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Federated learning of predictive models from federated Electronic Health Records
Open accessAbstract
Background In an era of "big data," computationally efficient and privacy-aware solutions for large-scale machine learning problems become crucial, especially in the healthcare domain, where large amounts of data are stored in different locations and owned by different entities. Past research has been focused on centralized algorithms, which assume the existence of a central data repository (database) which stores and can process the data from all participants. Such an architecture, however, can be impractical when data are not centrally located, it does not scale well to very large datasets, and introduces single-point of failure risks which could compromise the integrity and privacy of the data. Given scores of data widely spread across hospitals/individuals, a decentralized computationally scalable methodology is very much in need.Objective We aim at solving a binary supervised classification problem to predict hospitalizations for cardiac events using a distributed algorithm. We seek to develop a general decentralized optimization framework enabling multiple data holders to collaborate and converge to a common predictive model, without explicitly exchanging raw data.Methods We focus on the soft-margin l 1-regularized sparse Support Vector Machine (sSVM) classifier. We develop an iterative cluster Primal Dual Splitting (cPDS) algorithm for solving the large-scale sSVM problem in a decentralized fashion. Such a distributed learning scheme is relevant for multi-institutional collaborations or peer-to-peer applications, allowing the data holders to collaborate, while keeping every participant's data private.Results We test cPDS on the problem of predicting hospitalizations due to heart diseases within a calendar year based on information in the patients Electronic Health Records prior to that year. cPDS converges faster than centralized methods at the cost of some communication between agents. It also converges faster and with less communication overhead compared to an alternative distributed algorithm. In both cases, it achieves similar prediction accuracy measured by the Area Under the Receiver Operating Characteristic Curve (AUC) of the classifier. We extract important features discovered by the algorithm that are predictive of future hospitalizations, thus providing a way to interpret the classification results and inform prevention efforts.
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“A similar scheme is used by Xie et al. [485] to design a variant of local SGD in which clients locally perform Adagrad [335, 161].”
From Advances and Open Problems in Federated Learning (2021) · cites this paper as [485]
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“Federated learning has also enabled predictive modeling based on diverse sources, which can provide clinicians with additional insights into the risks and benefits of treating patients earlier [9, 10, 90].”
From Federated Learning for Healthcare Informatics (2021) · cites this paper as [10]
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In the citing paper
“In the context of electronic health records (EHR), for example, FL helps to represent and to find clinically similar patients13,47, as well as predicting hospitalisations due to cardiac events14, mortality and ICU stay time19.”
From The future of digital health with federated learning (2020) · cites this paper as [14]
In the citing paper
“Governance of data for FL is maintained locally, alleviating privacy concerns, with only model weights or gradients communicated between the client-sites and the federated server38,39.”
From Federated learning for predicting clinical outcomes in patients with COVID-19 (2021) · cites this paper as [39]
In the citing paper
“For example, FL can be used to improve the perceiving and learning ability of AIoT devices such as connected vehicles for autonomous driving [199] and wearable devices for health monitoring [222], [197].”
From Empowering things with intelligence: a survey of the progress, challenges, and opportunities in artificial intelligence of things (2021) · cites this paper as [222]
In the citing paper
“The FL algorithm is used to describe and identify physician-related persons and to estimate their hospitalization, deaths, and survival rates based on electronic health records (EHR) [54].”
From A comprehensive survey on federated learning techniques for healthcare informatics (2023) · cites this paper as [54]
In the citing paper
“Deep Leakage from Gradients (DLG) [152] obtained the private training data at the inference phase.”
From Challenges, Applications and Design Aspects of Federated Learning: A Survey (2021) · cites this paper as [152]
In the citing paper
“The theoretical and experimental comparisons show that the proposed model converges faster and with less communication overhead compared to an alternative distributed algorithm.”
From Handling privacy-sensitive medical data with federated learning: Challenges and future directions (2023) · cites this paper as [35]
In the citing paper
“Furthermore, an FL-based approach is proposed in [81] to predict hospitalizations for patients diagnosed with heart diseases using their historic EHRs.”
