High computation costs and latency of large language models such as GPT-4 have limited their deployment in clinical settings. Small language models (SLMs) offer a cost-effective alternative, but their limited capacity requires biomedical domain adaptation, which remains challenging. An additional bottleneck is the unavailability and high sensitivity of clinical data. To address these challenges, we propose a novel framework for adapting SLMs into high-performing clinical models. We introduce the MediPhi collection of 3.8B-parameter SLMs developed with our novel framework: pre-instruction tuning of experts on relevant medical and clinical corpora (PMC, Medical Guideline, MedWiki, etc.), model merging, and clinical-tasks alignment. To cover most clinical tasks, we extended the CLUE benchmark to CLUE+, doubling its size. Our expert models deliver relative improvements on this benchmark over the base model without any task-specific fine-tuning: 64.3% on medical entities, 49.5% on radiology reports, and 44% on ICD-10 coding (outperforming GPT-4-0125 by 14%). We unify the expert models into MediPhi via model merging, preserving gains across benchmarks. Furthermore, we built the MediFlow collection, a synthetic dataset of 2.5 million high-quality instructions on 14 medical NLP tasks, 98 fine-grained document types, and JSON format support. Alignment of MediPhi using supervised fine-tuning and direct preference optimization achieves further gains of 18.9% on average.

Large language models (LLMs) such as GPT-4o and o1 have demonstrated strong performance on clinical natural language processing (NLP) tasks across multiple medical benchmarks. Nonetheless, two high-impact NLP tasks — structured tabular reporting from nurse dictations and medical order extraction from doctor-patient consultations — remain underexplored due to data scarcity and sensitivity, despite active industry efforts. Practical solutions to these real-world clinical tasks can significantly reduce the documentation burden on healthcare providers, allowing greater focus on patient care. In this paper, we investigate these two challenging tasks using private and open-source clinical datasets, evaluating the performance of both open- and closed-weight LLMs, and analyzing their respective strengths and limitations. Furthermore, we propose an agentic pipeline for generating realistic, non-sensitive nurse dictations, enabling structured extraction of clinical observations. To support further research in both areas, we release SYNUR and SIMORD, the first open-source datasets for nurse observation extraction and medical order extraction.

We present our work on building large scale sequence-to-sequence models for generating clinical note from patient-doctor conversation. This is formulated as an abstractive summarization task for which we use encoder-decoder transformer model with pointer-generator. We discuss various modeling enhancements to this baseline model which include using subword and multiword tokenization scheme, prefixing the targets with a chain-of-clinical-facts, and training with contrastive loss that is defined over various candidate summaries. We also use flash attention during training and query chunked attention during inference to be able to process long input and output sequences and to improve computational efficiency. Experiments are conducted on a dataset containing about 900K encounters from around 1800 healthcare providers covering 27 specialties. The results are broken down into primary care and non-primary care specialties. Consistent accuracy improvements are observed across both of these categories.

We discuss automatic creation of medical reports from ASR-generated patient-doctor conversational transcripts using an end-to-end neural summarization approach. We explore both recurrent neural network (RNN) and Transformer-based sequence-to-sequence architectures for summarizing medical conversations. We have incorporated enhancements to these architectures, such as the pointer-generator network that facilitates copying parts of the conversations to the reports, and a hierarchical RNN encoder that makes RNN training three times faster with long inputs. A comparison of the relative improvements from the different model architectures over an oracle extractive baseline is provided on a dataset of 800k orthopedic encounters. Consistent with observations in literature for machine translation and related tasks, we find the Transformer models outperform RNN in accuracy, while taking less than half the time to train. Significantly large wins over a strong oracle baseline indicate that sequence-to-sequence modeling is a promising approach for automatic generation of medical reports, in the presence of data at scale.

In recent years the use of electronic medical records has accelerated resulting in large volumes of medical data when a patient visits a healthcare facility. As a first step towards reimbursement healthcare institutions need to associate ICD-10 billing codes to these documents. This is done by trained clinical coders who may use a computer assisted solution for shortlisting of codes. In this work, we present our work to build a machine learning based scalable system for predicting ICD-10 codes from electronic medical records. We address data imbalance issues by implementing two system architectures using convolutional neural networks and logistic regression models. We illustrate the pros and cons of those system designs and show that the best performance can be achieved by leveraging the advantages of both using a system combination approach.