# Guided Discrete Diffusion for Electronic Health Record Generation

arXiv: https://arxiv.org/abs/2404.12314 · HTML: https://mlsanity.com/paper/2404.12314/

## Key facts

- Cited by 5 papers in the map (data through 14 Oct 2026).
- Placed in Medical imaging and segmentation, one of 14 directions in Diffusion models.
- Builds on 46 of its 67 references that are in the map.
- First posted on arXiv 18 Apr 2024.

## Placed in

- Diffusion models / [Medical imaging and segmentation](https://mlsanity.com/diffusion/medical-imaging-and-segmentation/)

## Builds on (most cited first, 30 of 46)

- [Denoising Diffusion Probabilistic Models](https://mlsanity.com/paper/2006.11239/) (2020)
- [Denoising Diffusion Implicit Models](https://mlsanity.com/paper/2010.02502/) (2020)
- [Diffusion Models Beat GANs on Image Synthesis](https://mlsanity.com/paper/2105.05233/) (2021)
- [Deep Unsupervised Learning using Nonequilibrium Thermodynamics](https://mlsanity.com/paper/1503.03585/) (2015)
- [Classifier-Free Diffusion Guidance](https://mlsanity.com/paper/2207.12598/) (2022)
- [Membership Inference Attacks against Machine Learning Models](https://mlsanity.com/paper/1610.05820/) (2016)
- [Improved Training of Wasserstein GANs](https://mlsanity.com/paper/1704.00028/) (2017)
- [Structured Denoising Diffusion Models in Discrete State-Spaces](https://mlsanity.com/paper/2107.03006/) (2021)
- [Linformer: Self-Attention with Linear Complexity](https://mlsanity.com/paper/2006.04768/) (2020)
- [DiffWave: A Versatile Diffusion Model for Audio Synthesis](https://mlsanity.com/paper/2009.09761/) (2020)
- [Improved Techniques for Training Score-Based Generative Models](https://mlsanity.com/paper/2006.09011/) (2020)
- [Improved Precision and Recall Metric for Assessing Generative Models](https://mlsanity.com/paper/1904.06991/) (2019)
- [Plug and Play Language Models: A Simple Approach to Controlled Text Generation](https://mlsanity.com/paper/1912.02164/) (2019)
- [Discrete Diffusion Modeling by Estimating the Ratios of the Data Distribution](https://mlsanity.com/paper/2310.16834/) (2023)
- [WaveGrad: Estimating Gradients for Waveform Generation](https://mlsanity.com/paper/2009.00713/) (2020)
- [Argmax Flows and Multinomial Diffusion: Learning Categorical Distributions](https://mlsanity.com/paper/2102.05379/) (2021)
- [Stein Variational Gradient Descent: A General Purpose Bayesian Inference Algorithm](https://mlsanity.com/paper/1608.04471/) (2016)
- [A Continuous Time Framework for Discrete Denoising Models](https://mlsanity.com/paper/2205.14987/) (2022)
- [TabDDPM: Modelling Tabular Data with Diffusion Models](https://mlsanity.com/paper/2209.15421/) (2022)
- [Med-BERT: pre-trained contextualized embeddings on large-scale structured electronic health records for disease prediction](https://mlsanity.com/paper/2005.12833/) (2020)
- [Generative Flows on Discrete State-Spaces: Enabling Multimodal Flows with Applications to Protein Co-Design](https://mlsanity.com/paper/2402.04997/) (2024)
- [Scalable and accurate deep learning for electronic health records](https://mlsanity.com/paper/1801.07860/) (2018)
- [BEHRT: Transformer for Electronic Health Records](https://mlsanity.com/paper/1907.09538/) (2019)
- [MMD GAN: Towards Deeper Understanding of Moment Matching Network](https://mlsanity.com/paper/1705.08584/) (2017)
- [Gotta Go Fast When Generating Data with Score-Based Models](https://mlsanity.com/paper/2105.14080/) (2021)
- [Autoregressive Diffusion Models](https://mlsanity.com/paper/2110.02037/) (2021)
- [Generating Multi-label Discrete Patient Records using Generative Adversarial Networks](https://mlsanity.com/paper/1703.06490/) (2017)
- [Mixed-Type Tabular Data Synthesis with Score-based Diffusion in Latent Space](https://mlsanity.com/paper/2310.09656/) (2023)
- [Score-based Continuous-time Discrete Diffusion Models](https://mlsanity.com/paper/2211.16750/) (2022)
- [Protein Design with Guided Discrete Diffusion](https://mlsanity.com/paper/2305.20009/) (2023)

## Built on by (most cited first, 5 of 5)

- [Fast Solvers for Discrete Diffusion Models: Theory and Applications of High-Order Algorithms](https://mlsanity.com/paper/2502.00234/) (2025)
- [Diffusion and Flow Matching Models for Tabular Data: A Survey](https://mlsanity.com/paper/2502.17119/) (2025)
- [G2D2: Gradient-Guided Discrete Diffusion for Inverse Problem Solving](https://mlsanity.com/paper/2410.14710/) (2024)
- [DDPS: Discrete Diffusion Posterior Sampling for Paths in Layered Graphs](https://mlsanity.com/paper/2504.20754/) (2025)
- [CDMT-EHR: A Continuous-Time Diffusion Framework for Generating Mixed-Type Time-Series Electronic Health Records](https://mlsanity.com/paper/2603.23719/) (2026)

## Abstract (arXiv)

Electronic health records (EHRs) are a pivotal data source that enables numerous applications in computational medicine, e.g., disease progression prediction, clinical trial design, and health economics and outcomes research. Despite wide usability, their sensitive nature raises privacy and confidentially concerns, which limit potential use cases. To tackle these challenges, we explore the use of generative models to synthesize artificial, yet realistic EHRs. While diffusion-based methods have recently demonstrated state-of-the-art performance in generating other data modalities and overcome the training instability and mode collapse issues that plague previous GAN-based approaches, their applications in EHR generation remain underexplored. The discrete nature of tabular medical code data in EHRs poses challenges for high-quality data generation, especially for continuous diffusion models. To this end, we introduce a novel tabular EHR generation method, EHR-D3PM, which enables both unconditional and conditional generation using the discrete diffusion model. Our experiments demonstrate that EHR-D3PM significantly outperforms existing generative baselines on comprehensive fidelity and utility metrics while maintaining less attribute and membership vulnerability risks. Furthermore, we show EHR-D3PM is effective as a data augmentation method and enhances performance on downstream tasks when combined with real data.