From Federated learning for smart healthcare: A survey (2023) · cites this paper as [81]
In the citing paper
“In addition, Brisimi et al., (2018) also use EMRs to evaluate whether a patient with heart disease will be hospitalized based on a FL algorithm called cluster Primal Dual Splitting (cPDS).”
From A review of applications in federated learning (2020) · cites this paper as Brisimi et al., (2018)
In the citing paper
“Brisimi et al. 2018 Predict future hospitalizations for patients Cluster Primal Dual Splitting algorithm Yield classifiers using relatively few features Need more iterations for convergence”
From A review of applications in federated learning (2020) · cites this paper as Brisimi et al. 2018
In the citing paper
“Brisimi et al. 2018 Predict future hospitalizations for patients Cluster Primal Dual Splitting algorithm Yield classifiers using relatively few features Need more iterations for convergence”
From A review of applications in federated learning (2020) · cites this paper as Brisimi et al. 2018
In the citing paper
“Brisimi et al. 2018 Predict future hospitalizations for patients Cluster Primal Dual Splitting algorithm Yield classifiers using relatively few features Need more iterations for convergence”
From A review of applications in federated learning (2020) · cites this paper as Brisimi et al. 2018
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Blockchain-Supported Federated Learning for Trustworthy Vehicular Networks
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The Internet of Federated Things (IoFT)
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Kumar, R., Kumar, J., Khan, A. A., Zakria, Z., Ali, H., Bernard, C. M., Khan, R. U., & Zeng, S. (2022) · Computerized Medical Imaging and Graphics · doi:10.1016/j.compmedimag.2022.102139 · Cited by 66
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BackgroundMethodBlockchain-Enabled Asynchronous Federated Learning in Edge Computing
Liu, Y., Qu, Y., Xu, C., Hao, Z., & Gu, B. (2021) · Sensors · doi:10.3390/s21103335 · Cited by 65
“…in many areas, e.g., the facial recognition model trained by convolutional neural network (CNN) has been widely applied for smartphone authentication [2], hospital utilizes regression model based on historical medical records to predict patient condition [3], and forthcoming autonomous vehicles.”
MethodA Systematic Survey of Blockchained Federated LearningPreprint
Wang, Z., Hu, Q., Xu, M., Zhuang, Y., Wang, Y., & Cheng, X. (2021) · arXiv (Cornell University) · doi:10.48550/arxiv.2110.02182 · Cited by 103
Anomaly detection and defense techniques in federated learning: a comprehensive review
Zhang, C., Yang, S., Mao, L., & Ning, H. (2024) · Artificial Intelligence Review · doi:10.1007/s10462-024-10796-1 · Cited by 73
“Other applications in healthcare include the use of FL to manage digital health records Brisimi et al. (2018) and to detect attacks in physical medical information systems (i.e., those maintaining sensitive information in patient health records Long et al. (2022)).”
Fed-BioMed: A General Open-Source Frontend Framework for Federated Learning in Healthcare
Silva, S., Altmann, A., Gutman, B. A., & Lorenzi, M. (2020) · Lecture notes in computer science · doi:10.1007/978-3-030-60548-3_20 · Cited by 71
“Initially conceived for mobile applications [8], federated learning allows to optimize machine learning models on datasets that are distributed across clients, such as multiple clinical centers in healthcare [4].”
BackgroundOptimal Rate Adaption in Federated Learning with Compressed Communications
Cui, L., Su, X., Zhou, Y., & Liu, J. (2022) · IEEE Conference on Computer Communications (INFOCOM) · doi:10.1109/infocom48880.2022.9796982 · Cited by 63
“, for smart devices to predict human trajectories [4] or for healthcare systems to develop predictive models [5].”
BackgroundA Sharp Estimate on the Transient Time of Distributed Stochastic Gradient Descent
Pu, S., Olshevsky, A., & Paschalidis, I. C. (2021) · IEEE Transactions on Automatic Control · doi:10.1109/tac.2021.3126253 · Cited by 67
“Problems in the form of (1) find applications in multiagent target seeking [1], distributed machine learning [2]–[8], and wireless networks [5], [9], [10], among other scenarios.”
