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Jun 6

EHRCon: Dataset for Checking Consistency between Unstructured Notes and Structured Tables in Electronic Health Records

Electronic Health Records (EHRs) are integral for storing comprehensive patient medical records, combining structured data (e.g., medications) with detailed clinical notes (e.g., physician notes). These elements are essential for straightforward data retrieval and provide deep, contextual insights into patient care. However, they often suffer from discrepancies due to unintuitive EHR system designs and human errors, posing serious risks to patient safety. To address this, we developed EHRCon, a new dataset and task specifically designed to ensure data consistency between structured tables and unstructured notes in EHRs. EHRCon was crafted in collaboration with healthcare professionals using the MIMIC-III EHR dataset, and includes manual annotations of 3,943 entities across 105 clinical notes checked against database entries for consistency. EHRCon has two versions, one using the original MIMIC-III schema, and another using the OMOP CDM schema, in order to increase its applicability and generalizability. Furthermore, leveraging the capabilities of large language models, we introduce CheckEHR, a novel framework for verifying the consistency between clinical notes and database tables. CheckEHR utilizes an eight-stage process and shows promising results in both few-shot and zero-shot settings. The code is available at https://github.com/dustn1259/EHRCon.

EHRSHOT: An EHR Benchmark for Few-Shot Evaluation of Foundation Models

While the general machine learning (ML) community has benefited from public datasets, tasks, and models, the progress of ML in healthcare has been hampered by a lack of such shared assets. The success of foundation models creates new challenges for healthcare ML by requiring access to shared pretrained models to validate performance benefits. We help address these challenges through three contributions. First, we publish a new dataset, EHRSHOT, which contains deidentified structured data from the electronic health records (EHRs) of 6,739 patients from Stanford Medicine. Unlike MIMIC-III/IV and other popular EHR datasets, EHRSHOT is longitudinal and not restricted to ICU/ED patients. Second, we publish the weights of CLMBR-T-base, a 141M parameter clinical foundation model pretrained on the structured EHR data of 2.57M patients. We are one of the first to fully release such a model for coded EHR data; in contrast, most prior models released for clinical data (e.g. GatorTron, ClinicalBERT) only work with unstructured text and cannot process the rich, structured data within an EHR. We provide an end-to-end pipeline for the community to validate and build upon its performance. Third, we define 15 few-shot clinical prediction tasks, enabling evaluation of foundation models on benefits such as sample efficiency and task adaptation. Our model and dataset are available via a research data use agreement from the Stanford AIMI Center. Code to reproduce our results are available at our Github repo: https://github.com/som-shahlab/ehrshot-benchmark

EHRMamba: Towards Generalizable and Scalable Foundation Models for Electronic Health Records

Transformers have significantly advanced the modeling of Electronic Health Records (EHR), yet their deployment in real-world healthcare is limited by several key challenges. Firstly, the quadratic computational cost and insufficient context length of these models pose significant obstacles for hospitals in processing the extensive medical histories typical in EHR data. Additionally, existing models employ separate finetuning for each clinical task, complicating maintenance in healthcare environments. Moreover, these models focus exclusively on either clinical prediction or EHR forecasting, lacking the flexibility to perform well across both. To overcome these limitations, we introduce EHRMamba, a robust foundation model built on the Mamba architecture. EHRMamba can process sequences up to four times longer than previous models due to its linear computational cost. We also introduce a novel approach to Multitask Prompted Finetuning (MTF) for EHR data, which enables EHRMamba to simultaneously learn multiple clinical tasks in a single finetuning phase, significantly enhancing deployment and cross-task generalization. Furthermore, our model leverages the HL7 FHIR data standard to simplify integration into existing hospital systems. Alongside EHRMamba, we open-source Odyssey, a toolkit designed to support the development and deployment of EHR foundation models, with an emphasis on data standardization and interpretability. Our evaluations on the MIMIC-IV dataset demonstrate that EHRMamba advances state-of-the-art performance across 6 major clinical tasks and excels in EHR forecasting, marking a significant leap forward in the field.

