CAAT-EHR: Cross-Attentional Autoregressive Transformer for Multimodal Electronic Health Record Embeddings

Electronic health records (EHRs) provide a comprehensive source of longitudinal patient data, encompassing structured modalities such as laboratory results, imaging data, and vital signs, and unstructured clinical notes. These datasets, after necessary preprocessing to clean and format the data for analysis, often remain in their raw EHR form, representing numerical or categorical values without further transformation into task-agnostic embeddings. While such raw EHR data enables predictive modeling, its reliance on manual feature engineering or downstream task-specific optimization limits its utility for general-purpose applications. Deep learning (DL) techniques, such as recurrent neural networks (RNNs) and Transformers, have facilitated predictive tasks like disease progression and diagnosis prediction. However, these methods often struggle to fully exploit the temporal and multimodal dependencies inherent in EHR data due to their reliance on pre-processed but untransformed raw EHR inputs. In this study, we introduce CAAT-EHR, a novel architecture designed to bridge this gap by generating robust, task-agnostic longitudinal embeddings from raw EHR data. CAAT-EHR leverages self- and cross-attention mechanisms in its encoder to integrate temporal and contextual relationships across multiple modalities, transforming the data into enriched embeddings that capture complex dependencies. An autoregressive decoder complements the encoder by predicting future time points data during pre-training, ensuring that the resulting embeddings maintain temporal consistency and alignment. CAAT-EHR eliminates the need for manual feature engineering and enables seamless transferability across diverse downstream tasks. Extensive evaluations on benchmark datasets, demonstrate the superiority of CAAT-EHR-generated embeddings over pre-processed raw EHR data and other baseline approaches.