With their growing capabilities, generative large language models (LLMs) are being increasingly investigated for complex medical tasks.However, their effectiveness in real-world clinical applications remains underexplored. To address this, we present CliniBench, the first benchmark that enables comparability of well-studied encoder-based classifiers and generative LLMs for discharge diagnosis prediction from admission notes in the MIMIC-IV dataset. Our extensive study compares 12 generative LLMs and 3 encoder-based classifiers and demonstrates that encoder-based classifiers consistently outperform generative models in diagnosis prediction. We assess several retrieval augmentation strategies for in-context learning from similar patients and find that they provide notable performance improvements for generative LLMs.

Clinical NLP research faces a scarcity of publicly available datasets due to privacy concerns. MIMIC-III marked a significant milestone, enabling substantial progress, and now, with MIMIC-IV, the dataset has expanded significantly, offering a broader scope. In this paper, we focus on the task of predicting clinical outcomes from clinical text. This is crucial in modern healthcare, aiding in preventive care, differential diagnosis, and capacity planning. We introduce a novel clinical outcome prediction dataset derived from MIMIC-IV. Furthermore, we provide initial insights into the performance of models trained on MIMIC-III when applied to our new dataset, with specific attention to potential data drift. We investigate challenges tied to evolving documentation standards and changing codes in the International Classification of Diseases (ICD) taxonomy, such as the transition from ICD-9 to ICD-10. We also explore variations in clinical text across different hospital wards. Our study aims to probe the robustness and generalization of clinical outcome prediction models, contributing to the ongoing advancement of clinical NLP in healthcare.