models and run different models simultaneously on the same data.

The first set of results yielded AUC curve similar to this -

Tight Iterations

We did our first real world test with a model of an AUC of 0.58 (which is not a very good score). We took the top 100 predictions by the model and started verifying if the identified people were chronic. We recorded this data and then used it to create a newer model. This gave us another 100 predictions. Then we repeated the cycle again.

The model started improving with each iteration. Reconstructing new model with new data took only a couple of days and the model training process itself was only a few minutes. Gathering the data was the only bottleneck.

Our model’s curve improved as shown below. And our total dataset from a raw data standpoint was around 1.2 million discrete values. Our accuracy was approaching ~80% (first couple of hundred predictions for every iteration). The AUC of the best model would vary from 0.74 to 0.80.  The accuracy had a steep fall afterwards, but it was still significantly better than the 15% to 20% accuracy you would get with a random sample.

Predictive Factors

More interesting were the predictive factors for chronic conditions. While I cannot delve into too many details, one of the most interesting find was that Vitamin D (both the number of purchases done and the values of it) were one of the most predictive factors for someone being chronic or not. It neatly fits into the current research which suggests that Vit D is extremely important to maintain since it affects almost every system in our body. You should get Vit D levels checked every 6 months or a year - especially if a large part of your day is spent indoors.

Conclusion

Yes, you can predict, with a high degree of accuracy as well as high AUC, if someone is suffering from a chronic condition based on a combination of their purchase behavior (surprising) and their test values (not very surprising, still exciting). The next question was whether we could actually hone down to a specific condition like Diabetes, Thyroid disorders etc. That is a post for another day. 

There is also the long term possibility of actually providing diagnosis while working side by side with doctors. This system is a small step in fulfilling that vision. We have miles to go before we sleep.

We are very excited about the possibilities that this kind of data enables. If you would like access to this data (especially for medical research purposes) or would like to know additional details please contact me on karan at the rate doctorc dot in.

[doctorcindia]

10 Things You Didn’t Know About Sh!t

Website: doctorc.in

[doctorcindia]

Reality Check: Thyroid Wars

Reality Check is a multi-part series to take a closer look at what data says about our health

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How a young doctor exercised her right to information

Our customers are the people leading the change in healthcare today. They are inquisitive, proactive, and resourceful. They take charge of their health and the health of those around them. They question and probe and don't take things at face value. We have been inspired by their stories and feel compelled to share them with the world. The second in our series of Stories is here!

Meet Gayathri Ramaseri, a recent MBBS graduate from MNR College, Medak. We have had the pleasure of knowing Gayathri since November 2013.

Recently, we got to meet her entire family. She lives in Secunderabad with her parents-- M.G Ramachandran, a retired Mathematics lecturer and Poornima, headmistress of a local school-- and her brother Abhishek, who now works with TCS.

Gayathri’s first experience with DoctorC dates back to November 2013, when her father needed to get an MRI scan. That was the first major investigation they had to undergo in their family. She didn’t know much about MRI scans so she started looking online and chanced upon DoctorC. At first, she was very doubtful, but she was convinced by the confidence instilled by one of our Customer Advisors.

“We Indians tend to think that what is more costly is more reliable. We don’t doubt the efficacy of existing or established brands that might be more expensive," she said, looking back at her thought process. 

Once she got the films of the MRI scan, she took them to a professor at her medical college for a second opinion, and was satisfied entirely only when he said that the images were of good quality. You may call that being cautious — I think of it as her being informed and prudent.

After that episode, Gayathri dealt with uncertainty again with great prudence and perseverance recently when her brother got hospitalised for 14 days. It was shocking and eye-opening for her in many ways-- her first experience with a corporate hospital. 

Abhishek was admitted to a shared room first, and then moved to a high dependency unit (which was closer to the ICU), and within a day he was asked to move to the ICU. Wary that this was in the commercial interest of the hospital, Gayathri probed and checked with doctors outside the hospital and with their counsel, insisted that they didn’t want to be moved to the ICU.

Fortunately, Abhishek’s insurance provider covered most of his hospital bill, but this was only after relentless follow up— Gayathri checked with the billing department everyday to see what they needed to be prepared for. They even prepared for the worst, which would have been to pay out of pocket. When they finally saw the bill, they saw that more than 50% of the cost went into investigations- a simple test like a CBP (Complete Blood Picture) was broken down into 10 sub-tests, each with a price of Rs 100 or more.