BackgroundSelf-citationFederated User Modeling from Hierarchical Information
Liu, Q., Wu, J., Huang, Z., Wang, H., Ning, Y., Chen, M., Chen, E., Yi, J., & Zhou, B. (2023) · ACM Transactions on Information Systems · doi:10.1145/3560485 · Cited by 65
“Some work focuses on combining federated learning with practical applications, such as education [96], news recommendation [69], recommendation systems [101], medical [6, 11], inancial [81].”
BackgroundDeep Federated Learning for IoT-based Decentralized Healthcare Systems
Elayan, H., Aloqaily, M., & Guizani, M. (2021) · International Wireless Communications and Mobile Computing Conference (IWCMC) · doi:10.1109/iwcmc51323.2021.9498820 · Cited by 61
Secure and robust machine learning for healthcare: A survey
Qayyum, A., Qadir, J., Bilal, M., & Al-Fuqaha, A. (2021) · IEEE Reviews in Biomedical Engineering · doi:10.1109/rbme.2020.3013489 · Cited by 59
“EHR of heart-related diseases is presented in [151].”
BackgroundFailure prediction in production line based on federated learning: an empirical study
Ge, N., Li, G., Zhang, L., & Liu, Y. (2021) · Journal of Intelligent Manufacturing · doi:10.1007/s10845-021-01775-2 · Cited by 59
“FL has also been applied to various fields like medical systems Boughorbel et al. (2019b); Brisimi et al. (2018); Huang et al. (2019a); Sheller et al. (2018b), Internet finance Suzumura et al. (2019); Yang et al. (2019b), smart city Liu et al. (2020b); Sama-rakoon et al. (2019); Saputra et al.…”
BackgroundClinical Knowledge Graph Integrates Proteomics Data into Clinical Decision-MakingPreprint
Santos, A., Colaço, A. R., Nielsen, A. B., Niu, L., Geyer, P. E., Coscia, F., Albrechtsen, N. J. W., Mundt, F. O., Jensen, L. J., & Mann, M. (2020) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2020.05.09.084897 · Cited by 59
“New approaches, such as differential privacy and federated learning (Bonawitz et al., 2019; Brisimi et al., 2018), would allow researchers to use the CKG to train models iteratively across institutions without direct access to the sensitive data (Figure 7C).”
BackgroundToward Energy-Efficient Federated Learning Over 5G+ Mobile Devices
Shi, D., Li, L., Chen, R., Prakash, P., Pan, M., & Fang, Y. M. (2022) · IEEE Wireless Communications · doi:10.1109/mwc.003.2100028 · Cited by 68
“Such a combination of 5G+ and FL prompts tremendous successful applications over 5G mobile devices, including keyboard prediction [3], cardiac event prediction [4], financial risk management [5], etc.”
BackgroundSelf-citationYaqoob, M. M., Nazir, M., Yousafzai, A., Khan, M. A., Shaikh, A. A., Algarni, A. D., & Elmannai, H. (2022) · Applied Sciences · doi:10.3390/app122312080 · Cited by 57
“In the paper [21], the authors developed a model based on federated learning for the prediction of hospitalization of health-related disease patients.”
BackgroundPrivacy-preserving Decentralized Learning Framework for Healthcare System
Kasyap, H., & Tripathy, S. (2021) · ACM Transactions on Multimedia Computing Communications and Applications · doi:10.1145/3426474 · Cited by 56
“[5] proposed a decentralized computationally scalable methodology for large-scale machine learning problems in the healthcare domain.”
