Search arXivSearch

arXiv · 2107.10650

Read, Attend, and Code: Pushing the Limits of Medical Codes Prediction from Clinical Notes by Machines

Abstract

Prediction of medical codes from clinical notes is both a practical and essential need for every healthcare delivery organization within current medical systems. Automating annotation will save significant time and excessive effort spent by human coders today. However, the biggest challenge is directly identifying appropriate medical codes out of several thousands of high-dimensional codes from unstructured free-text clinical notes. In the past three years, with Convolutional Neural Networks (CNN) and Long Short-Term Memory (LTSM) networks, there have been vast improvements in tackling the most challenging benchmark of the MIMIC-III-full-label inpatient clinical notes dataset. This progress raises the fundamental question of how far automated machine learning (ML) systems are from human coders' working performance. We assessed the baseline of human coders' performance on the same subsampled testing set. We also present our Read, Attend, and Code (RAC) model for learning the medical code assignment mappings. By connecting convolved embeddings with self-attention and code-title guided attention modules, combined with sentence permutation-based data augmentations and stochastic weight averaging training, RAC establishes a new state of the art (SOTA), considerably outperforming the current best Macro-F1 by 18.7%, and reaches past the human-level coding baseline. This new milestone marks a meaningful step toward fully autonomous medical coding (AMC) in machines reaching parity with human coders' performance in medical code prediction.

Explore related subjects

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

Byung-Hak Kim, Varun Ganapathi. 2021-07-10. Read, Attend, and Code: Pushing the Limits of Medical Codes Prediction from Clinical Notes by Machines. https://arxiv.org/abs/2107.10650

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related papers

Hierarchical attention interpretation: an interpretable speech-level transformer for bi-modal depression detection

Depression is a common mental disorder. Automatic depression detection tools using speech, enabled by machine learning, help early screening of depression. This paper addresses two limitations that may hinder the clinical implementations of such tools: noise resulting from segment-level labelling and a lack of model interpretability. We propose a bi-modal speech-level transformer to avoid segment-level labelling and introduce a hierarchical interpretation approach to provide both speech-level and sentence-level interpretations, based on gradient-weighted attention maps derived from all attention layers to track interactions between input features. We show that the proposed model outperforms a model that learns at a segment level ($p$=0.854, $r$=0.947, $F1$=0.897 compared to $p$=0.732, $r$=0.808, $F1$=0.768). For model interpretation, using one true positive sample, we show which sentences within a given speech are most relevant to depression detection; and which text tokens and Mel-spectrogram regions within these sentences are most relevant to depression detection. These interpretations allow clinicians to verify the validity of predictions made by depression detection tools, promoting their clinical implementations.

cs.CL

Cultural Alignment in Large Language Models Using Soft Prompt Tuning

Large Language Model (LLM) alignment is commonly achieved through supervised fine-tuning or reinforcement learning, both of which require labeled or preference data and update model weights. Without targeted cultural adaptation, however, deployed LLMs often exhibit culturally homogeneous behavior that fails to reflect diverse local values. Aligning models to cultural value frameworks such as Hofstede's Value Survey Module (VSM13) presents a distinct challenge: alignment signals are available only as aggregated survey-level scores computed after generating responses to an entire survey, providing no per-token gradient and requiring no preference data by construction. This makes standard gradient-based alignment methods ill-suited to the task. We propose a deployment-friendly approach that encodes cultural behavior in short, tunable soft prompts optimized with Differential Evolution (DE), while keeping model weights frozen and requiring no preference data. At inference, the system inserts the appropriate cultural-specific prompt to adapt model responses for different cultures. Experiments across four countries and four instruction-tuned models show that DE-optimized prompts generally reduce discrepancy with VSM13 reference profiles, improve rank agreement with the World Values Survey (WVS), an independent framework not seen during optimization, and are preferred in blinded pairwise evaluations using majority voting across three LLM judges.

cs.CL

VQ-Logits: Compressing the Output Bottleneck of Large Language Models via Vector Quantized Logits

Large Language Models (LLMs) have achieved remarkable success but face significant computational and memory challenges, particularly due to their extensive output vocabularies. The final linear projection layer, mapping hidden states to vocabulary-sized logits, often constitutes a substantial portion of the model's parameters and computational cost during inference. Existing methods like adaptive softmax or hierarchical softmax introduce structural complexities. In this paper, we propose VQ-Logits, a novel approach that leverages Vector Quantization (VQ) to drastically reduce the parameter count and computational load of the LLM output layer. VQ-Logits replaces the large V * dmodel output embedding matrix with a small, shared codebook of K embedding vectors (K << V ). Each token in the vocabulary is mapped to one of these K codebook vectors. The LLM predicts logits over this compact codebook, which are then efficiently "scattered" to the full vocabulary space using the learned or preassigned mapping. We demonstrate through extensive experiments on standard language modeling benchmarks (e.g., WikiText-103, C4) that VQ-Logits can achieve up to 99% parameter reduction in the output layer and 6x speedup in logit computation, with only a marginal 4% increase in perplexity compared to full softmax baselines. We further provide detailed ablation studies on codebook size, initialization, and learning strategies, showcasing the robustness and effectiveness of our approach.

cs.CL