United Arab Emirates

Clinical notes are the backbone of electronic health records, often containing vital information not observed in other structured data. Unfortunately, the unstructured nature of clinical notes can lead to critical patient-related information being lost. Algorithms that organize clinical notes into distinct sections are often proposed in order to allow medical professionals to better access information in a given note. These algorithms, however, often assume a given partition over the note, and classify section types given this information. In this paper, we propose a multi-task solution for note sectioning, where a single model identifies context changes and labels each section with its medically-relevant title. Results on in-distribution (MIMIC-III) and out-of-distribution (private held-out) datasets reveal that our approach successfully identifies note sections across different hospital systems.

EMNLP 2022

Section Classification in Clinical Notes with Multi-task Transformers

document segmentation

medical nlp

health informatics

clinical nlp

workshop paper

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Clinical notes often contain useful information not documented in structured data, but their unstructured nature can lead to critical patient-related information being missed. To increase the likelihood that this valuable information is utilized for patient care, algorithms that summarize notes into a problem list have been proposed. Focused on identifying medically-relevant entities in the free-form text, these solutions are often detached from a canonical ontology and do not allow downstream use of the detected text-spans. Mitigating these issues, we present here a system for generating a canonical problem list from medical notes, consisting of two major stages. At the first stage, annotation, we use a transformer model to detect all clinical conditions which are mentioned in a single note. These clinical conditions are then grounded to a predefined ontology, and are linked to spans in the text. At the second stage, summarization, we develop a novel algorithm that aggregates over the set of clinical conditions detected on all of the patient's notes, and produce a concise patient summary that organizes their most important conditions.

Building a Clinically-Focused Problem List From Medical Notes

Domain adaptation of word embeddings has mainly been  explored in the context of retraining general models on large specialized corpora. While this usually yields good results, we argue that knowledge graphs, which are used less frequently, could also be utilized to enhance existing representations with specialized knowledge. In this work, we aim to shed some light on whether such knowledge injection could be achieved using a basic set of tools: graph-level embeddings and concatenation. To that end, we adopt an incremental approach where we first demonstrate that static embeddings can indeed be improved through concatenation with in-domain node2vec representations. Then, we validate this approach on contextual models and generalize it further by proposing a variant of BERT that incorporates knowledge embeddings within its hidden states through the same process of concatenation. We show that this variant outperforms plain retraining on several specialized tasks, then discuss how this simple approach could be improved further. Both our code and pre-trained models are open-sourced for future research. In this work, we conduct experiments that target the medical domain and the English language.

Specializing Static and Contextual Embeddings in the Medical Domain Using Knowledge Graphs: Let's Keep It Simple

Sentence embeddings in the form of fixed-size vectors that capture the information in the sentence as well as the context are critical components of Natural Language Processing systems. With transformer model based sentence encoders outperforming the other sentence embedding methods in the general domain, we explore the transformer based architectures to generate dense sentence embeddings in the biomedical domain. In this work, we present BioSimCSE, where we train sentence embeddings with domain specific transformer based models with biomedical texts. We assess our model's performance with zero-shot and fine-tuned settings on Semantic Textual Similarity (STS) and Recognizing Question Entailment (RQE) tasks. Our BioSimCSE model using BioLinkBERT achieves state of the art (SOTA) performance on both tasks.

BioSimCSE: BioMedical Sentence Embeddings using Contrastive learning

A recent advancement in the domain of biomedical Entity Linking is the development of powerful two-stage algorithms – an initial candidate retrieval stage that generates a shortlist of entities for each mention, followed by a candidate ranking stage. However, the effectiveness of both stages are inextricably dependent on computationally expensive components. Specifically, in candidate retrieval via dense representation retrieval it is important to have hard negative samples, which require repeated forward passes and nearest neighbour searches across the entire entity label set throughout training. In this work, we show that pairing a proxy-based metric learning loss with an adversarial regularizer provides an efficient alternative to hard negative sampling in the candidate retrieval stage. In particular, we show competitive performance on the recall@1 metric, thereby providing the option to leave out the expensive candidate ranking step. Finally, we demonstrate how the model can be used in a zero-shot setting to discover out of knowledge base biomedical entities.

Proxy-based Zero-Shot Entity Linking by Effective Candidate Retrieval

Transformer models have achieved great success across many NLP problems. However, previous studies in automated ICD coding concluded that these models fail to outperform some of the earlier solutions such as CNN-based models. In this paper we challenge this conclusion. We present a simple and scalable method to process long text with the existing transformer models such as BERT. We show that this method significantly improves the previous results reported for transformer models in ICD coding, and is able to outperform one of the prominent CNN-based methods.

