INTERVenE: Temporal-Abstraction-Interval Based Transformers for Short-Horizon Medical Event Prediction

arXiv:2608.29901v2 Announce Type: replace Abstract: Electronic Health Record (EHR) prediction models in the intensive care unit must learn from sparse and irregular measurements while preserving the clinical meaning of time and supporting transparent decision-making. We present INTERVenE, a family of Transformer architectures whose input is an interval-based, knowledge-based temporal abstraction (KBTA), a token stream of named clinical concepts (states, trends, events, contexts) drawn from a curated medical ontology, rather than an unnamed bin index or a raw measurement triplet. This naming layer is what we ask KBTA to do: it makes the model's per-token attributions resolve to clinical concepts by construction. INTERVenE offers two complementary variants: an auto-regressive decoder that generates future abstraction trajectories with a per-step risk readout (localizing \emph{when} and \emph{after which events} risk rises), and a bidirectional encoder for single-pass joint risk and time-to-event prediction. On 57,078 MIMIC-IV admissions, INTERVenE-Enc outperformed GRU-D, STraTS, and KarmaLego, reaching a support-weighted AUPRC of 0.672 ($+0.046$ over the strongest neural baseline, with non-overlapping 95\% bootstrap CIs), AUROC of 0.901, and length-of-stay MAE of 44.4\,h. INTERVenE-Ar complements these predictions with generated abstraction trajectories and evolving risk scores, achieving AUROC of 0.854 and AUPRC of 0.588 under the harder generative readout. An alternative-discretization ablation preserved predictive performance, supporting KBTA's role as a clinically named attribution substrate rather than a prerequisite for accuracy.