BackgroundMethodZhao, J., Hu, L., Dong, Y., Huang, L., Weng, S., & Zhang, D. (2021) · International Journal of Applied Earth Observation and Geoinformation · doi:10.1016/j.jag.2021.102459 · Cited by 57
StarFL: Hybrid Federated Learning Architecture for Smart Urban Computing
Huang, A., Liu, Y., Chen, T., Zhou, Y., Sun, Q., Chai, H., & Yang, Q. (2021) · ACM Transactions on Intelligent Systems and Technology · doi:10.1145/3467956 · Cited by 60
Chen, J., Coyner, A. S., Chan, R. V. P., Hartnett, M. E., Moshfeghi, D. M., Owen, L. A., Kalpathy–Cramer, J., Chiang, M. F., & Campbell, J. P. (2021) · Ophthalmology Science · doi:10.1016/j.xops.2021.100079 · Cited by 56
“11 Data-and model-sharing methods including federated 12,13 and distributed 14,15 learning have shown potential in facilitating DL algorithm training without inter-institutional data sharing.”
MethodAn Overview of Federated Deep Learning Privacy Attacks and Defensive Strategies
Enthoven, D., & Al-Ars, Z. (2021) · Studies in computational intelligence · doi:10.1007/978-3-030-70604-3_8 · Cited by 72
Review on Federated Learning for digital transformation in healthcare through big data analytics
Babar, M., Qureshi, B., & Koubaa, A. (2024) · Future Generation Computer Systems · doi:10.1016/j.future.2024.05.046 · Cited by 55
A comprehensive review of federated learning for COVID‐19 detection
Naz, S., Phan, K. T., & Chen, Y. P. (2021) · International Journal of Intelligent Systems · doi:10.1002/int.22777 · Cited by 59
“22,23 A huge communication overhead is reported in other areas of research 62,64 and an effort to reduce communication overhead while preserving data privacy is also reported in Xia et al. 65 4.”
BackgroundEmpowering federated learning techniques for privacy-preserving PV forecasting
Michalakopoulos, V., Sarantinopoulos, E., Sarmas, E., & Marinakis, V. (2024) · Energy Reports · doi:10.1016/j.egyr.2024.08.033 · Cited by 59
Exploring privacy mechanisms and metrics in federated learning
Shenoy, D., Bhat, R., & Prakash, K. (2025) · Artificial Intelligence Review · doi:10.1007/s10462-025-11170-5 · Cited by 63
Privacy-preserving federated k-means for proactive caching in next generation cellular networks
Liu, Y., Ma, Z., Yan, Z., Wang, Z., Liu, X., & Ma, J. (2020) · Information Sciences · doi:10.1016/j.ins.2020.02.042 · Cited by 57
Privacy-Preserving Federated Learning Model for Healthcare Data
Islam, T. U., Ghasemi, R., & Mohammed, N. (2022) · 2022 IEEE 12th Annual Computing and Communication Workshop and Conference (CCWC) · doi:10.1109/ccwc54503.2022.9720752 · Cited by 56
“Recent works demonstrate the advantages of using FL techniques over traditional centralized ML models for several health applications such as predicting hospital admissions and adverse drug reaction [5], [19].”
MethodPu, S., Olshevsky, A., & Paschalidis, I. C. (2020) · IEEE Signal Processing Magazine · doi:10.1109/msp.2020.2975212 · Cited by 58
“…that train such models quickly and reliably in a distributed fashion over networks where the individual processors or GPUs may be scattered across the globe and communicate over an unreliable network, which may suffer from message losses, delays, and asynchrony (see [1], [2], [29], and [33]).”
BackgroundSelf-citationDefinition of a novel federated learning approach to reduce communication costs
Paragliola, G., & Coronato, A. (2021) · Expert Systems with Applications · doi:10.1016/j.eswa.2021.116109 · Cited by 54
Service Delay Minimization for Federated Learning Over Mobile Devices
Chen, R., Shi, D., Qin, X., Liu, D., Pan, M., & Cui, S. R. (2023) · IEEE Journal on Selected Areas in Communications · doi:10.1109/jsac.2023.3242711 · Cited by 54
“FL over mobile devices can provide a variety of services, including Google’s next word prediction [3], cardiac event prediction [4], mobile object detection [5], etc.”
