Automated Clinical Coding for Outpatient Departments

Computerised clinical coding approaches aim to automate the process of assigning a set of codes to medical records. While there is active research pushing the state of the art on clinical coding for hospitalized patients, the outpatient setting -- where doctors tend to non-hospitalised patients -- is overlooked. Although both settings can be formalised as a multi-label classification task, they present unique and distinct challenges, which raises the question of whether the success of inpatient clinical coding approaches translates to the outpatient setting. This paper is the first to investigate how well state-of-the-art deep learning-based clinical coding approaches work in the outpatient setting at hospital scale. To this end, we collect a large outpatient dataset comprising over 7 million notes documenting over half a million patients. We adapt four state-of-the-art clinical coding approaches to this setting and evaluate their potential to assist coders. We find evidence that clinical coding in outpatient settings can benefit from more innovations in popular inpatient coding benchmarks. A deeper analysis of the factors contributing to the success -- amount and form of data and choice of document representation -- reveals the presence of easy-to-solve examples, the coding of which can be completely automated with a low error rate.

PULSAR at MEDIQA-Sum 2023: Large Language Models Augmented by Synthetic Dialogue Convert Patient Dialogues to Medical Records

This paper describes PULSAR, our system submission at the ImageClef 2023 MediQA-Sum task on summarising patient-doctor dialogues into clinical records. The proposed framework relies on domain-specific pre-training, to produce a specialised language model which is trained on task-specific natural data augmented by synthetic data generated by a black-box LLM. We find limited evidence towards the efficacy of domain-specific pre-training and data augmentation, while scaling up the language model yields the best performance gains. Our approach was ranked second and third among 13 submissions on task B of the challenge. Our code is available at https://github.com/yuping-wu/PULSAR.

PULSAR: Pre-training with Extracted Healthcare Terms for Summarising Patients' Problems and Data Augmentation with Black-box Large Language Models

Medical progress notes play a crucial role in documenting a patient's hospital journey, including his or her condition, treatment plan, and any updates for healthcare providers. Automatic summarisation of a patient's problems in the form of a problem list can aid stakeholders in understanding a patient's condition, reducing workload and cognitive bias. BioNLP 2023 Shared Task 1A focuses on generating a list of diagnoses and problems from the provider's progress notes during hospitalisation. In this paper, we introduce our proposed approach to this task, which integrates two complementary components. One component employs large language models (LLMs) for data augmentation; the other is an abstractive summarisation LLM with a novel pre-training objective for generating the patients' problems summarised as a list. Our approach was ranked second among all submissions to the shared task. The performance of our model on the development and test datasets shows that our approach is more robust on unknown data, with an improvement of up to 3.1 points over the same size of the larger model.

A Two-Stage Decoder for Efficient ICD Coding

Clinical notes in healthcare facilities are tagged with the International Classification of Diseases (ICD) code; a list of classification codes for medical diagnoses and procedures. ICD coding is a challenging multilabel text classification problem due to noisy clinical document inputs and long-tailed label distribution. Recent automated ICD coding efforts improve performance by encoding medical notes and codes with additional data and knowledge bases. However, most of them do not reflect how human coders generate the code: first, the coders select general code categories and then look for specific subcategories that are relevant to a patient's condition. Inspired by this, we propose a two-stage decoding mechanism to predict ICD codes. Our model uses the hierarchical properties of the codes to split the prediction into two steps: At first, we predict the parent code and then predict the child code based on the previous prediction. Experiments on the public MIMIC-III data set show that our model performs well in single-model settings without external data or knowledge.

Do You Hear The People Sing? Key Point Analysis via Iterative Clustering and Abstractive Summarisation

Argument summarisation is a promising but currently under-explored field. Recent work has aimed to provide textual summaries in the form of concise and salient short texts, i.e., key points (KPs), in a task known as Key Point Analysis (KPA). One of the main challenges in KPA is finding high-quality key point candidates from dozens of arguments even in a small corpus. Furthermore, evaluating key points is crucial in ensuring that the automatically generated summaries are useful. Although automatic methods for evaluating summarisation have considerably advanced over the years, they mainly focus on sentence-level comparison, making it difficult to measure the quality of a summary (a set of KPs) as a whole. Aggravating this problem is the fact that human evaluation is costly and unreproducible. To address the above issues, we propose a two-step abstractive summarisation framework based on neural topic modelling with an iterative clustering procedure, to generate key points which are aligned with how humans identify key points. Our experiments show that our framework advances the state of the art in KPA, with performance improvement of up to 14 (absolute) percentage points, in terms of both ROUGE and our own proposed evaluation metrics. Furthermore, we evaluate the generated summaries using a novel set-based evaluation toolkit. Our quantitative analysis demonstrates the effectiveness of our proposed evaluation metrics in assessing the quality of generated KPs. Human evaluation further demonstrates the advantages of our approach and validates that our proposed evaluation metric is more consistent with human judgment than ROUGE scores.

