EHRCon: Dataset for Checking Consistency between Unstructured Notes and Structured Tables in Electronic Health Records

Electronic Health Records (EHRs) are integral for storing comprehensive patient medical records, combining structured data (e.g., medications) with detailed clinical notes (e.g., physician notes). These elements are essential for straightforward data retrieval and provide deep, contextual insights into patient care. However, they often suffer from discrepancies due to unintuitive EHR system designs and human errors, posing serious risks to patient safety. To address this, we developed EHRCon, a new dataset and task specifically designed to ensure data consistency between structured tables and unstructured notes in EHRs. EHRCon was crafted in collaboration with healthcare professionals using the MIMIC-III EHR dataset, and includes manual annotations of 3,943 entities across 105 clinical notes checked against database entries for consistency. EHRCon has two versions, one using the original MIMIC-III schema, and another using the OMOP CDM schema, in order to increase its applicability and generalizability. Furthermore, leveraging the capabilities of large language models, we introduce CheckEHR, a novel framework for verifying the consistency between clinical notes and database tables. CheckEHR utilizes an eight-stage process and shows promising results in both few-shot and zero-shot settings. The code is available at https://github.com/dustn1259/EHRCon.

DialSim: A Real-Time Simulator for Evaluating Long-Term Dialogue Understanding of Conversational Agents

Recent advancements in Large Language Models (LLMs) have significantly enhanced the capabilities of conversational agents, making them applicable to various fields (e.g., education). Despite their progress, the evaluation of the agents often overlooks the complexities of real-world conversations, such as real-time interactions, multi-party dialogues, and extended contextual dependencies. To bridge this gap, we introduce DialSim, a real-time dialogue simulator. In this simulator, an agent is assigned the role of a character from popular TV shows, requiring it to respond to spontaneous questions using past dialogue information and to distinguish between known and unknown information. Key features of DialSim include evaluating the agent's ability to respond within a reasonable time limit, handling long-term multi-party dialogues, and managing adversarial settings (e.g., swap character names) to challenge the agent's reliance on pre-trained knowledge. We utilized this simulator to evaluate the latest conversational agents and analyze their limitations. Our experiments highlight both the strengths and weaknesses of these agents, providing valuable insights for future improvements in the field of conversational AI. DialSim is available at https://github.com/jiho283/Simulator.

EHR-SeqSQL : A Sequential Text-to-SQL Dataset For Interactively Exploring Electronic Health Records

In this paper, we introduce EHR-SeqSQL, a novel sequential text-to-SQL dataset for Electronic Health Record (EHR) databases. EHR-SeqSQL is designed to address critical yet underexplored aspects in text-to-SQL parsing: interactivity, compositionality, and efficiency. To the best of our knowledge, EHR-SeqSQL is not only the largest but also the first medical text-to-SQL dataset benchmark to include sequential and contextual questions. We provide a data split and the new test set designed to assess compositional generalization ability. Our experiments demonstrate the superiority of a multi-turn approach over a single-turn approach in learning compositionality. Additionally, our dataset integrates specially crafted tokens into SQL queries to improve execution efficiency. With EHR-SeqSQL, we aim to bridge the gap between practical needs and academic research in the text-to-SQL domain.

Overview of the EHRSQL 2024 Shared Task on Reliable Text-to-SQL Modeling on Electronic Health Records

Electronic Health Records (EHRs) are relational databases that store the entire medical histories of patients within hospitals. They record numerous aspects of patients' medical care, from hospital admission and diagnosis to treatment and discharge. While EHRs are vital sources of clinical data, exploring them beyond a predefined set of queries requires skills in query languages like SQL. To make information retrieval more accessible, one strategy is to build a question-answering system, possibly leveraging text-to-SQL models that can automatically translate natural language questions into corresponding SQL queries and use these queries to retrieve the answers. The EHRSQL 2024 shared task aims to advance and promote research in developing a question-answering system for EHRs using text-to-SQL modeling, capable of reliably providing requested answers to various healthcare professionals to improve their clinical work processes and satisfy their needs. Among more than 100 participants who applied to the shared task, eight teams completed the entire shared task processes and demonstrated a wide range of methods to effectively solve this task. In this paper, we describe the task of reliable text-to-SQL modeling, the dataset, and the methods and results of the participants. We hope this shared task will spur further research and insights into developing reliable question-answering systems for EHRs.

Towards Unbiased Evaluation of Detecting Unanswerable Questions in EHRSQL

Incorporating unanswerable questions into EHR QA systems is crucial for testing the trustworthiness of a system, as providing non-existent responses can mislead doctors in their diagnoses. The EHRSQL dataset stands out as a promising benchmark because it is the only dataset that incorporates unanswerable questions in the EHR QA system alongside practical questions. However, in this work, we identify a data bias in these unanswerable questions; they can often be discerned simply by filtering with specific N-gram patterns. Such biases jeopardize the authenticity and reliability of QA system evaluations. To tackle this problem, we propose a simple debiasing method of adjusting the split between the validation and test sets to neutralize the undue influence of N-gram filtering. By experimenting on the MIMIC-III dataset, we demonstrate both the existing data bias in EHRSQL and the effectiveness of our data split strategy in mitigating this bias.