GENIE: Generative Note Information Extraction model for structuring EHR data

Electronic Health Records (EHRs) hold immense potential for advancing healthcare, offering rich, longitudinal data that combines structured information with valuable insights from unstructured clinical notes. However, the unstructured nature of clinical text poses significant challenges for secondary applications. Traditional methods for structuring EHR free-text data, such as rule-based systems and multi-stage pipelines, are often limited by their time-consuming configurations and inability to adapt across clinical notes from diverse healthcare settings. Few systems provide a comprehensive attribute extraction for terminologies. While giant large language models (LLMs) like GPT-4 and LLaMA 405B excel at structuring tasks, they are slow, costly, and impractical for large-scale use. To overcome these limitations, we introduce GENIE, a Generative Note Information Extraction system that leverages LLMs to streamline the structuring of unstructured clinical text into usable data with standardized format. GENIE processes entire paragraphs in a single pass, extracting entities, assertion statuses, locations, modifiers, values, and purposes with high accuracy. Its unified, end-to-end approach simplifies workflows, reduces errors, and eliminates the need for extensive manual intervention. Using a robust data preparation pipeline and fine-tuned small scale LLMs, GENIE achieves competitive performance across multiple information extraction tasks, outperforming traditional tools like cTAKES and MetaMap and can handle extra attributes to be extracted. GENIE strongly enhances real-world applicability and scalability in healthcare systems. By open-sourcing the model and test data, we aim to encourage collaboration and drive further advancements in EHR structurization.

MedAgentBench: A Realistic Virtual EHR Environment to Benchmark Medical LLM Agents

Recent large language models (LLMs) have demonstrated significant advancements, particularly in their ability to serve as agents thereby surpassing their traditional role as chatbots. These agents can leverage their planning and tool utilization capabilities to address tasks specified at a high level. However, a standardized dataset to benchmark the agent capabilities of LLMs in medical applications is currently lacking, making the evaluation of LLMs on complex tasks in interactive healthcare environments challenging. To address this gap, we introduce MedAgentBench, a broad evaluation suite designed to assess the agent capabilities of large language models within medical records contexts. MedAgentBench encompasses 300 patient-specific clinically-derived tasks from 10 categories written by human physicians, realistic profiles of 100 patients with over 700,000 data elements, a FHIR-compliant interactive environment, and an accompanying codebase. The environment uses the standard APIs and communication infrastructure used in modern EMR systems, so it can be easily migrated into live EMR systems. MedAgentBench presents an unsaturated agent-oriented benchmark that current state-of-the-art LLMs exhibit some ability to succeed at. The best model (Claude 3.5 Sonnet v2) achieves a success rate of 69.67%. However, there is still substantial space for improvement which gives the community a next direction to optimize. Furthermore, there is significant variation in performance across task categories. MedAgentBench establishes this and is publicly available at https://github.com/stanfordmlgroup/MedAgentBench , offering a valuable framework for model developers to track progress and drive continuous improvements in the agent capabilities of large language models within the medical domain.

Context Clues: Evaluating Long Context Models for Clinical Prediction Tasks on EHRs

Foundation Models (FMs) trained on Electronic Health Records (EHRs) have achieved state-of-the-art results on numerous clinical prediction tasks. However, most existing EHR FMs have context windows of <1k tokens. This prevents them from modeling full patient EHRs which can exceed 10k's of events. Recent advancements in subquadratic long-context architectures (e.g., Mamba) offer a promising solution. However, their application to EHR data has not been well-studied. We address this gap by presenting the first systematic evaluation of the effect of context length on modeling EHR data. We find that longer context models improve predictive performance -- our Mamba-based model surpasses the prior state-of-the-art on 9/14 tasks on the EHRSHOT prediction benchmark. For clinical applications, however, model performance alone is insufficient -- robustness to the unique properties of EHR is crucial. Thus, we also evaluate models across three previously underexplored properties of EHR data: (1) the prevalence of "copy-forwarded" diagnoses which creates artificial repetition of tokens within EHR sequences; (2) the irregular time intervals between EHR events which can lead to a wide range of timespans within a context window; and (3) the natural increase in disease complexity over time which makes later tokens in the EHR harder to predict than earlier ones. Stratifying our EHRSHOT results, we find that higher levels of each property correlate negatively with model performance, but that longer context models are more robust to more extreme levels of these properties. Our work highlights the potential for using long-context architectures to model EHR data, and offers a case study for identifying new challenges in modeling sequential data motivated by domains outside of natural language. We release our models and code at: https://github.com/som-shahlab/long_context_clues

