Many diagnostic errors occur because clinicians cannot easily access relevant information in patient Electronic Health Records (EHRs). In this work we propose a method to use LLMs to identify pieces of evidence in patient EHR data that indicate increased or decreased risk of specific diagnoses; our ultimate aim is to increase access to evidence and reduce diagnostic errors. In particular, we propose a Neural Additive Model to make predictions backed by evidence with individualized risk estimates at time-points where clinicians are still uncertain, aiming to specifically mitigate delays in diagnosis and errors stemming from an incomplete differential. To train such a model, it is necessary to infer temporally fine-grained retrospective labels of eventual “true” diagnoses. We do so with LLMs, to ensure that the input text is from before a confident diagnosis can be made. We use an LLM to retrieve an initial pool of evidence, but then refine this set of evidence according to correlations learned by the model. We conduct an in-depth evaluation of the usefulness of our approach by simulating how it might be used by a clinician to decide between a pre-defined list of differential diagnoses.

We propose CHiLL (Crafting High-Level Latents), an approach for natural-language specification of features for linear models. CHiLL prompts LLMs with expert-crafted queries to generate interpretable features from health records. The resulting noisy labels are then used to train a simple linear classifier. Generating features based on queries to an LLM can empower physicians to use their domain expertise to craft features that are clinically meaningful for a downstream task of interest, without having to manually extract these from raw EHR. We are motivated by a real-world risk prediction task, but as a reproducible proxy, we use MIMIC-III and MIMIC-CXR data and standard predictive tasks (e.g., 30-day readmission) to evaluate this approach. We find that linear models using automatically extracted features are comparably performant to models using reference features, and provide greater interpretability than linear models using “Bag-of-Words” features. We verify that learned feature weights align well with clinical expectations.

Pretraining multimodal models on Electronic Health Records (EHRs) provides a means of learning representations that can transfer to downstream tasks with minimal supervision. Recent multimodal models induce soft local alignments between image regions and sentences. This is of particular interest in the medical domain, where alignments might highlight regions in an image relevant to specific phenomena described in free-text. While past work has suggested that attention “heatmaps” can be interpreted in this manner, there has been little evaluation of such alignments. We compare alignments from a state-of-the-art multimodal (image and text) model for EHR with human annotations that link image regions to sentences. Our main finding is that the text has an often weak or unintuitive influence on attention; alignments do not consistently reflect basic anatomical information. Moreover, synthetic modifications — such as substituting “left” for “right” — do not substantially influence highlights. Simple techniques such as allowing the model to opt out of attending to the image and few-shot finetuning show promise in terms of their ability to improve alignments with very little or no supervision. We make our code and checkpoints open-source.

Representations from large pretrained models such as BERT encode a range of features into monolithic vectors, affording strong predictive accuracy across a range of downstream tasks. In this paper we explore whether it is possible to learn disentangled representations by identifying existing subnetworks within pretrained models that encode distinct, complementary aspects. Concretely, we learn binary masks over transformer weights or hidden units to uncover subsets of features that correlate with a specific factor of variation; this eliminates the need to train a disentangled model from scratch for a particular task. We evaluate this method with respect to its ability to disentangle representations of sentiment from genre in movie reviews, toxicity from dialect in Tweets, and syntax from semantics. By combining masking with magnitude pruning we find that we can identify sparse subnetworks within BERT that strongly encode particular aspects (e.g., semantics) while only weakly encoding others (e.g., syntax). Moreover, despite only learning masks, disentanglement-via-masking performs as well as — and often better than —previously proposed methods based on variational autoencoders and adversarial training.

Recent work has shown that fine-tuning large networks is surprisingly sensitive to changes in random seed(s). We explore the implications of this phenomenon for model fairness across demographic groups in clinical prediction tasks over electronic health records (EHR) in MIMIC-III —— the standard dataset in clinical NLP research. Apparent subgroup performance varies substantially for seeds that yield similar overall performance, although there is no evidence of a trade-off between overall and subgroup performance. However, we also find that the small sample sizes inherent to looking at intersections of minority groups and somewhat rare conditions limit our ability to accurately estimate disparities. Further, we find that jointly optimizing for high overall performance and low disparities does not yield statistically significant improvements. Our results suggest that fairness work using MIMIC-III should carefully account for variations in apparent differences that may arise from stochasticity and small sample sizes.

We propose a method for learning disentangled representations of texts that code for distinct and complementary aspects, with the aim of affording efficient model transfer and interpretability. To induce disentangled embeddings, we propose an adversarial objective based on the (dis)similarity between triplets of documents with respect to specific aspects. Our motivating application is embedding biomedical abstracts describing clinical trials in a manner that disentangles the populations, interventions, and outcomes in a given trial. We show that our method learns representations that encode these clinically salient aspects, and that these can be effectively used to perform aspect-specific retrieval. We demonstrate that the approach generalizes beyond our motivating application in experiments on two multi-aspect review corpora.