EHRFL: Federated Learning Framework for Heterogeneous EHRs and Precision-guided Selection of Participating Clients

In this study, we provide solutions to two practical yet overlooked scenarios in federated learning for electronic health records (EHRs): firstly, we introduce EHRFL, a framework that facilitates federated learning across healthcare institutions with distinct medical coding systems and database schemas using text-based linearization of EHRs. Secondly, we focus on a scenario where a single healthcare institution initiates federated learning to build a model tailored for itself, in which the number of clients must be optimized in order to reduce expenses incurred by the host. For selecting participating clients, we present a novel precision-based method, leveraging data latents to identify suitable participants for the institution. Our empirical results show that EHRFL effectively enables federated learning across hospitals with different EHR systems. Furthermore, our results demonstrate the efficacy of our precision-based method in selecting reduced number of participating clients without compromising model performance, resulting in lower operational costs when constructing institution-specific models. We believe this work lays a foundation for the broader adoption of federated learning on EHRs.

TrustSQL: A Reliability Benchmark for Text-to-SQL Models with Diverse Unanswerable Questions

Recent advances in large language models (LLMs) have led to significant improvements in translating natural language questions into SQL queries. While achieving high accuracy in SQL generation is crucial, little is known about the extent to which these text-to-SQL models can reliably handle diverse types of questions encountered during real-world deployment, including unanswerable ones. To explore this aspect, we present TrustSQL, a new benchmark designed to assess the reliability of text-to-SQL models in both single-database and cross-database settings. The benchmark tasks models with providing one of two outcomes: 1) SQL prediction; or 2) abstention from making a prediction, either when there is a potential error in the generated SQL or when faced with unanswerable questions. For model evaluation, we explore various modeling approaches specifically designed for this task. These include: 1) optimizing separate models for answerability detection, SQL generation, and error detection, which are then integrated into a single pipeline; and 2) developing a unified approach that optimizes a single model to address the proposed task. Experimental results using our new reliability score show that addressing this challenge involves many different areas of research and opens new avenues for model development. Nonetheless, none of the methods surpass the reliability performance of the naive baseline, which abstains from answering all questions.

KorMedMCQA: Multi-Choice Question Answering Benchmark for Korean Healthcare Professional Licensing Examinations

We introduce KorMedMCQA, the first Korean multiple-choice question answering (MCQA) benchmark derived from Korean healthcare professional licensing examinations, covering from the year 2012 to year 2023. This dataset consists of a selection of questions from the license examinations for doctors, nurses, and pharmacists, featuring a diverse array of subjects. We conduct baseline experiments on various large language models, including proprietary/open-source, multilingual/Korean-additional pretrained, and clinical context pretrained models, highlighting the potential for further enhancements. We make our data publicly available on HuggingFace (https://huggingface.co/datasets/sean0042/KorMedMCQA) and provide a evaluation script via LM-Harness, inviting further exploration and advancement in Korean healthcare environments.

Recent Advances, Applications, and Open Challenges in Machine Learning for Health: Reflections from Research Roundtables at ML4H 2023 Symposium

The third ML4H symposium was held in person on December 10, 2023, in New Orleans, Louisiana, USA. The symposium included research roundtable sessions to foster discussions between participants and senior researchers on timely and relevant topics for the \ac{ML4H} community. Encouraged by the successful virtual roundtables in the previous year, we organized eleven in-person roundtables and four virtual roundtables at ML4H 2022. The organization of the research roundtables at the conference involved 17 Senior Chairs and 19 Junior Chairs across 11 tables. Each roundtable session included invited senior chairs (with substantial experience in the field), junior chairs (responsible for facilitating the discussion), and attendees from diverse backgrounds with interest in the session's topic. Herein we detail the organization process and compile takeaways from these roundtable discussions, including recent advances, applications, and open challenges for each topic. We conclude with a summary and lessons learned across all roundtables. This document serves as a comprehensive review paper, summarizing the recent advancements in machine learning for healthcare as contributed by foremost researchers in the field.

EHRNoteQA: A Patient-Specific Question Answering Benchmark for Evaluating Large Language Models in Clinical Settings

This study introduces EHRNoteQA, a novel patient-specific question answering benchmark tailored for evaluating Large Language Models (LLMs) in clinical environments. Based on MIMIC-IV Electronic Health Record (EHR), a team of three medical professionals has curated the dataset comprising 962 unique questions, each linked to a specific patient's EHR clinical notes. What makes EHRNoteQA distinct from existing EHR-based benchmarks is as follows: Firstly, it is the first dataset to adopt a multi-choice question answering format, a design choice that effectively evaluates LLMs with reliable scores in the context of automatic evaluation, compared to other formats. Secondly, it requires an analysis of multiple clinical notes to answer a single question, reflecting the complex nature of real-world clinical decision-making where clinicians review extensive records of patient histories. Our comprehensive evaluation on various large language models showed that their scores on EHRNoteQA correlate more closely with their performance in addressing real-world medical questions evaluated by clinicians than their scores from other LLM benchmarks. This underscores the significance of EHRNoteQA in evaluating LLMs for medical applications and highlights its crucial role in facilitating the integration of LLMs into healthcare systems. The dataset will be made available to the public under PhysioNet credential access, promoting further research in this vital field.