Foresight -- Generative Pretrained Transformer (GPT) for Modelling of Patient Timelines using EHRs

Background: Electronic Health Records hold detailed longitudinal information about each patient's health status and general clinical history, a large portion of which is stored within the unstructured text. Existing approaches focus mostly on structured data and a subset of single-domain outcomes. We explore how temporal modelling of patients from free text and structured data, using deep generative transformers can be used to forecast a wide range of future disorders, substances, procedures or findings. Methods: We present Foresight, a novel transformer-based pipeline that uses named entity recognition and linking tools to convert document text into structured, coded concepts, followed by providing probabilistic forecasts for future medical events such as disorders, substances, procedures and findings. We processed the entire free-text portion from three different hospital datasets totalling 811336 patients covering both physical and mental health. Findings: On tests in two UK hospitals (King's College Hospital, South London and Maudsley) and the US MIMIC-III dataset precision@10 0.68, 0.76 and 0.88 was achieved for forecasting the next disorder in a patient timeline, while precision@10 of 0.80, 0.81 and 0.91 was achieved for forecasting the next biomedical concept. Foresight was also validated on 34 synthetic patient timelines by five clinicians and achieved relevancy of 97% for the top forecasted candidate disorder. As a generative model, it can forecast follow-on biomedical concepts for as many steps as required. Interpretation: Foresight is a general-purpose model for biomedical concept modelling that can be used for real-world risk forecasting, virtual trials and clinical research to study the progression of disorders, simulate interventions and counterfactuals, and educational purposes.

CodeMonkeys: Scaling Test-Time Compute for Software Engineering

Scaling test-time compute is a promising axis for improving LLM capabilities. However, test-time compute can be scaled in a variety of ways, and effectively combining different approaches remains an active area of research. Here, we explore this problem in the context of solving real-world GitHub issues from the SWE-bench dataset. Our system, named CodeMonkeys, allows models to iteratively edit a codebase by jointly generating and running a testing script alongside their draft edit. We sample many of these multi-turn trajectories for every issue to generate a collection of candidate edits. This approach lets us scale "serial" test-time compute by increasing the number of iterations per trajectory and "parallel" test-time compute by increasing the number of trajectories per problem. With parallel scaling, we can amortize up-front costs across multiple downstream samples, allowing us to identify relevant codebase context using the simple method of letting an LLM read every file. In order to select between candidate edits, we combine voting using model-generated tests with a final multi-turn trajectory dedicated to selection. Overall, CodeMonkeys resolves 57.4% of issues from SWE-bench Verified using a budget of approximately 2300 USD. Our selection method can also be used to combine candidates from different sources. Selecting over an ensemble of edits from existing top SWE-bench Verified submissions obtains a score of 66.2% and outperforms the best member of the ensemble on its own. We fully release our code and data at https://scalingintelligence.stanford.edu/pubs/codemonkeys.

Hydragen: High-Throughput LLM Inference with Shared Prefixes

Transformer-based large language models (LLMs) are now deployed to hundreds of millions of users. LLM inference is commonly performed on batches of sequences that share a prefix, such as few-shot examples or a chatbot system prompt. Decoding in this large-batch setting can be bottlenecked by the attention operation, which reads large key-value (KV) caches from memory and computes inefficient matrix-vector products for every sequence in the batch. In this work, we introduce Hydragen, a hardware-aware exact implementation of attention with shared prefixes. Hydragen computes attention over the shared prefix and unique suffixes separately. This decomposition enables efficient prefix attention by batching queries together across sequences, reducing redundant memory reads and enabling the use of hardware-friendly matrix multiplications. Our method can improve end-to-end LLM throughput by up to 32x against competitive baselines, with speedup growing with the batch size and shared prefix length. Hydragen also enables the use of very long shared contexts: with a high batch size, increasing the prefix length from 1K to 16K tokens decreases Hydragen throughput by less than 15%, while the throughput of baselines drops by over 90%. Hydragen generalizes beyond simple prefix-suffix decomposition and can be applied to tree-based prompt sharing patterns, allowing us to further reduce inference time on competitive programming problems by 55%.

