Identifying Reasons for Contraceptive Switching from Real-World Data Using Large Language Models

Prescription contraceptives play a critical role in supporting women's reproductive health. With nearly 50 million women in the United States using contraceptives, understanding the factors that drive contraceptives selection and switching is of significant interest. However, many factors related to medication switching are often only captured in unstructured clinical notes and can be difficult to extract. Here, we evaluate the zero-shot abilities of a recently developed large language model, GPT-4 (via HIPAA-compliant Microsoft Azure API), to identify reasons for switching between classes of contraceptives from the UCSF Information Commons clinical notes dataset. We demonstrate that GPT-4 can accurately extract reasons for contraceptive switching, outperforming baseline BERT-based models with microF1 scores of 0.849 and 0.881 for contraceptive start and stop extraction, respectively. Human evaluation of GPT-4-extracted reasons for switching showed 91.4% accuracy, with minimal hallucinations. Using extracted reasons, we identified patient preference, adverse events, and insurance as key reasons for switching using unsupervised topic modeling approaches. Notably, we also showed using our approach that "weight gain/mood change" and "insurance coverage" are disproportionately found as reasons for contraceptive switching in specific demographic populations. Our code and supplemental data are available at https://github.com/BMiao10/contraceptive-switching.

Do We Still Need Clinical Language Models?

Although recent advances in scaling large language models (LLMs) have resulted in improvements on many NLP tasks, it remains unclear whether these models trained primarily with general web text are the right tool in highly specialized, safety critical domains such as clinical text. Recent results have suggested that LLMs encode a surprising amount of medical knowledge. This raises an important question regarding the utility of smaller domain-specific language models. With the success of general-domain LLMs, is there still a need for specialized clinical models? To investigate this question, we conduct an extensive empirical analysis of 12 language models, ranging from 220M to 175B parameters, measuring their performance on 3 different clinical tasks that test their ability to parse and reason over electronic health records. As part of our experiments, we train T5-Base and T5-Large models from scratch on clinical notes from MIMIC III and IV to directly investigate the efficiency of clinical tokens. We show that relatively small specialized clinical models substantially outperform all in-context learning approaches, even when finetuned on limited annotated data. Further, we find that pretraining on clinical tokens allows for smaller, more parameter-efficient models that either match or outperform much larger language models trained on general text. We release the code and the models used under the PhysioNet Credentialed Health Data license and data use agreement.

A collection of the accepted abstracts for the Machine Learning for Health symposium 2021

A collection of the accepted abstracts for the Machine Learning for Health (ML4H) symposium 2021. This index is not complete, as some accepted abstracts chose to opt-out of inclusion.

What's in a Summary? Laying the Groundwork for Advances in Hospital-Course Summarization

Summarization of clinical narratives is a long-standing research problem. Here, we introduce the task of hospital-course summarization. Given the documentation authored throughout a patient's hospitalization, generate a paragraph that tells the story of the patient admission. We construct an English, text-to-text dataset of 109,000 hospitalizations (2M source notes) and their corresponding summary proxy: the clinician-authored "Brief Hospital Course" paragraph written as part of a discharge note. Exploratory analyses reveal that the BHC paragraphs are highly abstractive with some long extracted fragments; are concise yet comprehensive; differ in style and content organization from the source notes; exhibit minimal lexical cohesion; and represent silver-standard references. Our analysis identifies multiple implications for modeling this complex, multi-document summarization task.

ML4H Abstract Track 2020

A collection of the accepted abstracts for the Machine Learning for Health (ML4H) workshop at NeurIPS 2020. This index is not complete, as some accepted abstracts chose to opt-out of inclusion.

Intimate Partner Violence and Injury Prediction From Radiology Reports

Intimate partner violence (IPV) is an urgent, prevalent, and under-detected public health issue. We present machine learning models to assess patients for IPV and injury. We train the predictive algorithms on radiology reports with 1) IPV labels based on entry to a violence prevention program and 2) injury labels provided by emergency radiology fellowship-trained physicians. Our full dataset includes 34,642 radiology reports and 1479 patients of IPV victims and control patients. We are able to accurately predict IPV victims and injury labels, and our best model predicts IPV a median of 1.34 years before violence prevention program entry with a sensitivity of 95\% and a specificity of 71\%. Our findings align with known clinical patterns of IPV injuries. We conduct error analysis to determine for which patients our model has especially high or low performance and discuss next steps for a deployed clinical risk model.

Subgraph Neural Networks

Deep learning methods for graphs achieve remarkable performance on many node-level and graph-level prediction tasks. However, despite the proliferation of the methods and their success, prevailing Graph Neural Networks (GNNs) neglect subgraphs, rendering subgraph prediction tasks challenging to tackle in many impactful applications. Further, subgraph prediction tasks present several unique challenges, because subgraphs can have non-trivial internal topology, but also carry a notion of position and external connectivity information relative to the underlying graph in which they exist. Here, we introduce SUB-GNN, a subgraph neural network to learn disentangled subgraph representations. In particular, we propose a novel subgraph routing mechanism that propagates neural messages between the subgraph's components and randomly sampled anchor patches from the underlying graph, yielding highly accurate subgraph representations. SUB-GNN specifies three channels, each designed to capture a distinct aspect of subgraph structure, and we provide empirical evidence that the channels encode their intended properties. We design a series of new synthetic and real-world subgraph datasets. Empirical results for subgraph classification on eight datasets show that SUB-GNN achieves considerable performance gains, outperforming strong baseline methods, including node-level and graph-level GNNs, by 12.4% over the strongest baseline. SUB-GNN performs exceptionally well on challenging biomedical datasets when subgraphs have complex topology and even comprise multiple disconnected components.

ML4H Abstract Track 2019

A collection of the accepted abstracts for the Machine Learning for Health (ML4H) workshop at NeurIPS 2019. This index is not complete, as some accepted abstracts chose to opt-out of inclusion.

Publicly Available Clinical BERT Embeddings

Contextual word embedding models such as ELMo (Peters et al., 2018) and BERT (Devlin et al., 2018) have dramatically improved performance for many natural language processing (NLP) tasks in recent months. However, these models have been minimally explored on specialty corpora, such as clinical text; moreover, in the clinical domain, no publicly-available pre-trained BERT models yet exist. In this work, we address this need by exploring and releasing BERT models for clinical text: one for generic clinical text and another for discharge summaries specifically. We demonstrate that using a domain-specific model yields performance improvements on three common clinical NLP tasks as compared to nonspecific embeddings. These domain-specific models are not as performant on two clinical de-identification tasks, and argue that this is a natural consequence of the differences between de-identified source text and synthetically non de-identified task text.

Extractive Summarization of EHR Discharge Notes

Patient summarization is essential for clinicians to provide coordinated care and practice effective communication. Automated summarization has the potential to save time, standardize notes, aid clinical decision making, and reduce medical errors. Here we provide an upper bound on extractive summarization of discharge notes and develop an LSTM model to sequentially label topics of history of present illness notes. We achieve an F1 score of 0.876, which indicates that this model can be employed to create a dataset for evaluation of extractive summarization methods.