Canada

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.

ACL 2023

Method for Designing Semantic Annotation of Sepsis Signs in Clinical Text

sepsis

norwegian

semantic annotation

clinical text

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.

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.

WangLab at MEDIQA-Chat 2023: Clinical Note Generation from Doctor-Patient Conversations using Large Language Models

Detecting testimonial injustice is an essential element of addressing inequities and promoting inclusive healthcare practices, many of which are life-critical. However, using a single demographic factor to detect testimonial injustice does not fully encompass the nuanced identities that contribute to a patient's experience. Further, some injustices may only be evident when examining the nuances that arise through the lens of intersectionality. Ignoring such injustices can result in poor quality of care or life-endangering events. Thus, considering intersectionality could result in more accurate classifications and just decisions. To illustrate this, we use real-world medical data to determine whether medical records exhibit words that could lead to testimonial injustice, employ fairness metrics (e.g. demographic parity, differential intersectional fairness, and subgroup fairness) to assess the severity to which subgroups are experiencing testimonial injustice, and analyze how the intersectionality of demographic features (e.g. gender and race) make a difference in uncovering testimonial injustice. From our analysis, we found that with intersectionality we can better see disparities in how subgroups are treated and there are differences in how someone is treated based on the intersection of their demographic attributes. This has not been previously studied in clinical records, nor has it been proven through empirical study.

Intersectionality and Testimonial Injustice in Medical Records

In this paper, we introduce the design and various attempts for Task B of MEDIQA-Chat 2023. The goal of Task B in MEDIQA-Chat 2023 is to generate full clinical note from doctor-patient consultation dialogues. This task has several challenging issues, such as lack of training data, handling long dialogue inputs, and generating semi-structured clinical note which have section heads. To address these issues, we conducted various experiments and analyzed their results. We utilized the DialogLED model pre-trained on long dialogue data to handle long inputs, and we pre-trained on other dialogue datasets to address the lack of training data. We also attempted methods such as using prompts and contrastive learning for handling sections. This paper provides insights into clinical note generation through analyzing experimental methods and results, and it suggests future research directions.

Teddysum at MEDIQA-Chat 2023: an analysis of fine-tuning strategy for long dialog summarization

Multi-label clinical text classification, such as automatic ICD coding, has always been a challenging subject in Natural Language Processing, due to its long, domain-specific documents and long-tail distribution over a large label set. Existing methods adopt different model architectures to encode the clinical notes. Whereas without digging out the useful connections between labels, the model presents a huge gap in predicting performances between rare and frequent codes. In this work, we propose a novel method for further mining the helpful relations between different codes via a relation-enhanced code encoder to improve the rare code performance. Starting from the simple code descriptions, the model reaches comparable, even better performances than models with heavy external knowledge. Our proposed method is evaluated on MIMIC-III, a common dataset in the medical domain. It outperforms the previous state-of-art models on both overall metrics and rare code performances. Moreover, the interpretation results further prove the effectiveness of our methods.

Rare Codes Count: Mining Inter-code Relations for Long-tail Clinical Text Classification

The field of clinical natural language processing (NLP) can extract useful information from clinical text. Since 2017, the NLP field has shifted towards using pre-trained language models (PLMs), improving performance in several tasks. Most of the research in this field has focused on English text, but there are some available PLMs in Spanish. In this work, we use clinical PLMs to analyze text from admission and medical reports in Spanish for an insurance and health provider to give a probability of no coverage in a labor insurance process. Our results show that fine-tuning a PLM pre-trained with the provider's data leads to better results, but this process is time-consuming and computationally expensive. At least for this task, fine-tuning publicly available clinical PLM leads to comparable results to a custom PLM, but in less time and with fewer resources. Analyzing large volumes of insurance requests is burdensome for employers, and models can ease this task by pre-classifying reports that are likely not to have coverage. Our approach of entirely using clinical-related text improves the current models while reinforcing the idea of clinical support systems that simplify human labor but do not replace it. To our knowledge, the clinical corpus collected for this study is the largest one reported for the Spanish language.

Pre-trained language models in Spanish for health insurance coverage

In response to the global challenge of mental health problems, we proposes a Logical Neural Network (LNN) based Neuro-Symbolic AI method for the diagnosis of mental disorders. Due to the lack of effective therapy coverage for mental disorders, there is a need for an AI solution that can assist therapists with the diagnosis. However, current Neural Network models lack explainability and may not be trusted by therapists. The LNN is a Recurrent Neural Network architecture that combines the learning capabilities of neural networks with the reasoning capabilities of classical logic-based AI. The proposed system uses input predicates from clinical interviews to output a mental disorder class, and different predicate pruning techniques are used to achieve scalability and higher scores. In addition, we provide an insight extraction method to aid therapists with their diagnosis. The proposed system addresses the lack of explainability of current Neural Network models and provides a more trustworthy solution for mental disorder diagnosis.

Utterance Classification with Logical Neural Network: Explainable AI for Mental Disorder Diagnosis

Medical Report Generation (MRG) is a sub-task of Natural Language Generation (NLG) and aims to present information from various sources in textual form and synthesize salient information, with the goal of reducing the time spent by domain experts in writing medical reports and providing support information for decision-making. Given the specificity of the medical domain, the evaluation of automatically generated medical reports is of paramount importance to the validity of these systems. Therefore, in this paper, we focus on the evaluation of automatically generated medical reports from the perspective of automatic and human evaluation. We present evaluation methods for general NLG evaluation and how they have been applied to domain-specific medical tasks. The study shows that MRG evaluation methods are very diverse, and that further work is needed to build shared evaluation methods. The state of the art also emphasizes that such an evaluation must be task specific and include human assessments, requesting the participation of experts in the field.

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Method for Designing Semantic Annotation of Sepsis Signs in Clinical Text

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

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