Hospital Management
Hospital Management
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II. Supervised and Unsupervised Machine                          (non-readmitted). In the second step, features contributing
    Learning techniques in health care                           to predictive risk from independent models were combined
    management system.                                           into a composite model using a correlation-based feature
                                                                 selection (CFS) method. Data extracted from EMR: I)
As per Chuang et al. [21] there are seven well known             Diagnoses codes were extracted from Mount Sinai Data
supervised learning techniques namely C4.5, C5.0,                Warehouse. II) Medications prescribed during the
CART(classification and regression tree), Logistic               hospitalization were extracted from Mount Sinai Data
regression, SVM(support vector machine), Random forest,          warehouse. Medication name, dosage, route of
Multivariate adaptive regression splines. The C4.5 and           administration      was     obtained.    III)   Laboratory
CART are the two most commonly used decision tree-               measurements. IV) Vital signs Pulse, respiration rate,
based learning techniques. These techniques are used to          systolic blood pressure, heartbeats and temperature were
develop a predictive model that determines the length of         compiled and captured in a MySQL database. The
stay of patient in the hospital. The case was divided into       research on CAD(computer aided diagnosis) and
urgent operation and non-urgent operation group to               intelligent patient management system using different
develop a prolonged length of stay prediction model using        Machine learning and operations research techniques is
several supervised learning techniques. Critical factors are     proposed by Florin Gorunescu [11]. CAD is used for
identified using the gain ratio technique contains medical       automated diagnosis of different major diseases, such as
records, lab data of 896 clinical cases involving surgeries      breast, pancreatic and lung cancer, heart attacks, diabetes
performed by general physicians. Supervised learning             using different supervised machine learning techniques
technique is suitable for analyzing patient medical record       (neural networks, support vector machines, Bayesian
in accurately predicting a prolonged length of stay. The         decision, k-nearest neighbor, etc) An intelligent patient
proposed model supports a physician in making clinical           management system develops an Application to patient
decision and communicating with medical team members,            grouping using different unsupervised machine learning
patients and patient family. The system may also use for         techniques(k-means clustering) and Application to hospital
making decision regarding whether patient require more           bed management by optimal bed allocation, in accordance
clinical care (therefore improving patient safety). Based on     with the population needs and quality medical service.
length of stay related literature, 119 independent variables     One can model a hospital/clinical department by using
are collected from laboratory information system, nursing        both queuing models and optimization tools (M/PH/c and
information system and from physician orders then                Genetic Algorithm). Nguyen et al. [17] proposed a remote
selected variables are divided into six categories.              health monitoring systems based on Internet of Things
Demographic, Medical history, vital signs, laboratory data,      (IoT) technology. This paper explores the use of IoT-based
operation physician data and operation & nursing data.           applications in medical field and proposes an IoT Tiered
WEKA(version 36.6) an open source data mining program            Architecture (IoTTA) towards an approach for
was used to execute variables. WEKA was used to                  transforming sensor data into real-time clinical feedback.
construct a length of stay prediction model using several        The IoT Tiered Architecture is based on the sensing,
classification techniques. Some limitations of the present       sending, processing, storing, mining and machine learning.
study are, First, the data used in this study were related to    Data mining involves discovering useful patterns from
general surgery patients from a single medical institution.      large data sets and applying algorithms to the extraction of
Proceeding with the evaluations of clinical cases from           hidden information. Its functions include classification,
other hospitals is critical for confirming the validity of the   clustering, association analysis, time series analysis, and
model. Second, other potentially valuable features, such as      outlier analysis. Machine learning techniques are very
data collected from the clinical pathway and supervised          useful in healthcare applications as they enable managing
learning techniques, can be considered for use in the            huge databases, learn from data and improve through
model. Finally, an interventional study may be initiated         experience (supervised as well as unsupervised). Alhamid
based on our finding in practicing an expert system that         et al. [7] proposed an open software framework that
may be conducted in future studies and try to predict            provides long-term monitoring of the patient’s health
which patients will require urgent surgery. Shameer et al.       situation by building a health monitoring system. That
[16] developed to predict readmission rates in heart failure     detecting any abnormality in the patient’s health situation
patients. Readmission rates is a quality assessment used to      and particularly during their time spent at home. The other
improve the quality of life index of patient population and      main objective is the development of a convenient method
the quality of healthcare delivery. A machine learning is        of analyzing and presenting the physiological data
used for the generation of composite model for performing        collected from a Wireless Body Sensor Network (WBSN).
