Thailand

Electronic Health Records (EHR) serve as a valuable source of patient information, offering insights into medical histories, treatments, and outcomes. Previous research has developed systems for detecting applicable ICD codes that should be assigned while writing a given EHR document, mainly focusing on discharge summaries written at the end of a hospital stay. In this work, we investigate the potential of predicting these codes for the whole patient stay at different time points during their stay, even before they are officially assigned by clinicians. The development of methods to predict diagnoses and treatments earlier in advance could open opportunities for predictive medicine, such as identifying disease risks sooner, suggesting treatments, and optimizing resource allocation. Our experiments show that predictions regarding final ICD codes can be made already two days after admission and we propose a custom model that improves performance on this early prediction task.

ACL 2024

Continuous Predictive Modeling of Clinical Notes and ICD Codes in Patient Health Records

long transformers

label attention

hierarchical transformer

model interpretability

icd coding

transformer

workshop paper

### Welcome!
The 62nd Annual Meeting of the Association for Computational Linguistics (ACL 2024) will take place in Bangkok, Thailand from August 11th to 16th, 2024. Our Virtual Poster Sessions will take place online Thursday, August 22, 2024.

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The 62nd Annual Meeting of the Association for Computational Linguistics (ACL 2024) will take place in Bangkok, Thailand from August 11th to 16th, 2024. More information will be announced soon.

Healthcare professionals often manually extract information from large clinical documents to address patient-related questions. The use of Natural Language Processing (NLP) techniques, particularly Question Answering (QA) models, is a promising direction for improving the efficiency of this process. However, document-level QA from large documents is often impractical or even infeasible (for model training and inference). In this work, we solve the document-level QA from clinical reports in a two-step approach: first, the entire report is split into segments and for a given question the most relevant segment is predicted by a NLP model; second, a QA model is applied to the question and the retrieved segment as context. We investigate the effectiveness of heading-based and naive paragraph segmentation approaches for various paragraph lengths on two subsets of the emrQA dataset. Our experiments reveal that an average paragraph length used as a parameter for the segmentation has no significant effect on performance during the whole document-level QA process. That means experiments focusing on segmentation into shorter paragraphs perform similarly to those focusing on entire unsegmented reports. Surprisingly, naive uniform segmentation is sufficient even though it is not based on prior knowledge of the clinical document's characteristics.

Paragraph Retrieval for Enhanced Question Answering in Clinical Documents

The success of pretrained language models (PLMs) across a spate of use-cases has led to significant investment from the NLP community towards building domain-specific foundational models. On the other hand, in mission critical settings such as biomedical applications, other aspects also factor in‚Äîchief of which is a model's ability to produce reasonable estimates of its own uncertainty. In the present study, we discuss these two desiderata through the lens of how they shape the entropy of a model's output probability distribution. We find that domain specificity and uncertainty awareness can often be successfully combined, but the exact task at hand weighs in much more strongly.

Domain-specific or Uncertainty-aware models: Does it really make a difference for biomedical text classification?

Developing imaging models capable of detecting pathologies from chest X-rays can be cost and time-prohibitive for large datasets as it requires supervision to attain state-of-the-art performance. Instead, labels extracted from radiology reports may serve as distant supervision since these are routinely generated as part of clinical practice. Despite their widespread use, current rule-based methods for label extraction rely on extensive rule sets that are limited in their robustness to syntactic variability. To alleviate these limitations, we introduce RadPert, a rule-based system that integrates an uncertainty-aware information schema with a streamlined set of rules, enhancing performance. Additionally, we have developed RadPrompt, a multi-turn prompting strategy that leverages RadPert to bolster the zero-shot predictive capabilities of large language models, achieving a statistically significant improvement in weighted average F1 score over GPT-4 Turbo. Most notably, RadPrompt surpasses both its underlying models, showcasing the synergistic potential of LLMs with rule-based models. We have evaluated our methods on two English Corpora: the MIMIC-CXR gold-standard test set and a gold-standard dataset collected from the Cambridge University Hospitals.

Can Rule-Based Insights Enhance LLMs for Radiology Report Classification? Introducing the RadPrompt Methodology.

Instruction-tuned Large Language Models (LLMs) can perform a wide range of tasks given natural language instructions to do so, but they are sensitive to how such instructions are phrased. 
This issue is especially concerning in healthcare, as clinicians are unlikely to be experienced prompt engineers and the potential consequences of inaccurate outputs are heightened in this domain. 

This raises a practical question: How robust are instruction-tuned LLMs to natural variations in the instructions provided for clinical NLP tasks?
We collect prompts from medical doctors across a range of tasks and quantify the sensitivity of seven LLMs---some general, others specialized---to natural (i.e., non-adversarial) instruction phrasings. 
We find that performance varies substantially across all models, and that---perhaps surprisingly---domain-specific models explicitly trained on clinical data are especially brittle, compared to their general domain counterparts. 
Further, arbitrary phrasing differences can affect fairness, e.g., valid but distinct instructions for mortality prediction yield a range both in overall performance, and in terms of differences between demographic groups.

