@Article{info:doi/10.2196/56893,
author="Suh, Jungyo
and Lee, Garam
and Kim, Jung Woo
and Shin, Junbum
and Kim, Yi-Jun
and Lee, Sang-Wook
and Kim, Sulgi",
title="Privacy-Preserving Prediction of Postoperative Mortality in Multi-Institutional Data: Development and Usability Study",
journal="JMIR Med Inform",
year="2024",
month="Jul",
day="5",
volume="12",
pages="e56893",
keywords="machine learning; privacy; in-hospital mortality; homomorphic encryption; multi-institutional system",
abstract="Background: To circumvent regulatory barriers that limit medical data exchange due to personal information security concerns, we use homomorphic encryption (HE) technology, enabling computation on encrypted data and enhancing privacy. Objective: This study explores whether using HE to integrate encrypted multi-institutional data enhances predictive power in research, focusing on the integration feasibility across institutions and determining the optimal size of hospital data sets for improved prediction models. Methods: We used data from 341,007 individuals aged 18 years and older who underwent noncardiac surgeries across 3 medical institutions. The study focused on predicting in-hospital mortality within 30 days postoperatively, using secure logistic regression based on HE as the prediction model. We compared the predictive performance of this model using plaintext data from a single institution against a model using encrypted data from multiple institutions. Results: The predictive model using encrypted data from all 3 institutions exhibited the best performance based on area under the receiver operating characteristic curve (0.941); the model combining Asan Medical Center (AMC) and Seoul National University Hospital (SNUH) data exhibited the best predictive performance based on area under the precision-recall curve (0.132). Both Ewha Womans University Medical Center and SNUH demonstrated improvement in predictive power for their own institutions upon their respective data's addition to the AMC data. Conclusions: Prediction models using multi-institutional data sets processed with HE outperformed those using single-institution data sets, especially when our model adaptation approach was applied, which was further validated on a smaller host hospital with a limited data set. ",
issn="2291-9694",
doi="10.2196/56893",
url="https://medinform.jmir.org/2024/1/e56893",
url="https://doi.org/10.2196/56893"
}