BERT for Long Documents: A Case Study of Automated ICD Coding

Pre-trained language models (LMs) have been  deployed as the state-of-the-art natural language processing (NLP) approaches for multiple clinical applications. Model generalisability is important in clinical domain due to the low available resources. In this study, we evaluated transfer learning techniques for an important clinical application: detecting suicide attempt (SA) and suicide ideation (SI) in electronic health records (EHRs). Using the annotation guideline provided by the authors of ScAN, we annotated two EHR datasets from different hospitals. We then fine-tuned ScANER, a publicly available SA and SI detection model, to evaluate five different parameter efficient transfer learning techniques, such as adapter-based learning and soft-prompt tuning, on the two datasets. Without any fine-tuning, ScANER achieve macro F1-scores of 0.85 and 0.87 for SA and SI evidence detection across the two datasets. We observed that by fine-tuning less than ~2% of ScANER's parameters, we were able to further improve the macro F1-score for SA-SI evidence detection by 3% and 5% for the two EHR datasets. Our results show that parameter-efficient transfer learning methods can help improve the performance of publicly available clinical models on new hospital datasets with few annotations.

Parameter Efficient Transfer Learning for Suicide Attempt and Ideation Detection

Training of physicians requires significant practice writing patient notes that document the patient's medical and health information and physician diagnostic reasoning. Assessment and feedback of the patient note requires experienced faculty, consumes significant amounts of time and delays feedback to learners. Grading patient notes is thus a tedious and expensive process for humans that could be improved with the addition of natural language processing. However, the large manual effort required to create labeled datasets increases the challenge, particularly when test cases change. Therefore, traditional supervised NLP methods relying on labelled datasets are impractical in such a low-resource scenario. In our work, we proposed an unsupervised framework as a simple baseline and a weakly supervised method utilizing transfer learning for automatic assessment of patient notes under a low-resource scenario. Experiments on our self-collected datasets show that our weakly-supervised methods could provide reliable assessment for patient notes with accuracy of 0.92.

Automatic Patient Note Assessment without Strong Supervision

Drug-drug interaction (DDI) may leads to adverse reactions in patients, thus it is important to extract such knowledge from biomedical texts. However, previously proposed approaches typically focus on capturing sentence-aspect information while ignoring valuable knowledge concerning the whole corpus. In this paper, we propose a Multi-aspect Graph-based DDI extraction model, named DDI-MuG. We first employ a bio-specific pre-trained language model to obtain the token contextualized representations. Then we use two graphs to get syntactic information from input instance and word co-occurrence information within the entire corpus, respectively. Finally, we combine the representations of drug entities and verb tokens for the final classification. It is encouraging to see that the proposed model outperforms all baseline models on two benchmark datasets. To the best of our knowledge, this is the first model that explores multi-aspect graphs to the DDI extraction task, and we hope it can establish a foundation for more robust multi-aspect works in the future.

DDI-MuG: Multi-aspect Graphs for Drug-Drug Interaction Extraction

Clinical coding is the task of transforming medical  documents into structured codes following a standard ontology. Since these terminologies are composed of hundreds of codes, this problem can be considered an Extreme Multi-label Classification task. This paper proposes a novel neural network-based architecture for clinical coding. First, we take full advantage of the hierarchical nature of ontologies to create clusters based on semantic relations. Then, we use a Matcher module to assign the probability of documents belonging to each cluster. Finally, the Ranker calculates the probability of each code considering only the documents in the cluster. This division allows a fine-grained differentiation within the cluster, which cannot be addressed using a single classifier. In addition, since most of the previous work has focused on solving this task in English, we conducted our experiments on three clinical coding corpora in Spanish. The experimental results demonstrate the effectiveness of our model, achieving state-of-the-art results on two of the three datasets. Specifically, we outperformed previous models on two subtasks of the CodiEsp shared task: CodiEsp-D (diseases) and CodiEsp-P (procedures). Automatic coding can profoundly impact healthcare by structuring critical information written in free text in electronic health records.

Divide and Conquer: An Extreme Multi-Label Classification Approach for Coding Diseases and Procedures in Spanish

Automatically generating short summaries from users' online mental health posts could save counselors' reading time and reduce their fatigue so that they can provide timely responses to those seeking help for improving their mental state. Recent Transformers-based summarization models have presented a promising approach to abstractive summarization. They go beyond sentence selection and extractive strategies to deal with more complicated tasks such as novel word generation and sentence paraphrasing. Nonetheless, these models have a prominent shortcoming; their training strategy is not quite efficient, which restricts the model's performance. In this paper, we include a curriculum learning approach to reweigh the training samples, bringing about an efficient learning procedure. We apply our model on extreme summarization dataset of MentSum posts ––a dataset of mental health related posts from Reddit social media. Compared to the state-of-the-art model, our proposed method makes substantial gains in terms of Rouge and Bertscore evaluation metrics, yielding 3.5% Rouge-1, 10.4% Rouge-2, and 4.7% Rouge-L, 1.5% Bertscore relative improvements.

Section Classification in Clinical Notes with Multi-task Transformers

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Building a Clinically-Focused Problem List From Medical Notes

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Section Classification in Clinical Notes with Multi-task Transformers

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Next from EMNLP 2022

Building a Clinically-Focused Problem List From Medical Notes

Stay up to date with the latest Underline news!

PRESENTATIONS

CONFERENCES

COMPANY

RESOURCES

Downloads