Recent studies on automatic note generation have shown that doctors can save significant amounts of time when using automatic clinical note generation (Knoll et al., 2022). Summarization models have been used for this task to generate clinical notes as summaries of doctor-patient conversations (Krishna et al., 2021; Cai et al., 2022). However, assessing which model would best serve clinicians in their daily practice is still a challenging task due to the large set of possible correct summaries, and the potential limitations of automatic evaluation metrics. In this paper we study evaluation methods and metrics for the automatic generation of clinical notes from medical conversation. In particular, we propose new task-specific metrics and we compare them to SOTA evaluation metrics in text summarization and generation, including: (i) knowledge-graph embedding-based metrics, (ii) customized model-based metrics with domain-specific weights, (iii) domain-adapted/fine-tuned metrics, and (iv) ensemble metrics. To study the correlation between the automatic metrics and manual judgments, we evaluate automatic notes/summaries by comparing the system and reference facts and computing the factual correctness, and the hallucination and omission rates for critical medical facts. This study relied on seven datasets manually annotated by domain experts. Our experiments show that automatic evaluation metrics can have substantially different behaviors on different types of clinical notes datasets. However, the results highlight one stable subset of metrics as the most correlated with human judgments with a relevant aggregation of different evaluation criteria.

The International Classification of Diseases (ICD) system is the international standard for classifying diseases and procedures during a healthcare encounter and is widely used for healthcare reporting and management purposes. Assigning correct codes for clinical procedures is important for clinical, operational and financial decision-making in healthcare. Contextual word embedding models have achieved state-of-the-art results in multiple NLP tasks. However, these models have yet to achieve state-of-the-art results in the ICD classification task since one of their main disadvantages is that they can only process documents that contain a small number of tokens which is rarely the case with real patient notes. In this paper, we introduce ICDBigBird a BigBird-based model which can integrate a Graph Convolutional Network (GCN), that takes advantage of the relations between ICD codes in order to create ‘enriched’ representations of their embeddings, with a BigBird contextual model that can process larger documents. Our experiments on a real-world clinical dataset demonstrate the effectiveness of our BigBird-based model on the ICD classification task as it outperforms the previous state-of-the-art models.

Lexical substitution is the task of generating meaningful substitutes for a word in a given textual context. Contextual word embedding models have achieved state-of-the-art results in the lexical substitution task by relying on contextual information extracted from the replaced word within the sentence. However, such models do not take into account structured knowledge that exists in external lexical databases. We introduce LexSubCon, an end-to-end lexical substitution framework based on contextual embedding models that can identify highly-accurate substitute candidates. This is achieved by combining contextual information with knowledge from structured lexical resources. Our approach involves: (i) introducing a novel mix-up embedding strategy to the target word’s embedding through linearly interpolating the pair of the target input embedding and the average embedding of its probable synonyms; (ii) considering the similarity of the sentence-definition embeddings of the target word and its proposed candidates; and, (iii) calculating the effect of each substitution on the semantics of the sentence through a fine-tuned sentence similarity model. Our experiments show that LexSubCon outperforms previous state-of-the-art methods by at least 2% over all the official lexical substitution metrics on LS07 and CoInCo benchmark datasets that are widely used for lexical substitution tasks.

We introduce MedicalSum, a transformer-based sequence-to-sequence architecture for summarizing medical conversations by integrating medical domain knowledge from the Unified Medical Language System (UMLS). The novel knowledge augmentation is performed in three ways: (i) introducing a guidance signal that consists of the medical words in the input sequence, (ii) leveraging semantic type knowledge in UMLS to create clinically meaningful input embeddings, and (iii) making use of a novel weighted loss function that provides a stronger incentive for the model to correctly predict words with a medical meaning. By applying these three strategies, MedicalSum takes clinical knowledge into consideration during the summarization process and achieves state-of-the-art ROUGE score improvements of 0.8-2.1 points (including 6.2% ROUGE-1 error reduction in the PE section) when producing medical summaries of patient-doctor conversations.

Contextual word embedding models, such as BioBERT and Bio_ClinicalBERT, have achieved state-of-the-art results in biomedical natural language processing tasks by focusing their pre-training process on domain-specific corpora. However, such models do not take into consideration structured expert domain knowledge from a knowledge base. We introduce UmlsBERT, a contextual embedding model that integrates domain knowledge during the pre-training process via a novel knowledge augmentation strategy. More specifically, the augmentation on UmlsBERT with the Unified Medical Language System (UMLS) Metathesaurus is performed in two ways: i) connecting words that have the same underlying ‘concept’ in UMLS and ii) leveraging semantic type knowledge in UMLS to create clinically meaningful input embeddings. By applying these two strategies, UmlsBERT can encode clinical domain knowledge into word embeddings and outperform existing domain-specific models on common named-entity recognition (NER) and clinical natural language inference tasks.

In most clinical practice settings, there is no rigorous reviewing of the clinical documentation, resulting in inaccurate information captured in the patient medical records. The gold standard in clinical data capturing is achieved via “expert-review”, where clinicians can have a dialogue with a domain expert (reviewers) and ask them questions about data entry rules. Automatically identifying “real questions” in these dialogues could uncover ambiguities or common problems in data capturing in a given clinical setting. In this study, we proposed a novel multi-channel deep convolutional neural network architecture, namely Quest-CNN, for the purpose of separating real questions that expect an answer (information or help) about an issue from sentences that are not questions, as well as from questions referring to an issue mentioned in a nearby sentence (e.g., can you clarify this?), which we will refer as “c-questions”. We conducted a comprehensive performance comparison analysis of the proposed multi-channel deep convolutional neural network against other deep neural networks. Furthermore, we evaluated the performance of traditional rule-based and learning-based methods for detecting question sentences. The proposed Quest-CNN achieved the best F1 score both on a dataset of data entry-review dialogue in a dialysis care setting, and on a general domain dataset.