Canada

We present our work on building large scale sequence-to-sequence models for generating clinical note from patient-doctor conversation. This is formulated as an abstractive summarization task for which we use encoder-decoder transformer model with pointer-generator. We discuss various modeling enhancements to this baseline model which include using subword and multiword tokenization scheme, prefixing the targets with a chain-of-clinical-facts, and training with contrastive loss that is defined over various candidate summaries. We also use flash attention during training and query chunked attention during inference to be able to process long input and output sequences and to improve computational efficiency. Experiments are conducted on a dataset containing about 900K encounters from around 1800 healthcare providers covering 27 specialties. The results are broken down into primary care and non-primary care specialties. Consistent accuracy improvements are observed across both of these categories.

ACL 2023

Large Scale Sequence-to-Sequence Models for Clinical Note Generation from Patient-Doctor Conversations

medical dialogue summarization

clinical note generation

transformers

abstractive summarization

workshop paper

### Welcome to ACL 2023, the 61st Annual Meeting of the Association for Computational Linguistics! 
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The Association for Computational Linguistics (ACL) is the premier international scientific and professional society for people working on computational problems involving human language, a field often referred to as either computational linguistics or natural language processing.

We propose a method to automate orthodontic diagnosis with natural language processing. It is worthwhile to assist dentists with such technology to prevent errors by inexperienced dentists and to reduce the workload of experienced ones. However, text length and style inconsistencies in medical findings make an automated orthodontic diagnosis with deep-learning models difficult. In this study, we improve the performance of automatic diagnosis utilizing short summaries of medical findings written in a consistent style by experienced dentists. Experimental results on 970 Japanese medical findings show that summarization consistently improves the performance of various machine learning models for automated orthodontic diagnosis. Although BERT is the model that gains the most performance with the proposed method, the convolutional neural network achieved the best performance.

Automated Orthodontic Diagnosis from a Summary of Medical Findings

Recent advancements in natural language processing (NLP) have been driven by large language models (LLMs), thereby revolutionizing the field. Our study investigates the impact of diverse pre-training strategies on the performance of Turkish clinical language models in a multi-label classification task involving radiology reports, with a focus on overcoming language resource limitations. Additionally, for the first time, we evaluated the simultaneous pre-training approach by utilizing limited clinical task data. We developed four models: TurkRadBERT-task v1, TurkRadBERT-task v2, TurkRadBERT-sim v1, and TurkRadBERT-sim v2. Our results revealed superior performance from BERTurk and TurkRadBERT-task v1, both of which leverage a broad general-domain corpus. Although task-adaptive pre-training is capable of identifying domain-specific patterns, it may be prone to overfitting because of the constraints of the task-specific corpus. Our findings highlight the importance of domain-specific vocabulary during pre-training to improve performance. They also affirmed that a combination of general domain knowledge and task-specific fine-tuning is crucial for optimal performance across various categories. This study offers key insights for future research on pre-training techniques in the clinical domain, particularly for low-resource languages.

Harnessing the Power of BERT in the Turkish Clinical Domain: Pretraining Approaches for Limited Data Scenarios

Over the last years, an increasing number of publicly available, semantically annotated medical corpora have been released for the German language. While their annotations cover comparable semantic classes, the synergies of such efforts have not been explored yet. This is due to substantial differences in the data schemas (syntax) and annotated entities (semantics), which hinder the creation of common meta-datasets. For instance, it is unclear whether named entity recognition (NER) taggers trained on one or more of such datasets are useful to detect entities in any of the other datasets. In this work, we create harmonized versions of German medical corpora using the BigBIO framework, and make them available to the community. Using these as a meta-dataset, we perform a series of cross-corpus evaluation experiments on two settings of aligned labels. These consist in fine-tuning various pre-trained Transformers on different combinations of training sets, and testing them against each dataset separately. We find that a) trained NER models generalize poorly, with F1 scores dropping approx. 20 pp. on unseen test data, and b) current pre-trained Transformer models for the German language do not systematically alleviate this issue. However, our results suggest that models benefit from additional training corpora in most cases, even if these belong to different medical fields or text genres.

A Meta-dataset of German Medical Corpora: Harmonization of Annotations and Cross-corpus NER Evaluation

Post-stroke speech and language deficits (aphasia) significantly impact patients’ quality of life. Many with mild symptoms remain undiagnosed, and the majority do not receive the intensive doses of therapy recommended, due to healthcare costs and/or inadequate services. Automatic Speech Recognition (ASR) may help overcome these difficulties by improving diagnostic rates and providing feedback during tailored therapy. However, its performance is often unsatisfactory due to the high variability in speech errors and scarcity of training datasets. This study assessed the performance of Whisper, a recently released end-to-end model, in patients with post-stroke aphasia (PWA). We tuned its hyperparameters to achieve the lowest word error rate (WER) on aphasic speech. WER was significantly higher in PWA compared to age-matched controls (10.3% vs 38.5%, p<0,001 ). We demonstrated that worse WER was related to the more severe aphasia as measured by expressive (overt naming, and spontaneous speech production) and receptive (written and spoken comprehension) language assessments. Stroke lesion size did not affect the performance of Whisper. Linear mixed models accounting for demographic factors, therapy duration, and time since stroke, confirmed worse Whisper performance with left hemispheric frontal lesions.
We discuss the implications of these findings for how future ASR can be improved in PWA.