"Most people don’t know how they’re being fleeced. Even if they have the guts to ask, they’re not always provided information,“ said Gayathri. There was a girl in their shared room who was was diagnosed with typhoid after spending a whole day in the ICU- which their family didn’t question. They were under the impression that doctors were going to take care of it, but no one did.

“People should stop believing things blindly. A lot of people think that once they go to a hospital, things will be taken care of. That mindset should change. These are investigations being performed on your own body— you have a right to know about it, you have a right to ask.”

"I befriended the duty doctor immediately, so she showed me the reports of investigations when I asked for them. But our neighbour in the shared room, the girl who was diagnosed with typhoid— they didn’t show her any reports even when they asked for it.”

“We didn’t keep quiet in the hospital. Our minds were running,” said Abhishek. Everyday, Abhishek and Gayathri would strategise on how to negotiate with the insurance provider. Abhishek rightly points out that most people don't know what to ask or what their rights are. 

“Patient awareness is lacking. The first step is to provide knowledge. People will then start to question.”

When I met this family, I couldn’t help but think of a social gadfly. A gadfly is a person who upsets the status quo by posing upsetting or novel questions. And I say that in the best way possible. While that term has a negative connotation, I truly believe that we need more gadflies for things to change. We need more people to step up and ask. 

The change begins with people like the Ramaseris, who aren’t afraid to stand up for themselves. And that is absolutely inspirational for us at DoctorC. We are proud to serve people like Gayathri and her family.

[doctorcindia]

How a young cop became his community’s advisor

Our customers are the kind of people leading the change in healthcare today. They are inquisitive, proactive, and resourceful. They take charge of their health and the health of those around them. We have been inspired by their stories and feel compelled to share them with the world. The first in our series of stories is here!

Meet Mohan, a truly inspiring young cop, who belongs to the Armed Reserve Police Forces and is currently working with the Traffic Police Department of Hyderabad. This is Mohan after his second knee-surgery in 2 years-- still resilient, optimistic, and going strong!

Mohan lives with his wife Jhansi, their two kids, his parents, and father-in-law in Hyderabad. Mohan and Jhansi -- childhood friends and classmates-- grew up playing volleyball and basketball in neighbouring courts in school. They fell in love and got married in 2013. 

Not much later, Mohan had torn a ligament while playing volleyball. He had already spent a month being barely able to walk because of the ligament tear in his knee. He went from hospital to hospital and doctor to doctor trying to find an affordable MRI scan since he couldn’t spend Rs 6000 -7000 on it. They were barely making ends meet, as a newly married couple. One day, through a doctor’s reference, he heard about DoctorC and was able to save Rs 4000 (more than half the price of the scan) on his MRI. He was able to undergo surgery based on the MRI report, and was soon back to normal. 

But their family, it seemed to them at the time, was struck by bad luck. Hospital visits seemed to be perpetual. No sooner had he recovered from his surgery, his father suffered from a hip joint fracture and needed a metal ball placed. His mother's condition (she was already diabetic and had thyroid issues) worsened because of all the stress, and to top it all, doctors told his wife that she was not capable of conceiving. Through all of this, they spent a lot of time hunting for the best doctors and low-cost hospitals where surgical procedures would be covered under Arogyasree. They spent more than Rs 30,000 only on investigations and did a lot of research to save on surgery costs. All of their effort paid off when they finally found affordable options.

Looking back, Anuradha says, “I don’t feel bad for what we went through. We are now able to help others who need advice.”

It was amazing to see their positivity and resilience in the face of hardship. After everything settled down, they wanted to share their newfound knowledge with other people going through similar circumstances. They wanted others to benefit from their learning.

This attitude was not new to Mohan. He was already the community's go-to guy for everything from bikes and clothes to gold jewellery. He was known as their advisor, and always went out of his way to help people. Having been through a lot of financial trouble, he was committed to saving people money whenever he could. If any of his friends or neighbours needed a test, they knew they could just go to Mohan, and this continues till date. He has booked tests on behalf of many people who came to him for advice.

“All it takes it one rupee and a phone call to DoctorC and I can save them money.”

Mohan uses the power of simple tools and his title to help people. He once saved his friend almost Rs 3 lakh on a surgery by finding out which hospitals are Arogyasree empanelled-- all through a five minute call to JustDial. If he is ever with a friend when they are getting billed or charged extra, he uses the fact that he's a cop to ensure they are treated fairly.

