United Arab Emirates

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.

EMNLP 2022

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

document classification

icd coding

transformers

workshop paper

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EMNLP 2022 will take place in Abu Dhabi from December 7th to December 11th, 2022. And it will be held in hybrid mode, both online and offline.

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.

Curriculum-guided Abstractive Summarization for Mental Health Online Posts

Clinical data often exists in different forms across the lifetime of a patient's interaction with the healthcare system - structured, unstructured or semi-structured data in the form of laboratory readings, clinical notes, diagnostic codes, imaging and audio data of various kinds, and other observational data. Formulating a representation model that aggregates information from these heterogeneous sources may allow us to jointly model on data with more predictive signal than noise and help inform our model with useful constraints learned from better data. Multimodal fusion approaches help produce representations combined from heterogeneous modalities, which can be used for clinical prediction tasks. Representations produced through different fusion techniques require different training strategies. We investigate the advantage of adding narrative clinical text to structured modalities to classification tasks in the clinical domain. We show that while there is a competitive advantage in combined representations of clinical data, the approach can be helped by training guidance customized to each modality. We show empirical results across binary/multiclass settings, single/multitask settings and unified/multimodal learning rate settings for early and late information fusion of clinical data.

Improving information fusion on multimodal clinical data in classification settings

Large pre-trained language models (LMs) have been widely adopted in biomedical and clinical domains, introducing many powerful LMs such as bio-lm and BioELECTRA. However, the applicability of these methods to real clinical use cases is hindered, due to the limitation of pre-trained LMs in processing long textual data with thousands of words, which is a common length for a clinical note. In this work, we explore long-range adaptation from such LMs with Longformer, allowing the LMs to capture longer clinical notes context. We conduct experiments on three n2c2 challenges datasets and a longitudinal clinical dataset from Hong Kong Hospital Authority electronic health record (EHR) system to show the effectiveness and generalizability of this concept, achieving ~10% F1-score improvement. Based on our experiments, we conclude that capturing a longer clinical note interval is beneficial to the model performance, but there are different cut-off intervals to achieve the optimal performance for different target variables.

How Long Is Enough? Exploring the Optimal Intervals of Long-Range Clinical Note Language Modeling

Schizophrenia is one of the most disabling mental health conditions to live with. Approximately one percent of the population has schizophrenia which makes it fairly common, and it affects many people and their families. Patients with schizophrenia suffer different symptoms: formal thought disorder (FTD), delusions, and emotional flatness. In this paper, we quantitatively and qualitatively analyze the language of patients with schizophrenia measuring various linguistic features in two modalities: speech and written text. We examine the following features: coherence and cohesion of thoughts, emotions, specificity, level of commit- ted belief (LCB), and personality traits. Our results show that patients with schizophrenia score high in fear and neuroticism compared to healthy controls. In addition, they are more committed to their beliefs, and their writing lacks details. They score lower in most of the linguistic features of cohesion with significant p-values.

A Quantitative and Qualitative Analysis of Schizophrenia Language

In recent years, there has been a surge of interest in research on automatic mental health detection (MHD) from social media data leveraging advances in natural language processing and machine learning techniques. While significant progress has been achieved in this interdisciplinary research area, the vast majority of work has treated MHD as a binary classification task.  The multiclass classification setup is, however, essential if we are to uncover the subtle differences among the statistical patterns of language use associated with particular mental health conditions. Here, we report on experiments aimed at predicting six conditions (anxiety, attention deficit hyperactivity disorder, bipolar disorder, post-traumatic stress disorder, depression, and psychological stress) from Reddit social media posts. We explore and compare the performance of hybrid and ensemble models leveraging transformer-based architectures (BERT and RoBERTa) and BiLSTM neural networks trained on within-text distributions of a diverse set of linguistic features. This set encompasses measures of syntactic complexity, lexical sophistication and diversity, readability, and register-specific ngram frequencies, as well as sentiment and emotion lexicons. In addition, we conduct feature ablation experiments to investigate which types of features are most indicative of particular mental health conditions.

Exploring Hybrid and Ensemble Models for Multiclass Prediction of Mental Health Status on Social Media

Using language models created from large data sources has improved the performance of several deep learning-based architectures, obtaining state-of-the-art results in several NLP extrinsic tasks. However, little research is related to creating intrinsic tests that allow us to compare the quality of different language models when obtaining contextualized embeddings. This gap increases even more when working on specific domains in languages other than English. This paper proposes a novel graph-based intrinsic test that allows us to measure the quality of different language models in clinical and biomedical domains in Spanish. Our results show that our intrinsic test performs better for clinical and biomedical language models than a general one. Also, it correlates with better outcomes for a NER task using a probing model over contextualized embeddings. We hope our work will help the clinical NLP research community to evaluate and compare new language models in other languages and find the most suitable models for solving downstream tasks.

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

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Parameter Efficient Transfer Learning for Suicide Attempt and Ideation Detection

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