predictions using feature selected from individual model.        BSN consists of wearable sensors that include Bluetooth
In his study a naïve bayes model is used for machine             for communication. The paper also focus on the
learning. Bayesian model were created using feature              monitoring of Activity of Daily Living (ADL), which
unique to each data element and validation of machine            includes fall detection, walking, sitting, standing, and
learning models was performed with logistic regression. In       lying down as well as physiological monitoring such as
the study we use multistep modeling strategy using Naïve         heart rate using (simple activity recognition algorithm
bayes algorithm. In the first step, an individual model is       based on accelerometers signals, K-nearest neighbor
created to classify the cases (readmitted) and controls          (KNN) classifier with an applied Bayesian Network. The
Int. J. Advanced Networking and Applications                                                                           4272
Volume: 11 Issue: 03 Pages: 4270-4276 (2019) ISSN: 0975-0290
researchers Madhumita Kathuria and Sapna Gambhir[8]              of smart environments. One such example is the so-called
focus on the E-health based on the Wireless Body Area            Health Smart Home (HSH). They have the potential to
Network (WBAN). WABN becomes an integral                         provide e-health services to meet the needs of this growing
component of healthcare management system where a                population. The machine learning methods and algorithms
patient needs to be monitors both inside and outside home        (supervised and unsupervised) to effectively interpret
or hospital. The applications is categorized into: Retrieval,    sensor data (low-level) and build new abstractions (high-
Alerting, Prediction, Suggestion and Reminders to health         level) in order to understand this complex and variable
related information using machine learning techniques            data on human behavior. The methods and techniques
such as Binary Decision Tree and Genetic Algorithm.              have been widely used to recognize human behaviors,
Decision tree is used to classify the unseen instances from      detect normal and abnormal situations and to predict
the training set of pre-labeled instance. GA is applied on       future health conditions. We broadly classify techniques
training sets to generate optimized training data sets. It is    into three categories: probabilistic and statistical
responsible for managing traffic flows at different levels       techniques, computational intelligence techniques, and
so that both real time traffic and non-real time health          knowledge-driven techniques.
related traffic get benefit. It is responsible to manage four    1. Behavior Recognition: Statistical Techniques (Hidden
kinds of works: Packet classification, queuing, scheduling       Markov Models, Bayesian Network Naive Bayes,
and dropping. The researcher Lih-Jen Kau and Chih-               Multiclass      Logistic     Regression)      Computational
Sheng Chen[13] proposed a smart phone based monitoring           Intelligence Techniques (Neural Networks             Support
and rescue system. The smart phone should be android             Vector Machine Decision tree (C4.5), Clustering)
based only. The various wearable sensors are used for            Knowledge-Driven Techniques in (Rule-based ,Fuzzy
detecting patient if the accident occurs. The proposed           logic)
system contains the triaxial accelerometer and gyroscope         2. Behavior Abnormality Detection: Statistical Techniques
sensors. The triaxial accelerometer and electronic compass       (Gaussian Mixture Model, Hidden Markov Model)
is uses as input if the fall detection occurs on smart           Computational Intelligence Techniques (Neural Networks,
phones. In order to process the input signal, system uses        Support Vector Machine, Clustering ) Knowledge-Driven
the cascading classifier and support vector machine              Techniques (Fuzzy logic, Ontologies )
(supervised learning) as detection tools. Once a fall            3. Prediction: Statistical Techniques (Hidden Markov
accident event is detected, the user’s position can be           Models Computational Intelligence Techniques) Neural
acquired by the global positioning system (GPS) or the           Networks (Support Vector Machine, Data Mining
assisted GPS (A-GPS), and sent to the rescue center via          Techniques) Knowledge-Driven Techniques (Fuzzy logic).
