ICD coding is the process of mapping unstructured text from Electronic Health Records (EHRs) to standardised codes defined by the International Classification of Diseases (ICD) system. In order to promote trust and transparency, existing explorations on the explainability of ICD coding models primarily rely on attention-based rationales and qualitative assessments conducted by physicians, yet lack a systematic evaluation across diverse types of rationales using consistent criteria and high-quality rationale-annotated datasets specifically designed for the ICD coding task. Moreover, dedicated methods explicitly trained to generate plausible rationales remain scarce. In this work, we present evaluations of the explainability of rationales in ICD coding, focusing on two fundamental dimensions: faithfulness and plausibility—in short how rationales influence model decisions and how convincing humans find them. For plausibility, we construct a novel, multi-granular rationale-annotated ICD coding dataset, based on the MIMIC-IV database and the updated ICD-10 coding system. We conduct a comprehensive evaluation across three types of ICD coding rationales: entity-level mentions automatically constructed via entity linking, LLM-generated rationales, and rationales based on attention scores of ICD coding models. Building upon the strong plausibility exhibited by LLM-generated rationales, we further leverage them as distant supervision signals to develop rationale learning methods. Additionally, by prompting the LLM with few-shot human-annotated examples from our dataset, we achieve notable improvements in the plausibility of rationale generation in both the teacher LLM and the student rationale learning models.

Large Language Models (LLM) have revolutionized Natural Language Processing (NLP), improving state-of-the-art and exhibiting emergent capabilities across various tasks. However, their application in extracting information from visually rich documents, which is at the core of many document processing workflows and involving the extraction of key entities from semi-structured documents, has not yet been successful. The main obstacles to adopting LLMs for this task include the absence of layout encoding within LLMs, which is critical for high quality extraction, and the lack of a grounding mechanism to localize the predicted entities within the document. In this paper, we introduce Language Model-based Document Information EXtraction and Localization (LMDX), a methodology to reframe the document information extraction task for a LLM. LMDX enables extraction of singular, repeated, and hierarchical entities, both with and without training data, while providing grounding guarantees and localizing the entities within the document. Finally, we apply LMDX to the PaLM 2-S and Gemini Pro LLMs and evaluate it on VRDU and CORD benchmarks, setting a new state-of-the-art and showing how LMDX enables the creation of high quality, data-efficient parsers.