“Other people may not stand up for themselves. But being in the police, I can use my title to stand up for them.”

Mohan and his family are happy to share what they know. This positive ripple effect begins with people like Mohan, who go out of their way to support and stand up for those around them. And that is absolutely inspirational for us at DoctorC. 

- Manya

[doctorcindia]

Cervical Cancer Vaccinations - Now in Hyderabad!

Cancer. A word that strikes fear in so many of us. An illness that is quite painful, and often fatal.

Traditionally, there were very limited measures one could take to actively prevent any cancer from attacking our body. However, with great scientific strides made in the last few years, some types of cancer can actively be prevented to a large extent. One such cancer is Cervical Cancer.

What is Cervical Cancer?

Before we speak about prevention, let's understand a few quick details about the Cervical Cancer.

As the name suggests, it is a cancer arising from the Cervix, which is a part of the Uterus in the female reproductive system. It is caused by the Human Papillomavirus (HPV), which is transmitted mainly through sexual contact.

Do all kinds of HPV cause cancer?

No. As per the World Health Organization, there are more than 100 types of HPV, of which around 13 are known to be cancerous. However, just 2 types (HPV 16 and 18) cause more than 70% of cervical cancers and precancerous cervical lesions.

How common is Cervical Cancer?

Worldwide, Cervical Cancer is one of the most common types of cancer among women.

India alone is said to account for 20% of the worldwide Cervical Cancer cases (annually 1 lakh cases out of a total of 5 lakh worldwide, as per this report). This cancer appears to have no early symptoms. Symptoms only start being seen when the cancer has already had some time to develop in the body, thus making it harder to fight against.

How can I get vaccinated and stay safe?

Vaccination is recommended for girls between the ages of 12-26, but some doctors recommend it for older women as well.

DoctorC* now brings to Hyderabad, Cervical Cancer vaccinations at your doorstep. 

To book your vaccination REGISTER HERE today.

*DoctorC has emerged as one of the hottest start-ups in Online Diagnostics. We aggregate prices of diagnostic tests and provide great discounts on all tests to our customers. Check us out at http://doctorc.in/

[doctorcindia]

How one company helped 163 employees take charge of their health for just Rs. 100 per person.

Our lifestyle has changed from what it used to be 20-30 years ago. It has also brought along with it a lot of new lifestyle diseases. We don’t give our health as much importance as we should. Gone are the days when you needed to get regular check ups only post the age of 50 or 55. Now anyone post 30 should get check with basic checks to make sure if there is anything to be caught, it gets caught early enough and it's treatable. The earlier you catch an illness the easier it is to treat it and recover from it.

We also need to have the right environment and support to keep our health on top of our minds. It is great to see some companies take initiatives to keep their employees healthy. We recently interacted with Vibrant Automobiles on a health camp for their employees.

We checked for BP, diabetes, anemia, thyroid for a total of 163 employees, and here is what we found.

In a time of an emergency, its always good for an organisation to be prepared. Knowing blood groups help us to know what we have enough of, and where we need to make arrangements for.

It was very refreshing to see a head of a company take interest in his employees health. He led the way by getting his tests first and made sure all his employees got their tests done.

What was surprising, even to us, is that we could conduct this health camp at an average of just Rs. 100 per employee. If more companies know of such options, we are sure that many more companies will follow suit and help their employees better understand the importance of good health.

[doctorcindia]

Swine Flu Vaccination

Administered at Home. ₹650 per person.

DoctorC is determined to keep our customers safe and healthy. Given the current trend with Swine Flu (H1N1), we have partnered with Nightingales to provide vaccinations in the comfort of your home.

What is Swine Flu?

H1N1 flu is also known commonly as Swine Flu. Several decades ago, people caught it due to direct contact with pigs, thus the name. Today though a new virus has emerged that spreads amongst people who have not been near pigs at all. Swine flu is contagious and spreads through air. You can catch it from another infected person when they cough, sneeze or touch a surface that they have previously touched.

Who should get vaccinated?

Vaccination is recommended for:

Any healthy person wanting protection

Healthcare workers - doctors, nurses, caretakers etc

Healthy pregnant women

People over the age of 65 as their immunity is low

Children under the age of 5 as their immunity is low

People with chronic health conditions such as asthma, heart disease, diabetes, anemia etc as their immunity is low

Is it safe?

Absolutely! It is like any other flu vaccine.

Why DoctorC?