the 3G communication network so that the user can get            Mazhar et al. [18] developed a system using machine
medical help immediately. He Jian and Hu Chen [24]               learning algorithms to better care and to ensure better
proposed a system that detects the fall detection of elderly.    facilities to the inpatients to predict Spinal Cord Injured
The system consists of custom vast and smart phone. The          (SCI) patient’s length of stay. If we can predict accurate
custom vast contains wearable motion detection sensor            length of stay, patients do not have to leave in between the
integrated with tri-axial accelerometer, gyroscope and           treatment without medical advice. This study proposes the
Bluetooth. The tri-axial accelerometer, gyroscope is used        use of multiple linear regressions. which will help better
to measure the reluctant acceleration and angular velocity       patient care in the future and help the hospital for the
that vary real-timely, and then make up stream data.             better resource management. Baker et al. [19] proposed
Bluetooth is introduced to receive the stream data from          the web portal to support a patient healthcare decision.
sensors, Bluetooth is used to send the data to the smart         The portal is powered by semantics open source software
phone. After getting the data the individual is falling or not   (SEMOSS) and end-to-end analytic tool. Multiple linear
based on the k-NN algorithm (supervised machine                  regression and random forest analysis is used in order to
learning algorithm). The phone can make a call or send a         determine whether a patient would recommend a hospital
message with GPS position to a healthcare center or              on the basis of patient experience. The portal allows
family member as soon as it detects a fall. This system can      patient to search for and compare doctors and hospitals
provide a timely warning that a fall has occurred. The           based on their personal needs. In this study the doctor’s
software includes the on-chip program running on the             data used for analysis was obtained from the virgina board
sensor board and the fall detection program app                  of medicine website. The data set includes 20 attributes for
downloaded onto the mobile smart phone. Mshali et al.            40,0000 doctors attributes includes Name, Number of
[22] surveyed about health monitoring system in smart            years in experience, sex etc. The distance is calculated
environment. The aim of HMS is to not only reduce costs          using Google maps API. Hospital data include
but to also provide timely e-health services to individuals      communicate with doctors, communication with nurses,
wishing to maintain their independence. The most                 responsiveness of hospital staff, pain management,
important functions and services offered by HMS for              communication about medicines, discharge information,
monitoring and detecting human behavior including its            cleanliness of hospital environment etc. Patient can check
concepts, approaches, and processing techniques. The             the doctor’s data in their area and see the visualization of
HMS with intelligent technologies, such as sensors               practitioners clustered by specialty. This type of graphic
(Personal Sensor Network, Body Sensor Network,                   allows the patient to see how much choices they have
Multimedia Devices) have resulted in a rapid emergence           when choosing a doctor of a certain specialty. The
Int. J. Advanced Networking and Applications                                                                         4273
Volume: 11 Issue: 03 Pages: 4270-4276 (2019) ISSN: 0975-0290
Mockup of the portal includes a home screen, search page,      intervals, such as when varying treatments can be
and various methods for viewing search results and             administered. Finally, more hospitals are using electronic
visualization. Methods that are used for modeling a            medical record systems to gather large amounts of patient
hospital data is multiple linear regression. Random forest     data. While using this data will open the door for the
analysis of hospital group.                                    increased application of MDPs to medical treatment
                                                               problems. Hauskrecht and Fraser [1] proposed a method of
III. Reinforcement learning            in   health    care     Markov decision processes viz partially observable
     management system.                                        Markov decision processes for the treatment of ischemic
                                                               heart disease. A disease caused by an imbalance between
Niyato et al. [5] proposed A Remote patient monitoring         the supply and demand of oxygen to the heart. The
system in terms of e-health service A patient-attached         proposed system uses methods for the treatment of
monitoring device with a heterogeneous wireless                ischemic heart disease, characterized by hidden disease
transceiver (WiMAX based WMAN and WiFi-based                   states, investigative and treatment procedures, and
WLAN technologies) collects bio signal data from the           temporal cost and their outcomes. Khianjoom and
sensors and transmits the data through the radio access        Wipawee [9] Monitoring the patients by transferring the
network (RAN) to the eHealth service provider. The             diagnostic information if the patient fall. They presents an
proposed architecture along with the reinforcement             efficient, adaptive, distributed routing mechanism using
machine learning techniques (stochastic programming            Anycast Q-routing to route information to the nearest sink.
