Query-Focused EHR Summarization to Aid Imaging Diagnosis

Electronic Health Records (EHRs) provide vital contextual information to radiologists and other physicians when making a diagnosis. Unfortunately, because a given patient's record may contain hundreds of notes and reports, identifying relevant information within these in the short time typically allotted to a case is very difficult. We propose and evaluate models that extract relevant text snippets from patient records to provide a rough case summary intended to aid physicians considering one or more diagnoses. This is hard because direct supervision (i.e., physician annotations of snippets relevant to specific diagnoses in medical records) is prohibitively expensive to collect at scale. We propose a distantly supervised strategy in which we use groups of International Classification of Diseases (ICD) codes observed in 'future' records as noisy proxies for 'downstream' diagnoses. Using this we train a transformer-based neural model to perform extractive summarization conditioned on potential diagnoses. This model defines an attention mechanism that is conditioned on potential diagnoses (queries) provided by the diagnosing physician. We train (via distant supervision) and evaluate variants of this model on EHR data from Brigham and Women's Hospital in Boston and MIMIC-III (the latter to facilitate reproducibility). Evaluations performed by radiologists demonstrate that these distantly supervised models yield better extractive summaries than do unsupervised approaches. Such models may aid diagnosis by identifying sentences in past patient reports that are clinically relevant to a potential diagnosis.

Interpretability Analysis for Named Entity Recognition to Understand System Predictions and How They Can Improve

Named Entity Recognition systems achieve remarkable performance on domains such as English news. It is natural to ask: What are these models actually learning to achieve this? Are they merely memorizing the names themselves? Or are they capable of interpreting the text and inferring the correct entity type from the linguistic context? We examine these questions by contrasting the performance of several variants of LSTM-CRF architectures for named entity recognition, with some provided only representations of the context as features. We also perform similar experiments for BERT. We find that context representations do contribute to system performance, but that the main factor driving high performance is learning the name tokens themselves. We enlist human annotators to evaluate the feasibility of inferring entity types from the context alone and find that, while people are not able to infer the entity type either for the majority of the errors made by the context-only system, there is some room for improvement. A system should be able to recognize any name in a predictive context correctly and our experiments indicate that current systems may be further improved by such capability.

Entity-Switched Datasets: An Approach to Auditing the In-Domain Robustness of Named Entity Recognition Models

Named entity recognition systems perform well on standard datasets comprising English news. But given the paucity of data, it is difficult to draw conclusions about the robustness of systems with respect to recognizing a diverse set of entities. We propose a method for auditing the in-domain robustness of systems, focusing specifically on differences in performance due to the national origin of entities. We create entity-switched datasets, in which named entities in the original texts are replaced by plausible named entities of the same type but of different national origin. We find that state-of-the-art systems' performance vary widely even in-domain: In the same context, entities from certain origins are more reliably recognized than entities from elsewhere. Systems perform best on American and Indian entities, and worst on Vietnamese and Indonesian entities. This auditing approach can facilitate the development of more robust named entity recognition systems, and will allow research in this area to consider fairness criteria that have received heightened attention in other predictive technology work.

ERASER: A Benchmark to Evaluate Rationalized NLP Models

State-of-the-art models in NLP are now predominantly based on deep neural networks that are generally opaque in terms of how they come to specific predictions. This limitation has led to increased interest in designing more interpretable deep models for NLP that can reveal the `reasoning' underlying model outputs. But work in this direction has been conducted on different datasets and tasks with correspondingly unique aims and metrics; this makes it difficult to track progress. We propose the Evaluating Rationales And Simple English Reasoning (ERASER) benchmark to advance research on interpretable models in NLP. This benchmark comprises multiple datasets and tasks for which human annotations of "rationales" (supporting evidence) have been collected. We propose several metrics that aim to capture how well the rationales provided by models align with human rationales, and also how faithful these rationales are (i.e., the degree to which provided rationales influenced the corresponding predictions). Our hope is that releasing this benchmark facilitates progress on designing more interpretable NLP systems. The benchmark, code, and documentation are available at: www.eraserbenchmark.com .

