Electronic phenotyping entails using electronic health records (EHRs) to identify patients with specific health outcomes and determine when those outcomes occurred. Unstructured clinical notes, which contain a vast amount of information, are a valuable resource for electronic phenotyping. However, traditional methods, such as rule-based labeling functions or neural networks, require significant manual effort to tune and may not generalize well to multiple indications. To address these challenges, we propose HyDE (hybrid diagnosis extractor). HyDE is a simple framework for electronic phenotyping that integrates labeling functions and a disease-agnostic neural network to assign diagnoses to patients. By training HyDE’s model to correct predictions made by labeling functions, we are able to disambiguate hypertension true positives and false positives with a supervised area under the precision-recall curve (AUPRC) of 0.85. We extend this hypertension-trained model to zero-shot evaluation of four other diseases, generating AUPRC values ranging from 0.82 - 0.95 and outperforming a labeling function baseline by 44 points in F1 score and a Word2Vec baseline by 24 points in F1 score on average. Furthermore, we demonstrate a speedup of >4x by pruning the length of inputs into our language model to ~2.3% of the full clinical notes, with negligible impact to the AUPRC. HyDE has the potential to improve the efficiency and efficacy of interpreting large-scale unstructured clinical notes for accurate EHR phenotyping.

We systematically investigate lightweight strategies to adapt large language models (LLMs) for the task of radiology report summarization (RRS). Specifically, we focus on domain adaptation via pretraining (on natural language, biomedical text, or clinical text) and via discrete prompting or parameter-efficient fine-tuning. Our results consistently achieve best performance by maximally adapting to the task via pretraining on clinical text and fine-tuning on RRS examples. Importantly, this method fine-tunes a mere 0.32% of parameters throughout the model, in contrast to end-to-end fine-tuning (100% of parameters). Additionally, we study the effect of in-context examples and out-of-distribution (OOD) training before concluding with a radiologist reader study and qualitative analysis. Our findings highlight the importance of domain adaptation in RRS and provide valuable insights toward developing effective natural language processing solutions for clinical tasks.

There is a growing need to model interactions between data modalities (e.g., vision, language) — both to improve AI predictions on existing tasks and to enable new applications. In the recent field of multimodal medical AI, integrating multiple modalities has gained widespread popularity as multimodal models have proven to improve performance, robustness, require less training samples and add complementary information. To improve technical reproducibility and transparency for multimodal medical tasks as well as speed up progress across medical AI, we present ViLMedic, a Vision-and-Language medical library. As of 2022, the library contains a dozen reference implementations replicating the state-of-the-art results for problems that range from medical visual question answering and radiology report generation to multimodal representation learning on widely adopted medical datasets. In addition, ViLMedic hosts a model-zoo with more than twenty pretrained models for the above tasks designed to be extensible by researchers but also simple for practitioners. Ultimately, we hope our reproducible pipelines can enable clinical translation and create real impact. The library is available at https://github.com/jbdel/vilmedic.