Problem, constrained Markov decision process (CMDP))           Anycast has been used in wired networks and mobile ad
will be useful for an eHealth service provider to minimize     hoc networks, to select the nearest server, service
the service cost while maintaining the quality-of-service      identification, improve system reliability and policy
(QoS) requirements for remote and mobile patient               routing. Q-routing is based on Q-learning which is a well-
monitoring.                                                    known Reinforcement Learning method. RL is a machine
Due to the mobility of the patients, a stochastic              learning technique which aims at finding the optimal
programming problem has been formulated to obtain the          action to perform at a given state of the dynamic
optimal number of reserved connections and minimize the        environment. The proposed scheme requires low
connection cost and satisfy the delay requirements. A          communication overhead and fast path search time to
constrained Markov decision process formulation has been       discover optimal paths to the nearest sink. Gaweda et al.
used to obtain the optimal transmission scheduling             [2] proposed the system which provides an optimal
decision.                                                      treatment to the patient of anemia using reinforcement
                                                               learning approach. The learning for the optimal treatment
                                                               occurs in the form of immediate improvements in the drug
                                                               dosing policy due to the experience gained by observing
                                                               i.e. off -policy using Q-learning rather than on-policy that
                                                               is learning form processing. Q-learning is capable of
                                                               performing adequate anemia treatment in real time. To
                                                               classify the different types of patients, a Takagi-Sugeno
                                                               fuzzy model was first built on basis of available patient
                                                               data.
they are still in the operating room and corrective actions     etc. 2. Income Items which contains Total budget, Basic
can be taken. Cognitive system enables healthcare               salary expense, Social right expense, Medical device
organization to gain more value from data. Gaining more         expense, etc. and 3. Expense Items contains Medication
value from data is a multifaceted process that requires both    income, Inpatient medical implementation income,
technology and human knowledge. Getting the data right          Outpatient laboratory income, Social security institution
is more important. The relevant data needs to be accurate,      income, etc. is used. The provinces where hospitals are
trusted, consistent, and available for access. However,         located are also classified. A genetic algorithm is
having accurate data is only the baseline for improving         developed to generate fuzzy linguistic summaries. In this
health outcomes for patients. Physicians need the skill and     system, the parameters of genetic algorithms were
experience to make sense out of what is often a complex         established with trial and error for the presented
set of symptoms and diagnostic tests. They need to              operational and financial healthcare dataset. The proposed
internalize best practices that enable them to ask the right    approach is implemented in Java environment .linguistic
questions and listen for answers from the patient. A            summarization is meant as a process of a comprehensive
cognitive system helps in find patterns and outliers in data    description of big and complex datasets through short
that can help to fast track new treatments, improve             statements in natural language .but the limitation of this
efficiencies, and treat patients more effectively. But the      approach is representation and processing of imprecision
limitation of cognitive computing is that the system fails at   that is characteristic for natural language. Roderick et al.
analyzing the risk which is missing in unstructured data.       [15] used Data science in health care, Description of
That includes socio-economic factors, culture, political        medical data, Machine learning in health care, and
environment and people. The scope of cognitive                  Prediction of adverse events based on the traditional
technology is limited to engagement and decision.               medical data. Data science is defined as a process of
 In Altintop et al. [14] healthcare management, they tried      extracting knowledge from externally generated data. It is
to provide quality healthcare service and the effective         combination of mathematics, statistics, computer science
utilization of limited resources, it is necessary to make       and applied field of study. Description of medical data by
efficiency measurement or knowledge discoveries on raw          storing and analyzing medical histories for millions of
data in the Healthcare information system. This can be          patients, using thousands of variables to provide better
done using two methods. The first is the efficiency             resource allocations. The stored healthcare data is provide
measurement techniques and data mining techniques. In           as a input into the model in order to make predictive
this study, fuzzy linguistic summarization is used to           model for rare events. In this study the health care data are
analyze operational and financial data of the healthcare        in terms of : (a) Census information (such as age or
facilities. Fuzzy linguistic summarization has been shown       ethnicity) and simplest biometrics (such as weight). (b)
to be simple, efficient and human consistent way of             Clinical information: time stamped labels of transactions,
knowledge extraction. The linguistic summaries are kind         assigned according to a medical coding system. These
of outputs of Decision support systems (DSS). Decision          record instances of medical decisions, not detailed
support systems (DSS) are a class of computerized               outcomes. (c) Financial information: depending on
information system that support decision-making                 conditions of data sharing with insurance providers, this
activities. The main idea in linguistic summarization for       may include claims data, payments received and aggregate
the healthcare is to provide the statements such as “Most       metrics of subscriber loyalty or risk. (d) Narratives,
hospitals with few beds have a small amount of total            including unstructured text documents such as doctor’s
budget. There are two approaches for generating fuzzy           notes. (e) Multiformatted measurements and test results,
linguistic summaries. One way is to generate all possible       including numerical data and images. (f) Self‐reported
linguistic summaries and select them, of which truth            behavior, such as questionnaires of patient satisfaction. (g)
degree is over a predefined threshold. However, this way        Inferred and miscellaneous socioeconomic features, such
is very exhaustible when the number of summarizers              as frequency of use of social media or likelihood to
becomes very large. The other way to generate fuzzy             purchase an insurance plan. Machine learning methods
linguistic summaries is to use metaheuristics such as           (supervised and unsupervised algorithms ) are used for
genetic algorithms. The idea behind the use of genetic          medical data which is noisy, imbalanced, standard
algorithm is that the individuals (summaries) of which          predictors and classifiers makes the data proper and clear.
