Medical Triage as Pairwise Ranking: A Benchmark for Urgency in Patient Portal Messages

Medical triage is the task of allocating medical resources and prioritizing patients based on medical need. This paper introduces the first large-scale public dataset for studying medical triage in the context of asynchronous outpatient portal messages. Our novel task formulation views patient message triage as a pairwise inference problem, where we train LLMs to choose `"which message is more medically urgent" in a head-to-head tournament-style re-sort of a physician's inbox. Our novel benchmark PMR-Bench contains 1569 unique messages and 2,000+ high-quality test pairs for pairwise medical urgency assessment alongside a scalable training data generation pipeline. PMR-Bench includes samples that contain both unstructured patient-written messages alongside real electronic health record (EHR) data, emulating a real-world medical triage scenario. We develop a novel automated data annotation strategy to provide LLMs with in-domain guidance on this task. The resulting data is used to train two model classes, UrgentReward and UrgentSFT, leveraging Bradley-Terry and next token prediction objective, respectively to perform pairwise urgency classification. We find that UrgentSFT achieves top performance on PMR-Bench, with UrgentReward showing distinct advantages in low-resource settings. For example, UrgentSFT-8B and UrgentReward-8B provide a 15- and 16-point boost, respectively, on inbox sorting metrics over off-the-shelf 8B models. Paper resources can be found at https://tinyurl.com/Patient-Message-Triage

How Much Would a Clinician Edit This Draft? Evaluating LLM Alignment for Patient Message Response Drafting

Large language models (LLMs) show promise in drafting responses to patient portal messages, yet their integration into clinical workflows raises various concerns, including whether they would actually save clinicians time and effort in their portal workload. We investigate LLM alignment with individual clinicians through a comprehensive evaluation of the patient message response drafting task. We develop a novel taxonomy of thematic elements in clinician responses and propose a novel evaluation framework for assessing clinician editing load of LLM-drafted responses at both content and theme levels. We release an expert-annotated dataset and conduct large-scale evaluations of local and commercial LLMs using various adaptation techniques including thematic prompting, retrieval-augmented generation, supervised fine-tuning, and direct preference optimization. Our results reveal substantial epistemic uncertainty in aligning LLM drafts with clinician responses. While LLMs demonstrate capability in drafting certain thematic elements, they struggle with clinician-aligned generation in other themes, particularly question asking to elicit further information from patients. Theme-driven adaptation strategies yield improvements across most themes. Our findings underscore the necessity of adapting LLMs to individual clinician preferences to enable reliable and responsible use in patient-clinician communication workflows.

REGen: A Reliable Evaluation Framework for Generative Event Argument Extraction

Event argument extraction identifies arguments for predefined event roles in text. Traditional evaluations rely on exact match (EM), requiring predicted arguments to match annotated spans exactly. However, this approach fails for generative models like large language models (LLMs), which produce diverse yet semantically accurate responses. EM underestimates performance by disregarding valid variations, implicit arguments (unstated but inferable), and scattered arguments (distributed across a document). To bridge this gap, we introduce Reliable Evaluation framework for Generative event argument extraction (REGen), a framework that better aligns with human judgment. Across six datasets, REGen improves performance by an average of 23.93 F1 points over EM. Human validation further confirms REGen's effectiveness, achieving 87.67% alignment with human assessments of argument correctness.

In-Context Learning for Preserving Patient Privacy: A Framework for Synthesizing Realistic Patient Portal Messages

Since the COVID-19 pandemic, clinicians have seen a large and sustained influx in patient portal messages, significantly contributing to clinician burnout. To the best of our knowledge, there are no large-scale public patient portal messages corpora researchers can use to build tools to optimize clinician portal workflows. Informed by our ongoing work with a regional hospital, this study introduces an LLM-powered framework for configurable and realistic patient portal message generation. Our approach leverages few-shot grounded text generation, requiring only a small number of de-identified patient portal messages to help LLMs better match the true style and tone of real data. Clinical experts in our team deem this framework as HIPAA-friendly, unlike existing privacy-preserving approaches to synthetic text generation which cannot guarantee all sensitive attributes will be protected. Through extensive quantitative and human evaluation, we show that our framework produces data of higher quality than comparable generation methods as well as all related datasets. We believe this work provides a path forward for (i) the release of large-scale synthetic patient message datasets that are stylistically similar to ground-truth samples and (ii) HIPAA-friendly data generation which requires minimal human de-identification efforts.

Explicit, Implicit, and Scattered: Revisiting Event Extraction to Capture Complex Arguments

Prior works formulate the extraction of event-specific arguments as a span extraction problem, where event arguments are explicit -- i.e. assumed to be contiguous spans of text in a document. In this study, we revisit this definition of Event Extraction (EE) by introducing two key argument types that cannot be modeled by existing EE frameworks. First, implicit arguments are event arguments which are not explicitly mentioned in the text, but can be inferred through context. Second, scattered arguments are event arguments that are composed of information scattered throughout the text. These two argument types are crucial to elicit the full breadth of information required for proper event modeling. To support the extraction of explicit, implicit, and scattered arguments, we develop a novel dataset, DiscourseEE, which includes 7,464 argument annotations from online health discourse. Notably, 51.2% of the arguments are implicit, and 17.4% are scattered, making DiscourseEE a unique corpus for complex event extraction. Additionally, we formulate argument extraction as a text generation problem to facilitate the extraction of complex argument types. We provide a comprehensive evaluation of state-of-the-art models and highlight critical open challenges in generative event extraction. Our data and codebase are available at https://omar-sharif03.github.io/DiscourseEE.

