Mind the Missing: Variable-Aware Representation Learning for Irregular EHR Time Series using Large Language Models

Irregular sampling and high missingness are intrinsic challenges in modeling time series derived from electronic health records (EHRs),where clinical variables are measured at uneven intervals depending on workflow and intervention timing. To address this, we propose VITAL, a variable-aware, large language model (LLM) based framework tailored for learning from irregularly sampled physiological time series. VITAL differentiates between two distinct types of clinical variables: vital signs, which are frequently recorded and exhibit temporal patterns, and laboratory tests, which are measured sporadically and lack temporal structure. It reprograms vital signs into the language space, enabling the LLM to capture temporal context and reason over missing values through explicit encoding. In contrast, laboratory variables are embedded either using representative summary values or a learnable [Not measured] token, depending on their availability. Extensive evaluations on the benchmark datasets from the PhysioNet demonstrate that VITAL outperforms state of the art methods designed for irregular time series. Furthermore, it maintains robust performance under high levels of missingness, which is prevalent in real world clinical scenarios where key variables are often unavailable.

WoLF: Wide-scope Large Language Model Framework for CXR Understanding

Significant methodological strides have been made toward Chest X-ray (CXR) understanding via modern vision-language models (VLMs), demonstrating impressive Visual Question Answering (VQA) and CXR report generation abilities. However, existing CXR understanding frameworks still possess several procedural caveats. (1) Previous methods solely use CXR reports, which are insufficient for comprehensive Visual Question Answering (VQA), especially when additional health-related data like medication history and prior diagnoses are needed. (2) Previous methods use raw CXR reports, which are often arbitrarily structured. While modern language models can understand various text formats, restructuring reports for clearer, organized anatomy-based information could enhance their usefulness. (3) Current evaluation methods for CXR-VQA primarily emphasize linguistic correctness, lacking the capability to offer nuanced assessments of the generated answers. In this work, to address the aforementioned caveats, we introduce WoLF, a Wide-scope Large Language Model Framework for CXR understanding. To resolve (1), we capture multi-faceted records of patients, which are utilized for accurate diagnoses in real-world clinical scenarios. Specifically, we adopt the Electronic Health Records (EHR) to generate instruction-following data suited for CXR understanding. Regarding (2), we enhance report generation performance by decoupling knowledge in CXR reports based on anatomical structure even within the attention step via masked attention. To address (3), we introduce an AI-evaluation protocol optimized for assessing the capabilities of LLM. Through extensive experimental validations, WoLF demonstrates superior performance over other models on MIMIC-CXR in the AI-evaluation arena about VQA (up to +9.47%p mean score) and by metrics about report generation (+7.3%p BLEU-1).