The importance of domain knowledge – A healthcare data science perspective

Data scientists have (and need) many skills. They are frequently either former academic researchers or software engineers, with knowledge and skills in statistics, programming, machine learning, and many other domains of mathematics and computer science. These skills are general and allow data scientists to offer valuable services to almost any field. However, data scientists in some cases find themselves in industries they have relatively little knowledge of.

This is especially true in the healthcare field. In healthcare, there is an enormous amount of important clinical knowledge that might be relevant to a data scientist. It is unreasonable to expect a data scientist to not only have all of the skills typically required of a data scientist, but to also have all of the knowledge a medical professional may have.

Why is domain knowledge necessary?

This lack of domain knowledge, while perfectly understandable, can be a major barrier to healthcare data scientists. For one thing, it’s difficult to come up with project ideas in a domain that you don’t know much about. It can also be difficult to determine the type of data that may be helpful for a project – if you want to build a model to predict a health outcome (for example, whether a patient has or is likely to develop a gastrointestinal bleed), you need to know what types of variables might be related to this outcome so you can make sure to gather the right data.

Knowing the domain is useful not only for figuring out projects and how to approach them, but also for having rules of thumb for sanity checks on the data. Knowing how data is captured (is it hand-entered? Is it from machines that can give false readings for any number of reasons?) can help a data scientist with data cleaning and from going too far down the wrong path. It can also inform what true outliers are and which values might just be due to measurement error.

Often the most challenging part of building a machine learning model is feature engineering. Understanding clinical variables and how they relate to a health outcome is extremely important for this. Is a long history of high blood pressure important for predicting heart problems, or is only very recent history? How long a time horizon is considered ‘long’ or ‘short’ in this context? What other variables might be related to this health outcome? Knowing the domain can help direct the data exploration and greatly speed (and enhance) the feature engineering process.

Once features are generated, knowing what relationships between variables are plausible helps for basic sanity checks. If you’re finding the best predictor of hospitalization is the patient’s eye color, this might indicate an issue with your code. Being able to glance at the outcome of a model and determine if they make sense goes a long way for quality assurance of any analytical work.

Finally, one of the biggest reasons a strong understanding of the data is important is because you have to interpret the results of analyses and modeling work. Knowing what results are important and which are trivial is important for the presentation and communication of results. An analysis that determines there is a strong relationship between age and mortality is probably well-known to clinicians, while weaker but more surprising associations may be of more use. It’s also important to know what results are actionable. An analysis that finds that patients who are elderly are likely to end up hospitalized is less useful for trying to determine the best way to reduce hospitalizations (at least, without further context).

How do you get domain knowledge?

In some industries, such as tech, it’s fairly easy and straightforward to see an end-user’s prospective. By simply viewing a website or piece of software from the user’s point of view, a data scientist can gain a lot of the needed context and background knowledge needed to understand where their data is coming from and how their model output is being used. In the healthcare industry, it’s more difficult. A data scientist can’t easily choose to go through med school or the experience of being treated for a chronic illness. This means there is no easy single answer to where to gain domain knowledge. However, there are many avenues available.

Reading literature and attending presentations can boost one’s domain knowledge. However, it’s often difficult to find resources that are penetrable for someone who is not already a clinician. To gain deep knowledge, one needs to be steeped in the topic. One important avenue to doing this is through the establishment of good relationships with clinicians. Clinicians can be powerful allies that can help point you in the right direction for understanding your data, and simply by chatting with them you can gain important insights. They can also help you visit the clinics or practices to interact with the people that perform the procedures or even watch the procedures being done. At Fresenius Medical Care, where I work, members of my team regularly visit clinics. I have in the last year visited one of our dialysis clinics, a nephrology practice, and a vascular care unit. These experiences have been invaluable to me in developing my knowledge of the treatment of chronic illnesses.

In conclusion, it is crucial for data scientists to acquire basic familiarity in the field they are working in and in being part of collaborative teams that include people who are technically knowledgeable in the field they work in. This said, acquiring even an essential understanding (such as “Medicine 101”) may go a long way for the data scientists in being able to become self-sufficient in essential feature selection and design.

Thomas Blanchard

Tommy completed his PhD at the University of Rochester and performed his post-doctoral research at Harvard University. He is currently a data scientist at Fresenius Medical Care North America, where he uses data science to improve medical care of patients with chronic illnesses.