Learning to Identify Patients at Risk of Uncontrolled Hypertension Using Electronic Health Records Data

Hypertension is a major risk factor for stroke, cardiovascular disease, and end-stage renal disease, and its prevalence is expected to rise dramatically. Effective hypertension management is thus critical. A particular priority is decreasing the incidence of uncontrolled hypertension. Early identification of patients at risk for uncontrolled hypertension would allow targeted use of personalized, proactive treatments. We develop machine learning models (logistic regression and recurrent neural networks) to stratify patients with respect to the risk of exhibiting uncontrolled hypertension within the coming three-month period. We trained and tested models using EHR data from 14,407 and 3,009 patients, respectively. The best model achieved an AUROC of 0.719, outperforming the simple, competitive baseline of relying prediction based on the last BP measure alone (0.634). Perhaps surprisingly, recurrent neural networks did not outperform a simple logistic regression for this task, suggesting that linear models should be included as strong baselines for predictive tasks using EHR

Predicting Annotation Difficulty to Improve Task Routing and Model Performance for Biomedical Information Extraction

Modern NLP systems require high-quality annotated data. In specialized domains, expert annotations may be prohibitively expensive. An alternative is to rely on crowdsourcing to reduce costs at the risk of introducing noise. In this paper we demonstrate that directly modeling instance difficulty can be used to improve model performance, and to route instances to appropriate annotators. Our difficulty prediction model combines two learned representations: a `universal' encoder trained on out-of-domain data, and a task-specific encoder. Experiments on a complex biomedical information extraction task using expert and lay annotators show that: (i) simply excluding from the training data instances predicted to be difficult yields a small boost in performance; (ii) using difficulty scores to weight instances during training provides further, consistent gains; (iii) assigning instances predicted to be difficult to domain experts is an effective strategy for task routing. Our experiments confirm the expectation that for specialized tasks expert annotations are higher quality than crowd labels, and hence preferable to obtain if practical. Moreover, augmenting small amounts of expert data with a larger set of lay annotations leads to further improvements in model performance.

An Analysis of Attention over Clinical Notes for Predictive Tasks

The shift to electronic medical records (EMRs) has engendered research into machine learning and natural language technologies to analyze patient records, and to predict from these clinical outcomes of interest. Two observations motivate our aims here. First, unstructured notes contained within EMR often contain key information, and hence should be exploited by models. Second, while strong predictive performance is important, interpretability of models is perhaps equally so for applications in this domain. Together, these points suggest that neural models for EMR may benefit from incorporation of attention over notes, which one may hope will both yield performance gains and afford transparency in predictions. In this work we perform experiments to explore this question using two EMR corpora and four different predictive tasks, that: (i) inclusion of attention mechanisms is critical for neural encoder modules that operate over notes fields in order to yield competitive performance, but, (ii) unfortunately, while these boost predictive performance, it is decidedly less clear whether they provide meaningful support for predictions.

Inferring Which Medical Treatments Work from Reports of Clinical Trials

How do we know if a particular medical treatment actually works? Ideally one would consult all available evidence from relevant clinical trials. Unfortunately, such results are primarily disseminated in natural language scientific articles, imposing substantial burden on those trying to make sense of them. In this paper, we present a new task and corpus for making this unstructured evidence actionable. The task entails inferring reported findings from a full-text article describing a randomized controlled trial (RCT) with respect to a given intervention, comparator, and outcome of interest, e.g., inferring if an article provides evidence supporting the use of aspirin to reduce risk of stroke, as compared to placebo. We present a new corpus for this task comprising 10,000+ prompts coupled with full-text articles describing RCTs. Results using a suite of models --- ranging from heuristic (rule-based) approaches to attentive neural architectures --- demonstrate the difficulty of the task, which we believe largely owes to the lengthy, technical input texts. To facilitate further work on this important, challenging problem we make the corpus, documentation, a website and leaderboard, and code for baselines and evaluation available at http://evidence-inference.ebm-nlp.com/.

Attention is not Explanation

Attention mechanisms have seen wide adoption in neural NLP models. In addition to improving predictive performance, these are often touted as affording transparency: models equipped with attention provide a distribution over attended-to input units, and this is often presented (at least implicitly) as communicating the relative importance of inputs. However, it is unclear what relationship exists between attention weights and model outputs. In this work, we perform extensive experiments across a variety of NLP tasks that aim to assess the degree to which attention weights provide meaningful `explanations' for predictions. We find that they largely do not. For example, learned attention weights are frequently uncorrelated with gradient-based measures of feature importance, and one can identify very different attention distributions that nonetheless yield equivalent predictions. Our findings show that standard attention modules do not provide meaningful explanations and should not be treated as though they do. Code for all experiments is available at https://github.com/successar/AttentionExplanation.