BackgroundSelf-citationDeep learning in industrial machinery: A critical review of bearing fault classification methods
Rehman, A. U., Jiao, W., Jiang, Y., Wei, J., Sohaib, M., Sun, J., Shiju, E., Rehman, K. U., & Chi, Y. (2025) · Applied Soft Computing · doi:10.1016/j.asoc.2025.112785 · Cited by 59
Communication-Computation Efficient Secure Aggregation for Federated LearningPreprint
Choi, B., Sohn, J.-Y., Han, D.-J., & Moon, J. J. (2020) · arXiv (Cornell University) · doi:10.48550/arxiv.2012.05433 · Cited by 83
Pocket diagnosis: Secure federated learning against poisoning attack in the cloud
Ma, Z., Ma, J., Miao, Y., Liu, X., Choo, K.-K. R., & Deng, R. H. (2022) · IEEE Transactions on Services Computing · doi:10.1109/tsc.2021.3090771 · Cited by 50
“Driven by the above issue, federated learning [9], [10], [11] has been proposed as an efficient solution to provide privacy preservations in the cloud, in which a federatedmodel is constructed by aggregating locally-trained models.”
BackgroundGagalova, K., Elizalde, M. A. L., Portales-Casamar, É., & Görges, M. (2020) · JMIR Formative Research · doi:10.2196/17687 · Cited by 53
“A total of 241 articles were identified in the literature search [11,13-19,21-29,31,33-35,37,43,44,47-49,52-264]; the largest number of articles were identified in IEEE Xplore (n=112), followed by MEDLINE (n=95), and Google Scholar (n=71).”
BackgroundCollaborative deep learning framework for fault diagnosis in distributed complex systems
Wang, H., Liu, C., Jiang, D., & Jiang, Z. (2021) · Mechanical Systems and Signal Processing · doi:10.1016/j.ymssp.2021.107650 · Cited by 54
Multimodal Melanoma Detection with Federated Learning
Agbley, B. L. Y., Li, J., Haq, A. U., Bankas, E. K., Ahmad, S., Agyemang, I. O., Kulevome, D. K. B., Ndiaye, W. D., Cobbinah, B. M., & Latipova, S. (2021) · International Computer Conference on Wavelet Active Media Technology and Information Processing (ICCWAMTIP) · doi:10.1109/iccwamtip53232.2021.9674116 · Cited by 53
“Brisimi et al. [16] presented an FL model that predicts the chances of hospitalizing patients suffering from heart-related diseases.”
BackgroundElastic Aggregation for Federated Optimization
Chen, D., Hu, J., Tan, V. J., Wei, X., & Wu, E. (2023) · IEEE Computer Society Conference on Computer Vision and Pattern Recognition/Proceedings - IEEE Computer Society Conference on Computer Vision and Pattern Recognition/Proceedings · doi:10.1109/cvpr52729.2023.01173 · Cited by 56
“The server model then benefits from all client data and achieves superior performance, for tasks such as next word prediction [17, 56], emoji prediction [45], decoder models [8], vocabulary estimation [7], low latency vehicle-to-vehicle communication [49] and predictive models in health [6].”
MethodSlashing Communication Traffic in Federated Learning by Transmitting Clustered Model Updates
Cui, L., Su, X., Zhou, Y., & Pan, Y. F. (2021) · IEEE Journal on Selected Areas in Communications · doi:10.1109/jsac.2021.3087262 · Cited by 53
Naseri, M., Hayes, J., & Cristofaro, E. D. (2020) · arXiv (Cornell University) · Cited by 54
A framework for the prediction of earthquake using federated learning
Tehseen, R., Farooq, M. S., & Abid, A. (2021) · PeerJ Computer Science · doi:10.7717/peerj-cs.540 · Cited by 52
“The FL system has been applied on synchronous training of algorithms ( Lim et al., 2019 ), vehicle-to-vehicle communications ( Samarakoon et al., 2018 ), medical applications ( Brisimi et al., 2018 ), and for earthquake early warning system using smart phones ( Kong et al., 2016 ).”