Uncovering the Potential for a Weakly Supervised End-to-End Model in Recognising Speech from Patient with Post-Stroke Aphasia

We explore temporal dependency graph (TDG) parsing in the clinical domain. We leverage existing annotations on the THYME dataset to semi-automatically construct a TDG corpus. Then we propose a new natural language inference (NLI) approach to TDG parsing, and evaluate it both on general domain TDGs from wikinews and the newly constructed clinical TDG corpus. We achieve competitive performance on general domain TDGs with a much simpler model than prior work. On the clinical TDGs, our method establishes the first result of TDG parsing on clinical data with 0.79/0.88 micro/macro F1.

Textual Entailment for Temporal Dependency Graph Parsing

Annotated clinical text corpora are essential for machine learning studies that model and predict care processes and disease progression. However, few studies describe the necessary experimental design of the annotation guideline and annotation phases. This makes replication, reuse, and adoption challenging.

Using clinical questions about sepsis, we designed a semantic annotation guideline to capture sepsis signs from clinical text. The clinical questions aid guideline design, application, and evaluation. Our method incrementally evaluates each change in the guideline by testing the resulting annotated corpus using clinical questions. Additionally, our method uses inter-annotator agreement to judge the annotator compliance and quality of the guideline. We show that the method, combined with controlled design increments, is simple and allows the development and measurable improvement of a purpose-built semantic annotation guideline. We believe that our approach is useful for incremental design of semantic annotation guidelines in general.

Method for Designing Semantic Annotation of Sepsis Signs in Clinical Text

Information extraction from clinical text has the potential to facilitate clinical research and personalized clinical care, but annotating large amounts of data for each set of target tasks is prohibitive. We present a German medical Named Entity Recognition (NER) system capable of cross-domain knowledge transferring. The system builds on a pre-trained German language model and a token-level binary classifier, employing semantic types sourced from the Unified Medical Language System (UMLS) as entity labels to identify corresponding entity spans within the input text. To enhance the system's performance and robustness, we pre-train it using a medical literature corpus that incorporates UMLS semantic term annotations. We evaluate the system's effectiveness on two German annotated datasets obtained from different clinics in zero- and few-shot settings. Our work contributes to developing robust and transparent German medical NER models that can support the extraction of information from various clinical texts.

Cross-domain German Medical Named Entity Recognition using a Pre-Trained Language Model and Unified Medical Semantic Types

Graph-based techniques have gained traction for representing and analyzing data in various natural language processing (NLP) tasks. Knowledge graph-based language representation models have shown promising results in leveraging domain-specific knowledge for NLP tasks, particularly in the biomedical NLP field. However, such models have limitations, including knowledge noise and neglect of contextual relationships, leading to potential semantic errors and reduced accuracy. To address these issues, this paper proposes two novel methods. The first method combines knowledge graph-based language model with nearest-neighbor models to incorporate semantic and category information from neighboring instances. The second method involves integrating knowledge graph-based language model with graph neural networks (GNNs) to leverage feature information from neighboring nodes in the graph. Experiments on relation extraction (RE) and classification tasks in English and Chinese language datasets demonstrate significant performance improvements with both methods, highlighting their potential for enhancing the performance of language models and improving NLP applications in the biomedical domain.


Reducing Knowledge Noise for Improved Semantic Analysis in Biomedical Natural Language Processing Applications

Natural language tasks like Named Entity Recognition (NER) in the clinical domain on non-English texts can be very time-consuming and expensive due to the lack of annotated data. Cross-lingual transfer (CLT) is a way to circumvent this issue thanks to the ability of multilingual large language models to be fine-tuned on a specific task in one language and to provide high accuracy for the same task in another language. However, other methods leveraging translation models can be used to perform NER without annotated data in the target language, by either translating the training set or test set. This paper compares cross-lingual transfer with these two alternative methods, to perform clinical NER in French and in German without any training data in those languages. To this end, we release MedNERF a medical NER test set extracted from French drug prescriptions and annotated with the same guidelines as an English dataset. Through extensive experiments on this dataset and on a German medical dataset (Frei and Kramer, 2021), we show that translation-based methods can achieve similar performance to CLT but require more care in their design. And while they can take advantage of monolingual clinical language models, those do not guarantee better results than large general-purpose multilingual models, whether with cross-lingual transfer or translat

Multilingual Clinical NER: Translation or Cross-lingual Transfer?

This paper describes our submission to the MEDIQA-Chat 2023 shared task for automatic clinical note generation from doctor-patient conversations. We report results for two approaches: the first fine-tunes a pre-trained language model (PLM) on the shared task data, and the second uses few-shot in-context learning (ICL) with a large language model (LLM). Both achieve high performance as measured by automatic metrics (e.g. ROUGE, BERTScore) and ranked second and first, respectively, of all submissions to the shared task. Expert human scrutiny indicates that notes generated via the ICL-based approach with GPT-4 are preferred about as often as human-written notes, making it a promising path toward automated note generation from doctor-patient conversations.

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Large Scale Sequence-to-Sequence Models for Clinical Note Generation from Patient-Doctor Conversations

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Automated Orthodontic Diagnosis from a Summary of Medical Findings

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