Large Language Models are Powerful EHR Encoders

Electronic Health Records (EHRs) offer rich potential for clinical prediction, yet their inherent complexity and heterogeneity pose significant challenges for traditional machine learning approaches. Domain-specific EHR foundation models trained on large collections of unlabeled EHR data have demonstrated promising improvements in predictive accuracy and generalization; however, their training is constrained by limited access to diverse, high-quality datasets and inconsistencies in coding standards and healthcare practices. In this study, we explore the possibility of using general-purpose Large Language Models (LLMs) based embedding methods as EHR encoders. By serializing patient records into structured Markdown text, transforming codes into human-readable descriptors, we leverage the extensive generalization capabilities of LLMs pretrained on vast public corpora, thereby bypassing the need for proprietary medical datasets. We systematically evaluate two state-of-the-art LLM-embedding models, GTE-Qwen2-7B-Instruct and LLM2Vec-Llama3.1-8B-Instruct, across 15 diverse clinical prediction tasks from the EHRSHOT benchmark, comparing their performance to an EHRspecific foundation model, CLIMBR-T-Base, and traditional machine learning baselines. Our results demonstrate that LLM-based embeddings frequently match or exceed the performance of specialized models, even in few-shot settings, and that their effectiveness scales with the size of the underlying LLM and the available context window. Overall, our findings demonstrate that repurposing LLMs for EHR encoding offers a scalable and effective approach for clinical prediction, capable of overcoming the limitations of traditional EHR modeling and facilitating more interoperable and generalizable healthcare applications.

Leveraging CAM Algorithms for Explaining Medical Semantic Segmentation

Convolutional neural networks (CNNs) achieve prevailing results in segmentation tasks nowadays and represent the state-of-the-art for image-based analysis. However, the understanding of the accurate decision-making process of a CNN is rather unknown. The research area of explainable artificial intelligence (xAI) primarily revolves around understanding and interpreting this black-box behavior. One way of interpreting a CNN is the use of class activation maps (CAMs) that represent heatmaps to indicate the importance of image areas for the prediction of the CNN. For classification tasks, a variety of CAM algorithms exist. But for segmentation tasks, only one CAM algorithm for the interpretation of the output of a CNN exist. We propose a transfer between existing classification- and segmentation-based methods for more detailed, explainable, and consistent results which show salient pixels in semantic segmentation tasks. The resulting Seg-HiRes-Grad CAM is an extension of the segmentation-based Seg-Grad CAM with the transfer to the classification-based HiRes CAM. Our method improves the previously-mentioned existing segmentation-based method by adjusting it to recently published classification-based methods. Especially for medical image segmentation, this transfer solves existing explainability disadvantages.