As always we, at DoctorC, are looking to bring you the best in healthcare - both affordability and convenience-wise. Nightingales is an established home healthcare company. Their trained nurses are well equipped to administer the vaccine.

GET VACCINATED NOW -- BOOK TODAY

[doctorcindia]

All you need to know about YOUR Pregnancy! (Webinar)

Recently, DoctorC hosted a webinar with Dr. Jayasree Reddy, a practicing Gynaecologist/Obstrecian. The 25 minutes session covered all you need to know about your Pregnancy. Something that everyone would need to  know about their pregnancy. First or otherwise. 

Topics covered were:

How to plan for your Pregnancy?

Diagnosing your Pregnancy

Antenatal Care

Signs and Symptoms

Development of the Uterus

Daily Fetal Movement

Common Pregnancy Ailments 

Lifestyle changes during Pregnancy

Nutrition: Importance for mother and child

Care in Pregnancy

Exercise during Pregnancy

Some of the questions asked were:

In case of a fever, cough or cold during pregnancy, are we advised to take medicines or not?

What are the guidelines/restrictions on travel?

Can I eat papayas and bananas? Any restriction on other fruits?

I am RH (-) and my husband is RH (+), this is our first pregnancy, what do I need to take care of during my 9 months?

To view the whole session, click on the video attached! We are sure you will enjoy it and stay tuned for more Pregnancy related webinars in the future. 

[doctorcindia]

Hello Bangalore!

We are excited to launch in Bangalore this week. We start with Elbit Medical Diagnostics and Dr Lal PathLabs at 10 locations with 15-20% off all their diagnostic tests. Over the next few weeks we will be expanding to more locations and more services. 

Karan, Manya, Neehar and I have always loved Bangalore for the creative, smart culture and people. When we decided to expand to a new city, Bangalore was the obvious choice. 

Our aim with DoctorC is to help make diagnostics more accessible and affordable to everyone. We partner with high quality diagnostic centers to offer their tests online at 15-50% off. By only partnering with NABL accredited labs, we ensure quality so your health is uncompromised. 

Check us out: www.doctorc.in

Cheers,

Mansi, Co-Founder

[doctorcindia]

Hurrayyy! We got funded!

Official announcement of our Seed Round!

Since our launch in Feb 2014 we have received an amazing response from the Hyderabadis. We are currently selling tests at a rate of more than Rs. 10000000 per year; And we want to do more!

We are pleased to announce that we have closed our Seed Round raising Rs. 2.5 crores in funds. This marks a significant milestone in our journey so far. We'd like to thank all the investors for giving us their vote of confidence.

Our aim is to provide even better service to you - our customers. We want to be able to give more choice and have a larger set of products, so you can make informed decisions on all your healthcare needs. We want to provide a hassle free and easy to use software which helps you wherever and whenever you want. 

The funds raised will be used primarily to hire top talent and expand DoctorC to more cities. We are excited to embark on this journey which will surely help transform more lives.

Thank you for all your support every step of the way!

- Mansi, Neehar, Karan, Manya

[doctorcindia]

Hello Hyderabad. We're Here. And We're On Your Side

We'd like to introduce to you DoctorC - India's first healthcare aggregator.

Healthcare information - costs, prices, quality - is scattered. A lot of this information isn't easily available, even in highly organized and developed markets like the US or UK. For example, comparing the cost of a single procedure at various hospitals across your city is an incredibly painful task...you would have to literally call each one!

Today, the basic information that one needs to make educated healthcare choices isn't easily accessible. The disparity in quality and cost across the city's diagnostic centers and hospitals goes unnoticed. This often leads to patients being uninformed and going to a center nearby or one recommended by their doctor. 

At DoctorC, we want to empower the everyday person. We want to give you the ability to compare prices and quality across your city. We want to get you informed and be in charge of your own decisions. Plus, we offer ridiculously great discounts!

Who are we? We're a group of silicon valley techies, business graduates, healthcare leaders, and designers.

Check it out - www.doctorc.in 

We’re adding more centers and services every week, but if you need anything healthcare related, just give us a call on 040-30911054.

[doctorcindia]

Hello Tumblr

We  recently moved our blog onto tumblr because tumblr makes blogging so damn simple. 

If you are looking for some of the older posts you can find them here 

The Cost of MRI Scan

The Cost of CT Scan

Low Cost CT Scan in Hyderabad

Cost of Lasik in Hyderabad

Stay tuned for some awesome new stuff

Cheers, Neehar - Co-Founder