Multimodal Medical Code Tokenizer

Foundation models trained on patient electronic health records (EHRs) require tokenizing medical data into sequences of discrete vocabulary items. Existing tokenizers treat medical codes from EHRs as isolated textual tokens. However, each medical code is defined by its textual description, its position in ontological hierarchies, and its relationships to other codes, such as disease co-occurrences and drug-treatment associations. Medical vocabularies contain more than 600,000 codes with critical information for clinical reasoning. We introduce MedTok, a multimodal medical code tokenizer that uses the text descriptions and relational context of codes. MedTok processes text using a language model encoder and encodes the relational structure with a graph encoder. It then quantizes both modalities into a unified token space, preserving modality-specific and cross-modality information. We integrate MedTok into five EHR models and evaluate it on operational and clinical tasks across in-patient and out-patient datasets, including outcome prediction, diagnosis classification, drug recommendation, and risk stratification. Swapping standard EHR tokenizers with MedTok improves AUPRC across all EHR models, by 4.10% on MIMIC-III, 4.78% on MIMIC-IV, and 11.30% on EHRShot, with the largest gains in drug recommendation. Beyond EHR modeling, we demonstrate using MedTok tokenizer with medical QA systems. Our results demonstrate the potential of MedTok as a unified tokenizer for medical codes, improving tokenization for medical foundation models.

Controllable Sequence Editing for Counterfactual Generation

Sequence models generate counterfactuals by modifying parts of a sequence based on a given condition, enabling reasoning about "what if" scenarios. While these models excel at conditional generation, they lack fine-grained control over when and where edits occur. Existing approaches either focus on univariate sequences or assume that interventions affect the entire sequence globally. However, many applications require precise, localized modifications, where interventions take effect only after a specified time and impact only a subset of co-occurring variables. We introduce CLEF, a controllable sequence editing model for counterfactual reasoning about both immediate and delayed effects. CLEF learns temporal concepts that encode how and when interventions should influence a sequence. With these concepts, CLEF selectively edits relevant time steps while preserving unaffected portions of the sequence. We evaluate CLEF on cellular and patient trajectory datasets, where gene regulation affects only certain genes at specific time steps, or medical interventions alter only a subset of lab measurements. CLEF improves immediate sequence editing by up to 36.01% in MAE compared to baselines. Unlike prior methods, CLEF enables one-step generation of counterfactual sequences at any future time step, outperforming baselines by up to 65.71% in MAE. A case study on patients with type 1 diabetes mellitus shows that CLEF identifies clinical interventions that shift patient trajectories toward healthier outcomes.