Cited by 1Machine Learning in HealthcareElectronic Health Records SystemsMedical Coding and Health Information

Subtype-Aware Registration of Longitudinal Electronic Health Records

Gai, Xin, Jiang, Shiyi, Zhang, Anru R.·2026·Journal of the American Statistical Association

Abstract

Electronic Health Records (EHRs) contain extensive patient information that can inform downstream clinical decisions, such as mortality prediction, disease phenotyping, and disease onset prediction. A key challenge in EHR data analysis is the temporal gap between when a condition is first recorded and its actual onset time. Such timeline misalignment can lead to artificially distinct biomarker trends among patients with similar disease progression, undermining the reliability of downstream analyses and complicating tasks such as disease subtyping and outcome prediction. To address this challenge, we provide a subtype-aware timeline registration method that leverages data projection and discrete optimization to correct timeline misalignment. Through simulation and real-world data analyses, we demonstrate that the proposed method effectively aligns distorted observed records with the true disease progression patterns, enhancing subtyping clarity and improving performance in downstream clinical analyses. Supplementary materials for this article are available online, including a standardized description of the materials available for reproducing the work.

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Crossref · 10.1080/01621459.2026.2613464

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  • Documentation timestamps reflect when events are recorded rather than when they occur, introducing systematic errors that can distort event sequencing, bias time-to-event analyses, and undermine model validity.

    “Documentation timestamps are often used as surrogates for disease onset; however, they reflect when events are recorded rather than when they occur, introducing systematic errors that can distort event sequencing, bias time-to-event analyses, and undermine model validity9–12.”

    From TimeX: Phenotype Onset Extraction from Clinical Narratives (2026) · cites this paper as [12]

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Authors
Gai, X., Jiang, S., & Zhang, A. R.
Affiliations
  • Vanderbilt University (US)
  • Duke University (US)
Corresponding author
Zhang, Anru R.
Venue
Journal of the American Statistical Association
Published
2026-03-25
Volume
121
Issue
554
Pages
917-928
ISSN
  • 0162-1459 (ISSN-L)
  • 1537-274X
OpenAlex
W7123463902
Cited by
0
References
2
FWCI
0.00
Type
journal article
Language
en
Open access
closed
Locations
Journal of the American Statistical Association (publishedVersion)
Funders
  • Division of Mathematical Sciences (CAREER-2203741)
  • National Heart, Lung, and Blood Institute (R01HL168940)
Topics
  • Physical Sciences › Computer Science › Artificial Intelligence › Machine Learning in Healthcare
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
Keywords
electronic health records, disease subtyping, data projection, discrete optimization, disease progression, clinical outcome prediction

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