CPLLM: Clinical Prediction with Large Language Models

We present Clinical Prediction with Large Language Models (CPLLM), a method that involves fine-tuning a pre-trained Large Language Model (LLM) for clinical disease prediction. We utilized quantization and fine-tuned the LLM using prompts, with the task of predicting whether patients will be diagnosed with a target disease during their next visit or in the subsequent diagnosis, leveraging their historical diagnosis records. We compared our results versus various baselines, including Logistic Regression, RETAIN, and Med-BERT, which is the current state-of-the-art model for disease prediction using structured EHR data. Our experiments have shown that CPLLM surpasses all the tested models in terms of both PR-AUC and ROC-AUC metrics, displaying noteworthy enhancements compared to the baseline models.

Federated Learning of Medical Concepts Embedding using BEHRT

Electronic Health Records (EHR) data contains medical records such as diagnoses, medications, procedures, and treatments of patients. This data is often considered sensitive medical information. Therefore, the EHR data from the medical centers often cannot be shared, making it difficult to create prediction models using multi-center EHR data, which is essential for such models' robustness and generalizability. Federated Learning (FL) is an algorithmic approach that allows learning a shared model using data in multiple locations without the need to store all data in a central place. An example of a prediction model's task is to predict future diseases. More specifically, the model needs to predict patient's next visit diagnoses, based on current and previous clinical data. Such a prediction model can support care providers in making clinical decisions and even provide preventive treatment. We propose a federated learning approach for learning medical concepts embedding. This pre-trained model can be used for fine-tuning for specific downstream tasks. Our approach is based on an embedding model like BEHRT, a deep neural sequence transduction model for EHR. We train using federated learning, both the Masked Language Modeling (MLM) and the next visit downstream model. We demonstrate our approach on the MIMIC-IV dataset. We compare the performance of a model trained with FL against a model trained on centralized data. We find that our federated learning approach reaches very close to the performance of a centralized model, and it outperforms local models in terms of average precision. We also show that pre-trained MLM improves the model's average precision performance in the next visit prediction task, compared to an MLM model without pre-training. Our code is available at https://github.com/nadavlab/FederatedBEHRT.