truth degree are equal or greater than the predefined           Machine learning take a model in cognition process in that
threshold will only survive after several generation            it deals with patterns. It decomposes and synthesizes
evolutions. This makes that a desirable set of linguistic       information. Decomposition leads to creation of patterns
summaries can be efficiently found instead of generating        that will be recognized when observed again. Synthesis
all linguistic summaries. In this paper genetic algorithm is    allows completion of partially observed data into familiar
used to generate fuzzy linguistic summaries. In this study,     patterns. Supervised learning aims at achieving the best
the dataset of Operational and financial healthcare             representation of output. Unsupervised learning attempts
covering the records for the year 2013, which belong to         to best group subsets among different sets of data(input).
677 public hospitals located in Turkey with 227 features        Lastly the paper predicts rare adverse events for general
that are categorized into 3 groups, 1. Administrative which     patient population, based on nonspecific, traditional
contains Total number of medical examination, Load              clinical data, identified clinical and medical insurance
factor of beds, Total number of inpatients, City population,    records of 500,000 patients. This study is performed in the
Int. J. Advanced Networking and Applications                                                                           4275
Volume: 11 Issue: 03 Pages: 4270-4276 (2019) ISSN: 0975-0290
framework of personalized medicine that automatically            for ongoing care. Lee et al. [4] proposed a conceptual
select only the most relevant training data for each patient,    classification model toward consumer’s behavior in
but at the same time don’t want to restrict the study to any     choosing hospital, Besides, the back propagation network
particular population group such as in‐patients, or patients     was utilized to build the classification model for finding
already recorded as having increased risk of an adverse          consumers’ behavior of choosing hospitals. A neural
event. This has led us to a decision to build an individual      network model is useful in identifying existing patterns of
predictive model for each patient. In Khalaf et al. [12],        hospital’s consumers.
system reduces costs, provide 24 hours communication
between medical experts and patients and remote                  V. Conclusion:
monitoring for SCD patients. When the system detects any         In this study, we provide the comprehensive survey of
critical condition from the patient, it generates an             Machine learning approaches in terms of heath care
automatic message to the medical doctors based on web-           management system. we focus on how the different
based platform in order to assist them with optimal              methods of machine learning whether they are supervised,
decision-making using ANN with MlP algorithm is to               unsupervised or Reinforcement are used for different
extract the information from medical dataset automatically       healthcare problems. The healthcare problem can be: fast
and supervised machine learning algorithms for the               treatment of a patient, prediction of various diseases,
prediction of the amount of medication. The proposed             Remotely Monitoring the Patients using internet of things
framework is divided into two sides. The patient side is         (IOT) and Monitoring the patient using sensors.
used to monitor, to store and collect data, as well as to
send notifications to the clinicians in terms of abnormal        References:
conditions. The hospital side consists of a database and a
decision support system. Medjahed et al. [6] proposed an         1. Hauskrecht, Milos, and Hamish Fraser. "Planning
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HealthI IoT that connects the advantages of IoT with the         machine learning for optimize predictive classification and
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  Int. J. Advanced Networking and Applications                                                                        4276
  Volume: 11 Issue: 03 Pages: 4270-4276 (2019) ISSN: 0975-0290
  Computer,    Telecommunications        and     Information    21. Chuang, Mao‐Te, Ya‐han Hu, and Chia‐Lun Lo.