MethodFirdaus, M., Larasati, H. T., & Rhee, K.-H. (2025) · Internet of Things · doi:10.1016/j.iot.2025.101579 · Cited by 62
Detecting model misconducts in decentralized healthcare federated learning
Kuo, T.-T., & Pham, A. (2021) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2021.104658 · Cited by 52
Fida, K., Abbasi, U., Adnan, M., Iqbal, S., & Mohamed, S. E. G. (2024) · Results in Engineering · doi:10.1016/j.rineng.2024.102773 · Cited by 59
Fatema, K., Dey, S. K., Anannya, M., Khan, R. T., Rashid, M., Su, C., & Mazumder, R. (2025) · Future Internet · doi:10.3390/fi17060234 · Cited by 51
Kirienko, M., Sollini, M., Ninatti, G., Loiacono, D., Giacomello, E., Gozzi, N., Francesco Amigoni, A., Mainardi, L. T., Lanzi, P. L., & Chiti, A. (2021) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-021-05339-7 · Cited by 51
“Brisimi et al. [29] and Wang et al. [38] used clinical data to predict hospitalization risks for cardiac events and re-hospitalization for heart failure, respectively.”
BackgroundAlsharif, M. H., Kannadasan, R., Wei, W., Nisar, K. S., & Abdel‐Aty, A. (2024) · Internet of Things · doi:10.1016/j.iot.2024.101251 · Cited by 54
Javed, L., Anjum, A., Yakubu, B. M., Iqbal, M., Moqurrab, S. A., & Srivastava, G. (2022) · Expert Systems · doi:10.1111/exsy.13131 · Cited by 49
“Then, to give a useful resource for academics, it explains the general answers to the major issues in FL (Brisimi et al., 2021; Xu et al., 2021).”
BackgroundSafeguarding Patient Data-Sharing: Blockchain-Enabled Federated Learning in Medical Diagnostics
Myrzashova, R., Alsamhi, S. H., Hawbani, A., Curry, E., Guizani, M., & Wei, X. (2024) · IEEE Transactions on Sustainable Computing · doi:10.1109/tsusc.2024.3409329 · Cited by 53
“Au-thors in [33] implemented an FL system for predictive modelling in a network of hospitals, demonstrating this approach’s efficacy and privacy-preserving capabilities.”
Metadata
- Authors
- Brisimi, T. S., Chen, R., Mela, T., Olshevsky, A., Paschalidis, I. C., & Shi, W.
- Affiliations
- Boston University (US)
- Massachusetts General Hospital (US)
- Corresponding author
- Paschalidis, Ioannis Ch.
- Venue
- International Journal of Medical Informatics
- Publisher
- Elsevier BV
- Published
- 2018-04
- Volume
- 112
- Pages
- 59-67
- ISSN
- 1386-5056 (ISSN-L)
- PMC
- PMC5836813
- OpenAlex
- W2783522756
- Cited by
- 997
- References
- 24
- Citations by year
- 2026: 118 · 2025: 159 · 2024: 146 · 2023: 167 · 2022: 156 · 2021: 151 · 2020: 74 · 2019: 20 · 2018: 5
- FWCI
- 35.18
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Journal of Medical Informatics (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Science Foundation (IIS-1724990, CNS-1645681, CCF-1527292, IIS-1237022)
- Boston University
- Army Research Office (W911NF-12-1-0390)
- National Institutes of Health (1UL1TR001430)
- Topics
- Physical Sciences › Computer Science › Artificial Intelligence › Privacy-Preserving Technologies in Data
- Physical Sciences › Engineering › Control and Systems Engineering › Distributed Control Multi-Agent Systems
- Physical Sciences › Computer Science › Artificial Intelligence › Stochastic Gradient Optimization Techniques
- Keywords
- federated learning, electronic health records, distributed optimization, sparse support vector machines, primal-dual splitting, binary classification, data privacy, multi-institutional collaboration, feature extraction, heart disease prevention
- MeSH terms
- Machine Learning, Algorithms, Hospitalization, Humans, ROC Curve, Databases, Factual, Electronic Health Records, Support Vector Machine
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