Depth $F_1$: Improving Evaluation of Cross-Domain Text Classification by Measuring Semantic Generalizability

Recent evaluations of cross-domain text classification models aim to measure the ability of a model to obtain domain-invariant performance in a target domain given labeled samples in a source domain. The primary strategy for this evaluation relies on assumed differences between source domain samples and target domain samples in benchmark datasets. This evaluation strategy fails to account for the similarity between source and target domains, and may mask when models fail to transfer learning to specific target samples which are highly dissimilar from the source domain. We introduce Depth $F_1$, a novel cross-domain text classification performance metric. Designed to be complementary to existing classification metrics such as $F_1$, Depth $F_1$ measures how well a model performs on target samples which are dissimilar from the source domain. We motivate this metric using standard cross-domain text classification datasets and benchmark several recent cross-domain text classification models, with the goal of enabling in-depth evaluation of the semantic generalizability of cross-domain text classification models.

Do LLMs Find Human Answers To Fact-Driven Questions Perplexing? A Case Study on Reddit

Large language models (LLMs) have been shown to be proficient in correctly answering questions in the context of online discourse. However, the study of using LLMs to model human-like answers to fact-driven social media questions is still under-explored. In this work, we investigate how LLMs model the wide variety of human answers to fact-driven questions posed on several topic-specific Reddit communities, or subreddits. We collect and release a dataset of 409 fact-driven questions and 7,534 diverse, human-rated answers from 15 r/Ask{Topic} communities across 3 categories: profession, social identity, and geographic location. We find that LLMs are considerably better at modeling highly-rated human answers to such questions, as opposed to poorly-rated human answers. We present several directions for future research based on our initial findings.

Mad Libs Are All You Need: Augmenting Cross-Domain Document-Level Event Argument Data

Document-Level Event Argument Extraction (DocEAE) is an extremely difficult information extraction problem -- with significant limitations in low-resource cross-domain settings. To address this problem, we introduce Mad Lib Aug (MLA), a novel generative DocEAE data augmentation framework. Our approach leverages the intuition that Mad Libs, which are categorically masked documents used as a part of a popular game, can be generated and solved by LLMs to produce data for DocEAE. Using MLA, we achieve a 2.6-point average improvement in overall F1 score. Moreover, this approach achieves a 3.9 and 5.2 point average increase in zero and few-shot event roles compared to augmentation-free baselines across all experiments. To better facilitate analysis of cross-domain DocEAE, we additionally introduce a new metric, Role-Depth F1 (RDF1), which uses statistical depth to identify roles in the target domain which are semantic outliers with respect to roles observed in the source domain. Our experiments show that MLA augmentation can boost RDF1 performance by an average of 5.85 points compared to non-augmented datasets.

Scope of Large Language Models for Mining Emerging Opinions in Online Health Discourse

In this paper, we develop an LLM-powered framework for the curation and evaluation of emerging opinion mining in online health communities. We formulate emerging opinion mining as a pairwise stance detection problem between (title, comment) pairs sourced from Reddit, where post titles contain emerging health-related claims on a topic that is not predefined. The claims are either explicitly or implicitly expressed by the user. We detail (i) a method of claim identification -- the task of identifying if a post title contains a claim and (ii) an opinion mining-driven evaluation framework for stance detection using LLMs. We facilitate our exploration by releasing a novel test dataset, Long COVID-Stance, or LC-stance, which can be used to evaluate LLMs on the tasks of claim identification and stance detection in online health communities. Long Covid is an emerging post-COVID disorder with uncertain and complex treatment guidelines, thus making it a suitable use case for our task. LC-Stance contains long COVID treatment related discourse sourced from a Reddit community. Our evaluation shows that GPT-4 significantly outperforms prior works on zero-shot stance detection. We then perform thorough LLM model diagnostics, identifying the role of claim type (i.e. implicit vs explicit claims) and comment length as sources of model error.

Chain-of-Thought Embeddings for Stance Detection on Social Media

Stance detection on social media is challenging for Large Language Models (LLMs), as emerging slang and colloquial language in online conversations often contain deeply implicit stance labels. Chain-of-Thought (COT) prompting has recently been shown to improve performance on stance detection tasks -- alleviating some of these issues. However, COT prompting still struggles with implicit stance identification. This challenge arises because many samples are initially challenging to comprehend before a model becomes familiar with the slang and evolving knowledge related to different topics, all of which need to be acquired through the training data. In this study, we address this problem by introducing COT Embeddings which improve COT performance on stance detection tasks by embedding COT reasonings and integrating them into a traditional RoBERTa-based stance detection pipeline. Our analysis demonstrates that 1) text encoders can leverage COT reasonings with minor errors or hallucinations that would otherwise distort the COT output label. 2) Text encoders can overlook misleading COT reasoning when a sample's prediction heavily depends on domain-specific patterns. Our model achieves SOTA performance on multiple stance detection datasets collected from social media.