Recent advances in large language models have led to renewed interest in natural language processing in healthcare using the free text of clinical notes. One distinguishing characteristic of clinical notes is their long time span over multiple long documents. The unique structure of clinical notes creates a new design choice: when the context length for a language model predictor is limited, which part of clinical notes should we choose as the input? Existing studies either choose the inputs with domain knowledge or simply truncate them. We propose a framework to analyze the sections with high predictive power. Using MIMIC-III, we show that: 1) predictive power distribution is different between nursing notes and discharge notes and 2) combining different types of notes could improve performance when the context length is large. Our findings suggest that a carefully selected sampling function could enable more efficient information extraction from clinical notes.

The Ninth Revision of the International Classification of Diseases (ICD-9) is a standardized coding system used to classify health conditions. It is used for billing, tracking individual patient conditions, and for epidemiology. The highly detailed and technical nature of the codes and their associated medical conditions make it difficult for humans to accurately record them. Researchers have explored the use of neural networks, particularly language models, for automated ICD-9 code assignment. However, the imbalanced distribution of ICD-9 codes leads to poor performance. One solution is to use domain knowledge to incorporate a useful prior. This paper evaluates the usefulness of the correlation bias: we hypothesize that correlations between ICD-9 codes and other medical codes could help improve language models’ performance. We showed that while the correlation bias worsens the overall performance, the effect on individual class can be negative or positive. Performance on classes that are more imbalanced and less correlated with other codes is more sensitive to incorporating the correlation bias. This suggests that while the correlation bias has potential to improve ICD-9 code assignment in certain cases, the applicability criteria need to be more carefully studied.