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.
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