Beyond Words: A Comprehensive Survey of Sentence Representations

Sentence representations have become a critical component in natural language processing applications, such as retrieval, question answering, and text classification. They capture the semantics and meaning of a sentence, enabling machines to understand and reason over human language. In recent years, significant progress has been made in developing methods for learning sentence representations, including unsupervised, supervised, and transfer learning approaches. In this paper, we provide an overview of the different methods for sentence representation learning, including both traditional and deep learning-based techniques. We provide a systematic organization of the literature on sentence representation learning, highlighting the key contributions and challenges in this area. Overall, our review highlights the progress made in sentence representation learning, the importance of this area in natural language processing, and the challenges that remain. We conclude with directions for future research, suggesting potential avenues for improving the quality and efficiency of sentence representations in NLP applications.

Mimic-IV-ICD: A new benchmark for eXtreme MultiLabel Classification

Clinical notes are assigned ICD codes - sets of codes for diagnoses and procedures. In the recent years, predictive machine learning models have been built for automatic ICD coding. However, there is a lack of widely accepted benchmarks for automated ICD coding models based on large-scale public EHR data. This paper proposes a public benchmark suite for ICD-10 coding using a large EHR dataset derived from MIMIC-IV, the most recent public EHR dataset. We implement and compare several popular methods for ICD coding prediction tasks to standardize data preprocessing and establish a comprehensive ICD coding benchmark dataset. This approach fosters reproducibility and model comparison, accelerating progress toward employing automated ICD coding in future studies. Furthermore, we create a new ICD-9 benchmark using MIMIC-IV data, providing more data points and a higher number of ICD codes than MIMIC-III. Our open-source code offers easy access to data processing steps, benchmark creation, and experiment replication for those with MIMIC-IV access, providing insights, guidance, and protocols to efficiently develop ICD coding models.

Towards Human-Centred Explainability Benchmarks For Text Classification

Progress on many Natural Language Processing (NLP) tasks, such as text classification, is driven by objective, reproducible and scalable evaluation via publicly available benchmarks. However, these are not always representative of real-world scenarios where text classifiers are employed, such as sentiment analysis or misinformation detection. In this position paper, we put forward two points that aim to alleviate this problem. First, we propose to extend text classification benchmarks to evaluate the explainability of text classifiers. We review challenges associated with objectively evaluating the capabilities to produce valid explanations which leads us to the second main point: We propose to ground these benchmarks in human-centred applications, for example by using social media, gamification or to learn explainability metrics from human judgements.

Can Transformers Reason in Fragments of Natural Language?

State-of-the-art deep-learning-based approaches to Natural Language Processing (NLP) are credited with various capabilities that involve reasoning with natural language texts. In this paper we carry out a large-scale empirical study investigating the detection of formally valid inferences in controlled fragments of natural language for which the satisfiability problem becomes increasingly complex. We find that, while transformer-based language models perform surprisingly well in these scenarios, a deeper analysis re-veals that they appear to overfit to superficial patterns in the data rather than acquiring the logical principles governing the reasoning in these fragments.

RaFoLa: A Rationale-Annotated Corpus for Detecting Indicators of Forced Labour

Forced labour is the most common type of modern slavery, and it is increasingly gaining the attention of the research and social community. Recent studies suggest that artificial intelligence (AI) holds immense potential for augmenting anti-slavery action. However, AI tools need to be developed transparently in cooperation with different stakeholders. Such tools are contingent on the availability and access to domain-specific data, which are scarce due to the near-invisible nature of forced labour. To the best of our knowledge, this paper presents the first openly accessible English corpus annotated for multi-class and multi-label forced labour detection. The corpus consists of 989 news articles retrieved from specialised data sources and annotated according to risk indicators defined by the International Labour Organization (ILO). Each news article was annotated for two aspects: (1) indicators of forced labour as classification labels and (2) snippets of the text that justify labelling decisions. We hope that our data set can help promote research on explainability for multi-class and multi-label text classification. In this work, we explain our process for collecting the data underpinning the proposed corpus, describe our annotation guidelines and present some statistical analysis of its content. Finally, we summarise the results of baseline experiments based on different variants of the Bidirectional Encoder Representation from Transformer (BERT) model.