Multimodal Machine Learning for Automated ICD Coding

This study presents a multimodal machine learning model to predict ICD-10 diagnostic codes. We developed separate machine learning models that can handle data from different modalities, including unstructured text, semi-structured text and structured tabular data. We further employed an ensemble method to integrate all modality-specific models to generate ICD-10 codes. Key evidence was also extracted to make our prediction more convincing and explainable. We used the Medical Information Mart for Intensive Care III (MIMIC -III) dataset to validate our approach. For ICD code prediction, our best-performing model (micro-F1 = 0.7633, micro-AUC = 0.9541) significantly outperforms other baseline models including TF-IDF (micro-F1 = 0.6721, micro-AUC = 0.7879) and Text-CNN model (micro-F1 = 0.6569, micro-AUC = 0.9235). For interpretability, our approach achieves a Jaccard Similarity Coefficient (JSC) of 0.1806 on text data and 0.3105 on tabular data, where well-trained physicians achieve 0.2780 and 0.5002 respectively.Comment: Machine Learning for Healthcare 201

MultiZoo & MultiBench: A Standardized Toolkit for Multimodal Deep Learning

Learning multimodal representations involves integrating information from multiple heterogeneous sources of data. In order to accelerate progress towards understudied modalities and tasks while ensuring real-world robustness, we release MultiZoo, a public toolkit consisting of standardized implementations of > 20 core multimodal algorithms and MultiBench, a large-scale benchmark spanning 15 datasets, 10 modalities, 20 prediction tasks, and 6 research areas. Together, these provide an automated end-to-end machine learning pipeline that simplifies and standardizes data loading, experimental setup, and model evaluation. To enable holistic evaluation, we offer a comprehensive methodology to assess (1) generalization, (2) time and space complexity, and (3) modality robustness. MultiBench paves the way towards a better understanding of the capabilities and limitations of multimodal models, while ensuring ease of use, accessibility, and reproducibility. Our toolkits are publicly available, will be regularly updated, and welcome inputs from the community.Comment: JMLR Open Source Software 2023, Code available at https://github.com/pliang279/MultiBenc

Automated Clinical Coding:What, Why, and Where We Are?

Clinical coding is the task of transforming medical information in a patient's health records into structured codes so that they can be used for statistical analysis. This is a cognitive and time-consuming task that follows a standard process in order to achieve a high level of consistency. Clinical coding could potentially be supported by an automated system to improve the efficiency and accuracy of the process. We introduce the idea of automated clinical coding and summarise its challenges from the perspective of Artificial Intelligence (AI) and Natural Language Processing (NLP), based on the literature, our project experience over the past two and half years (late 2019 - early 2022), and discussions with clinical coding experts in Scotland and the UK. Our research reveals the gaps between the current deep learning-based approach applied to clinical coding and the need for explainability and consistency in real-world practice. Knowledge-based methods that represent and reason the standard, explainable process of a task may need to be incorporated into deep learning-based methods for clinical coding. Automated clinical coding is a promising task for AI, despite the technical and organisational challenges. Coders are needed to be involved in the development process. There is much to achieve to develop and deploy an AI-based automated system to support coding in the next five years and beyond.Comment: accepted for npj Digital Medicin

Automated Fidelity Assessment for Strategy Training in Inpatient Rehabilitation using Natural Language Processing

Strategy training is a multidisciplinary rehabilitation approach that teaches skills to reduce disability among those with cognitive impairments following a stroke. Strategy training has been shown in randomized, controlled clinical trials to be a more feasible and efficacious intervention for promoting independence than traditional rehabilitation approaches. A standardized fidelity assessment is used to measure adherence to treatment principles by examining guided and directed verbal cues in video recordings of rehabilitation sessions. Although the fidelity assessment for detecting guided and directed verbal cues is valid and feasible for single-site studies, it can become labor intensive, time consuming, and expensive in large, multi-site pragmatic trials. To address this challenge to widespread strategy training implementation, we leveraged natural language processing (NLP) techniques to automate the strategy training fidelity assessment, i.e., to automatically identify guided and directed verbal cues from video recordings of rehabilitation sessions. We developed a rule-based NLP algorithm, a long-short term memory (LSTM) model, and a bidirectional encoder representation from transformers (BERT) model for this task. The best performance was achieved by the BERT model with a 0.8075 F1-score. This BERT model was verified on an external validation dataset collected from a separate major regional health system and achieved an F1 score of 0.8259, which shows that the BERT model generalizes well. The findings from this study hold widespread promise in psychology and rehabilitation intervention research and practice.Comment: Accepted at the AMIA Informatics Summit 202

ICD Coding from Clinical Text Using Multi-Filter Residual Convolutional Neural Network

Automated ICD coding, which assigns the International Classification of Disease codes to patient visits, has attracted much research attention since it can save time and labor for billing. The previous state-of-the-art model utilized one convolutional layer to build document representations for predicting ICD codes. However, the lengths and grammar of text fragments, which are closely related to ICD coding, vary a lot in different documents. Therefore, a flat and fixed-length convolutional architecture may not be capable of learning good document representations. In this paper, we proposed a Multi-Filter Residual Convolutional Neural Network (MultiResCNN) for ICD coding. The innovations of our model are two-folds: it utilizes a multi-filter convolutional layer to capture various text patterns with different lengths and a residual convolutional layer to enlarge the receptive field. We evaluated the effectiveness of our model on the widely-used MIMIC dataset. On the full code set of MIMIC-III, our model outperformed the state-of-the-art model in 4 out of 6 evaluation metrics. On the top-50 code set of MIMIC-III and the full code set of MIMIC-II, our model outperformed all the existing and state-of-the-art models in all evaluation metrics. The code is available at https://github.com/foxlf823/Multi-Filter-Residual-Convolutional-Neural-Network

Predicting Multiple ICD-10 Codes from Brazilian-Portuguese Clinical Notes

ICD coding from electronic clinical records is a manual, time-consuming and expensive process. Code assignment is, however, an important task for billing purposes and database organization. While many works have studied the problem of automated ICD coding from free text using machine learning techniques, most use records in the English language, especially from the MIMIC-III public dataset. This work presents results for a dataset with Brazilian Portuguese clinical notes. We develop and optimize a Logistic Regression model, a Convolutional Neural Network (CNN), a Gated Recurrent Unit Neural Network and a CNN with Attention (CNN-Att) for prediction of diagnosis ICD codes. We also report our results for the MIMIC-III dataset, which outperform previous work among models of the same families, as well as the state of the art. Compared to MIMIC-III, the Brazilian Portuguese dataset contains far fewer words per document, when only discharge summaries are used. We experiment concatenating additional documents available in this dataset, achieving a great boost in performance. The CNN-Att model achieves the best results on both datasets, with micro-averaged F1 score of 0.537 on MIMIC-III and 0.485 on our dataset with additional documents.Comment: Accepted at BRACIS 202