Zero-Burden Risk Assessment (ZeBRA):

Early Point-of-care Detection/screening
of

Complex Diseases with Routine EHR

Ishanu Chattopadhyay, PhD

Assistant Professor of Biomedical Informatics & Computer Science

University of Kentucky

ishanu_ch@uky.edu

Zero-Burden Co-morbid Risk Score (ZCoR*)

Zero Burden Risk Assessment (ZeBRA)

  • Universal point-of-care screening via AI-driven pattern recognition
  • No new tests or blood-work
  • Uses routine data (EHR) already in patient file
  • No specific data demands
  • Generalizable in future to other targets beyond PF, ILAs

CKD

PF

ZCoR

ICD

Enable early diagnosis

Target PF/IPF or ILDs broadly

Seamless background integration with Epic workflows

Primary care

*Onishchenko, Dmytro, Robert J. Marlowe, Che G. Ngufor, Louis J. Faust, Andrew H. Limper, Gary M. Hunninghake, Fernando J. Martinez, and Ishanu Chattopadhyay. "Screening for idiopathic pulmonary fibrosis using comorbidity signatures in electronic health records." Nature Medicine 28, no. 10 (2022): 2107-2116.

Raising Flags before patient or their doctor notice symptoms

downstream care modulation

model published, retrospectively validated*

TimestampedDiagnostic procedural codes & prescriptions

MASH

Rx

Px

Validation

CELL Reports

 

AI-driven Test-Free Prediction of ICU Admission, Insulin Dependence, and Exocrine Dysfunction after Acute Pancreatitis

Under Review

Technology Overview

2. Conventional AI attempts to model the physician

Current State of Art

1. Use of AI in point-of-care diagnostic workflow is limited

ZeBRA

  1. Use under-utilized diagnostic modalities
  2. Discover co-morbidity patterns
  3. Go beyond know risk factors
  4. Personalized risk patterns

*Chattopadhyay, Ishanu, and Hod Lipson. "Abductive learning of quantized stochastic processes with probabilistic finite automata." Philosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Sciences 371, no. 1984 (2013): 20110543.

Curated Disease-agnostic Features | Odds ratio dictionaries combined with multi-stage LGBMs | Specialized HMM based Longitudinal Tracking*

Predictive AI platforms, including those from Merative, PathAI, Tempus, Google Health, and Microsoft, often rely on imaging data for early detection.

State of the art screening approaches are inadequate

Standard AI

Predictive Performance*

High AUC across high and low risk sub-cohorts

Highlights:

  • 1 yr out AUC ~88%
  • Positive Likelihood ration ~40

*Onishchenko, D., Marlowe, R.J., Ngufor, C.G. et al. Screening for idiopathic pulmonary fibrosis using comorbidity signatures in electronic health records. Nat Med 28, 2107–2116 (2022). https://doi.org/10.1038/s41591-022-02010-y

Model

ZeBRA Algorithmic Suite

CKD stage IV or later

CKD stage I-III \(\rightarrow\) IV or later

With history of liver disease

Without history of liver disease

[
    {
        "patient_id": "P000038",
        "sex": "F",
        "birth_date": "01-01-2006",
        "DX_record": [
            {"date": "07-31-2006", "code": "Z38.00"},
            {"date": "08-07-2006", "code": "P59.9"},
            {"date": "08-29-2016", "code": "J01.90"},
            {"date": "09-10-2016", "code": "J01.90"},
            {"date": "11-14-2016", "code": "J01.91"}
        ],
        "RX_record": [
            {"date": "10-29-2011", "code": "rxLDA017"},
            {"date": "05-16-2015", "code": "rxIDG004"},
            {"date": "08-08-2015", "code": "rxIDG004"},
            {"date": "06-04-2016", "code": "rxIDD013"}
        ],
        "PROC_record": [
            {"date": "02-05-2007", "code": "90723"},
            {"date": "11-05-2007", "code": "J1100"}
        ]
    }
]
{
  "predictions": [
    {
      "error_code": "",
      "patient_id": "P000012",
      "predicted_risk": 0.005794344620009157,
      "probability": 0.8253881317184486
    }
  ],
  "target": "TARGET"
}

Data Out

Data In

Current state: Fully functional API tested in cloud deployments*

  • user-specific API
  • Custom models targeting range of disorders
  • Scalable

*Documentation:  https://github.com/zeroknowledgediscovery/paraknowledgedoc

Model ready to deploy behind UK firewall

CKD

PF

ZCoR

ICD

Primary care

TimestampedDiagnostic procedural codes & prescriptions

MASH

Rx

Px

Future

Comprehensive Digital Twins that integrate genomic and life-style/clinical information

ZeBRA-brief

By Ishanu Chattopadhyay

ZeBRA-brief

Brief talk on the ZeBRA Platform

  • 5

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