  Technology (ECTI-CON), 2014            11th   International   "Predicting the prolonged length of stay of general surgery
  Conference on. IEEE, 2014.                                    patients: a supervised learning approach." International
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  Conference (EHB), 2015. IEEE, 2015.                           concept." Cybernetics & Informatics (K&I), 2018. IEEE,
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                                                                Profile
  13. Kau, Lih-Jen, and Chih-Sheng Chen. "A smart phone-
  based pocket fall accident detection, positioning, and                           Dr. Krishan Kumar Goyal received
  rescue system." IEEE journal of biomedical and health                            M.Tech in Computer science from U.P.
  informatics19.1 (2015): 44-56.                                                   Technical University, Lucknow. He has
  14. Altintop, Tunahan, et al. "Fuzzy Linguistic                                  received Ph.D. in cryptography from
  Summarization with Genetic Algorithm: An Application                             Dr. B. R. Ambedkar University, Agra.
  with     Operational      and     Financial     Healthcare    He has also received master's degree in Computer
  Data." International Journal of Uncertainty, Fuzziness and    Application & Mathematics from Dr. B.R. Ambedkar
  Knowledge-Based Systems 25.04 (2017): 599-620.                University, Agra. Presently, he is working as an Associate
                                                                Professor and Dean, Faculty of Computer Application at
  15. Roderick, Oleg, et al. "DATA ANALYSIS AND                 Raja Balwant Singh Management Technical Campus,
  MACHINE LEARNING EFFORT IN HEALTHCARE:                        Agra. He has participated in several faculty development
  ORGANIZATION,              LIMITATIONS,          AND          programs, seminars and workshops. He has published
  DEVELOPMENT OF AN APPROACH." Internet of                      several research papers in leading journals of national and
  Things and Data Analytics Handbook (2017): 295-328.           international repute. He has authored two books. He is
  16. Shameer, Khader, et al. "Predictive modeling of           Life member of several societies such as Computer
  hospital readmission rates using electronic medical record-   Society of India, Ramanujan Mathematical Society of
  wide machine learning: a case-study using Mount Sinai         India, Cryptology Research Society of India etc. He is
  Heart Failure Cohort." PACIFIC SYMPOSIUM ON                   also a reviewer and member of editorial board of
  BIOCOMPUTING 2017.                                            different national and international journals. His area of
                                                                interest includes Cryptography, Cyber Security, Privacy
  17. Nguyen, Hoa Hong, et al. "A review on IoT healthcare      and Security in Online Social Media, Machine Learning,
  monitoring applications and a vision for transforming         Natural Language Processing etc.
  sensor data into real-time clinical feedback." Computer
  Supported Cooperative Work in Design (CSCWD), 2017                                   Aejaz Hassan Paray received
  IEEE 21st International Conference on. IEEE, 2017.                                   Master         of          Computer
                                                                                       Application from University of
  18. Mazhar, Tabib Ibne, et al. "Spinal Cord Injured (SCI)                            Kashmir. Presently he is pursing his
  patients' length of stay (LOS) prediction based on hospital                          Ph.D     degree     in     Computer
  admission        data." Electrical    Information      and                           Application     from       Bhagwant
  Communication Technology (EICT), 2017 3rd                     University of Ajmer Rajasthan. He has participated in
  International Conference on. IEEE, 2017.                      several faculty development programs, seminars and
  19. Baker, Claire, et al. "Healthcare analytics and           workshops. He has published several research papers in
  visualization using SEMantic Open Source Software             leading journals of national and international repute. He is
  (SEMOSS)." Systems and Information Engineering                member of several societies such as Computer Society
  Design Symposium (SIEDS), 2017. IEEE, 2017.                   of India etc. His area of interest includes Artificial
                                                                Intelligence, Artificial Neural Network, Machine Learning
  20. Nithya, B., and V. Ilango. "Predictive analytics in       etc.
  health care using machine learning tools and techniques."
  International Conference on Intelligent Computing and
  Control Systems (ICICCS). IEEE, 2017.