Open (Clinical) LLMs are Sensitive to Instruction Phrasings

Large language models (LLMs) have shown remarkable performance on many tasks in different domains. However, their performance in contextual biomedical machine reading comprehension (MRC) has not been evaluated in depth. In this work, we evaluate GPT on four contextual biomedical MRC benchmarks. We experiment with different conventional prompting techniques as well as introduce our own novel prompting method. To solve some of the retrieval problems inherent to LLMs, we propose a prompting strategy named Implicit Retrieval Augmented Generation (RAG) that alleviates the need for using vector databases to retrieve important chunks in traditional RAG setups. Moreover, we report qualitative assessments on the natural language generation outputs from our approach. The results show that our new prompting technique is able to get the best performance in two out of four datasets and ranks second in rest of them. Experiments show that modern-day LLMs like GPT even in a zero-shot setting can outperform supervised models, leading to new state-of-the-art (SoTA) results on two of the benchmarks.

Can GPT Redefine Medical Understanding? Evaluating GPT on Biomedical Machine Reading Comprehension

The consequences of a healthcare data breach can be devastating for the patients, providers, and payers. The average financial impact of a data breach in recent months has been estimated to be close to USD 10 million. This is especially significant for healthcare organizations in India that are managing rapid digitization while still establishing data governance procedures that align with the letter and spirit of the law. Computer-based systems for de-identification of personal information are vulnerable to data drift, often rendering them ineffective in cross-institution settings. Therefore, a rigorous assessment of existing de-identification against local health datasets is imperative to support the safe adoption of digital health initiatives in India. Using a small set of de-identified patient discharge summaries provided by an Indian healthcare institution, in this paper, we report the nominal performance of de-identification algorithms (based on language models) trained on publicly available non-Indian datasets, pointing towards a lack of cross-institutional generalization. Similarly, experimentation with off-the-shelf de-identification systems reveals potential risks associated with the approach. To overcome data scarcity, we explore generating synthetic clinical reports (using publicly available and Indian summaries) by performing in-context learning over Large Language Models (LLMs). Our experiments demonstrate the use of generated reports as an effective strategy for creating high-performing de-identification systems with good generalization capabilities.

Generation and De-Identification of Indian Clinical Discharge Summaries using LLMs

Domain adaptation is a widely used method in natural language processing (NLP) to improve the performance of a language model within a specific domain. This method is particularly common in the biomedical domain, which sees regular publication of numerous scientific articles. PubMed, a significant corpus of text, is frequently used in the biomedical domain. The primary objective of this study is to explore whether refining a pre-training dataset using specific quality metrics for scientific papers can enhance the performance of the resulting model. To accomplish this, we employ two straightforward journal impact metrics and conduct experiments by continually pre-training BERT on various subsets of the complete PubMed training set, we then evaluate the resulting models on biomedical language understanding tasks from the BLURB benchmark. Our results show that pruning using journal impact metrics is not efficient. But we also show that pre-training using fewer abstracts (but with the same number of training steps) does not necessarily decrease the resulting model's performance.

Pre-training data selection for biomedical domain adaptation using journal impact metrics

This paper presents the first study for temporal relation extraction in a zero-shot setting focusing on biomedical text. We employ two types of prompts and five Large Language Models (LLMs; GPT-3.5, Mixtral, Llama 2, Gemma, and PMC-LLaMA) to obtain responses about the temporal relations between two events. Our experiments demonstrate that LLMs struggle in the zero-shot setting, performing worse than fine-tuned specialized models in terms of F1 score. This highlights the challenging nature of this task and underscores the need for further research to enhance the performance of LLMs in this context. We further contribute a novel comprehensive temporal analysis by calculating consistency scores for each LLM. Our findings reveal that LLMs face challenges in providing responses consistent with the temporal properties of uniqueness and transitivity. Moreover, we study the relation between the temporal consistency of an LLM and its accuracy, and whether the latter can be improved by solving temporal inconsistencies. 
Our analysis shows that even when temporal consistency is achieved, the predictions can remain inaccurate.

Analysing zero-shot temporal relation extraction on clinical notes using temporal consistency

While the popularity of large, versatile language models like ChatGPT continues to rise, the landscape shifts when considering open-source models tailored to specific domains. Moreover, many areas, such as clinical documents, suffer from a scarcity of training data, often amounting to only a few hundred instances. Additionally, in certain settings, such as hospitals, cloud-based solutions pose privacy concerns, necessitating the deployment of language models on traditional hardware, such as single GPUs or powerful CPUs. To address these complexities, we conduct extensive experiments on both clinical entity detection and relation extraction in clinical documents using 1B parameter models. Our study delves into traditional fine-tuning, continuous pre-training in the medical domain, and instruction-tuning methods, providing valuable insights into their effectiveness in a multilingual setting. Our results underscore the importance of domain-specific models and pre-training for clinical natural language processing tasks. Furthermore, data augmentation using cross-lingual information improves performance in most cases, highlighting the potential for multilingual enhancements.

Get the Best out of 1B LLMs: Insights from Information Extraction on Clinical Documents

This paper presents the setup and results of the second edition of the BioLaySumm shared task on the Lay Summarisation of Biomedical Research Articles, hosted at the BioNLP Workshop at ACL 2024. 
In this task edition, we aim to build on the first edition's success by further increasing research interest in this important task and encouraging participants to explore novel approaches that will help advance the state-of-the-art. 
Encouragingly, we found research interest in the task to be high, with this edition of the task attracting a total of 53 participating teams, a significant increase in engagement from the previous edition. Overall, our results show that a broad range of innovative approaches were adopted by task participants, with a predictable shift towards the use of Large Language Models (LLMs).

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Continuous Predictive Modeling of Clinical Notes and ICD Codes in Patient Health Records

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Paragraph Retrieval for Enhanced Question Answering in Clinical Documents

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