Automated Coding of Under-Studied Medical Concept Domains: Linking Physical Activity Reports to the International Classification of Functioning, Disability, and Health

Linking clinical narratives to standardized vocabularies and coding systems is a key component of unlocking the information in medical text for analysis. However, many domains of medical concepts lack well-developed terminologies that can support effective coding of medical text. We present a framework for developing natural language processing (NLP) technologies for automated coding of under-studied types of medical information, and demonstrate its applicability via a case study on physical mobility function. Mobility is a component of many health measures, from post-acute care and surgical outcomes to chronic frailty and disability, and is coded in the International Classification of Functioning, Disability, and Health (ICF). However, mobility and other types of functional activity remain under-studied in medical informatics, and neither the ICF nor commonly-used medical terminologies capture functional status terminology in practice. We investigated two data-driven paradigms, classification and candidate selection, to link narrative observations of mobility to standardized ICF codes, using a dataset of clinical narratives from physical therapy encounters. Recent advances in language modeling and word embedding were used as features for established machine learning models and a novel deep learning approach, achieving a macro F-1 score of 84% on linking mobility activity reports to ICF codes. Both classification and candidate selection approaches present distinct strengths for automated coding in under-studied domains, and we highlight that the combination of (i) a small annotated data set; (ii) expert definitions of codes of interest; and (iii) a representative text corpus is sufficient to produce high-performing automated coding systems. This study has implications for the ongoing growth of NLP tools for a variety of specialized applications in clinical care and research.Comment: Updated final version, published in Frontiers in Digital Health, https://doi.org/10.3389/fdgth.2021.620828. 34 pages (23 text + 11 references); 9 figures, 2 table

Explainable clinical coding with in-domain adapted transformers

Background and Objective: Automatic clinical coding is a crucial task in the process of extracting relevant in-formation from unstructured medical documents contained in Electronic Health Records (EHR). However, most of the existing computer-based methods for clinical coding act as “black boxes”, without giving a detailed description of the reasons for the clinical-coding assignments, which greatly limits their applicability to real-world medical scenarios. The objective of this study is to use transformer-based models to effectively tackle explainable clinical-coding. In this way, we require the models to perform the assignments of clinical codes to medical cases, but also to provide the reference in the text that justifies each coding assignment. Methods: We examine the performance of 3 transformer-based architectures on 3 different explainable clinical-coding tasks. For each transformer, we compare the performance of the original general-domain version with an in-domain version of the model adapted to the specificities of the medical domain. We address the explainable clinical-coding problem as a dual medical named entity recognition (MER) and medical named entity normal-ization (MEN) task. For this purpose, we have developed two different approaches, namely a multi-task and a hierarchical-task strategy. Results: For each analyzed transformer, the clinical-domain version significantly outperforms the corresponding general domain model across the 3 explainable clinical-coding tasks analyzed in this study. Furthermore, the hierarchical-task approach yields a significantly superior performance than the multi-task strategy. Specifically, the combination of the hierarchical-task strategy with an ensemble approach leveraging the predictive capa-bilities of the 3 distinct clinical-domain transformersFunding for open access charge: Universidad de Málaga / CBUA. The authors thankfully acknowledge the computer resources, technical expertise and assistance provided by the SCBI (Supercomputing and Bioinformatics) center of the University of Málaga

Exploration and adaptation of large language models for specialized domains

Large language models have transformed the field of natural language processing (NLP). Their improved performance on various NLP benchmarks makes them a promising tool—also for the application in specialized domains. Such domains are characterized by highly trained professionals with particular domain expertise. Since these experts are rare, improving the efficiency of their work with automated systems is especially desirable. However, domain-specific text resources hold various challenges for NLP systems. These challenges include distinct language, noisy and scarce data, and a high level of variation. Further, specialized domains present an increased need for transparent systems since they are often applied in high stakes settings. In this dissertation, we examine whether large language models (LLMs) can overcome some of these challenges and propose methods to effectively adapt them to domain-specific requirements. We first investigate the inner workings and abilities of LLMs and show how they can fill the gaps that are present in previous NLP algorithms for specialized domains. To this end, we explore the sources of errors produced by earlier systems to identify which of them can be addressed by using LLMs. Following this, we take a closer look at how information is processed within Transformer-based LLMs to better understand their capabilities. We find that their layers encode different dimensions of the input text. Here, the contextual vector representation, and the general language knowledge learned during pre-training are especially beneficial for solving complex and multi-step tasks common in specialized domains. Following this exploration, we propose solutions for further adapting LLMs to the requirements of domain-specific tasks. We focus on the clinical domain, which incorporates many typical challenges found in specialized domains. We show how to improve generalization by integrating different domain-specific resources into our models. We further analyze the behavior of the produced models and propose a behavioral testing framework that can serve as a tool for communication with domain experts. Finally, we present an approach for incorporating the benefits of LLMs while fulfilling requirements such as interpretability and modularity. The presented solutions show improvements in performance on benchmark datasets and in manually conducted analyses with medical professionals. Our work provides both new insights into the inner workings of pre-trained language models as well as multiple adaptation methods showing that LLMs can be an effective tool for NLP in specialized domains