Large Language Monkeys: Scaling Inference Compute with Repeated Sampling

Scaling the amount of compute used to train language models has dramatically improved their capabilities. However, when it comes to inference, we often limit the amount of compute to only one attempt per problem. Here, we explore inference compute as another axis for scaling by increasing the number of generated samples. Across multiple tasks and models, we observe that coverage - the fraction of problems solved by any attempt - scales with the number of samples over four orders of magnitude. In domains like coding and formal proofs, where all answers can be automatically verified, these increases in coverage directly translate into improved performance. When we apply repeated sampling to SWE-bench Lite, the fraction of issues solved with DeepSeek-V2-Coder-Instruct increases from 15.9% with one sample to 56% with 250 samples, outperforming the single-attempt state-of-the-art of 43% which uses more capable frontier models. Moreover, using current API pricing, amplifying the cheaper DeepSeek model with five samples is more cost-effective and solves more issues than paying a premium for one sample from GPT-4o or Claude 3.5 Sonnet. Interestingly, the relationship between coverage and the number of samples is often log-linear and can be modelled with an exponentiated power law, suggesting the existence of inference-time scaling laws. Finally, we find that identifying correct samples out of many generations remains an important direction for future research in domains without automatic verifiers. When solving math word problems from GSM8K and MATH, coverage with Llama-3 models grows to over 95% with 10,000 samples. However, common methods to pick correct solutions from a sample collection, such as majority voting or reward models, plateau beyond several hundred samples and fail to fully scale with the sample budget.

NIRVANA: Neural Implicit Representations of Videos with Adaptive Networks and Autoregressive Patch-wise Modeling

Implicit Neural Representations (INR) have recently shown to be powerful tool for high-quality video compression. However, existing works are limiting as they do not explicitly exploit the temporal redundancy in videos, leading to a long encoding time. Additionally, these methods have fixed architectures which do not scale to longer videos or higher resolutions. To address these issues, we propose NIRVANA, which treats videos as groups of frames and fits separate networks to each group performing patch-wise prediction. This design shares computation within each group, in the spatial and temporal dimensions, resulting in reduced encoding time of the video. The video representation is modeled autoregressively, with networks fit on a current group initialized using weights from the previous group's model. To further enhance efficiency, we perform quantization of the network parameters during training, requiring no post-hoc pruning or quantization. When compared with previous works on the benchmark UVG dataset, NIRVANA improves encoding quality from 37.36 to 37.70 (in terms of PSNR) and the encoding speed by 12X, while maintaining the same compression rate. In contrast to prior video INR works which struggle with larger resolution and longer videos, we show that our algorithm is highly flexible and scales naturally due to its patch-wise and autoregressive designs. Moreover, our method achieves variable bitrate compression by adapting to videos with varying inter-frame motion. NIRVANA achieves 6X decoding speed and scales well with more GPUs, making it practical for various deployment scenarios.

Prompt Tuned Embedding Classification for Multi-Label Industry Sector Allocation

Prompt Tuning is emerging as a scalable and cost-effective method to fine-tune Pretrained Language Models (PLMs), which are often referred to as Large Language Models (LLMs). This study benchmarks the performance and computational efficiency of Prompt Tuning and baselines for multi-label text classification. This is applied to the challenging task of classifying companies into an investment firm's proprietary industry taxonomy, supporting their thematic investment strategy. Text-to-text classification is frequently reported to outperform task-specific classification heads, but has several limitations when applied to a multi-label classification problem where each label consists of multiple tokens: (a) Generated labels may not match any label in the label taxonomy; (b) The fine-tuning process lacks permutation invariance and is sensitive to the order of the provided labels; (c) The model provides binary decisions rather than appropriate confidence scores. Limitation (a) is addressed by applying constrained decoding using Trie Search, which slightly improves classification performance. All limitations (a), (b), and (c) are addressed by replacing the PLM's language head with a classification head, which is referred to as Prompt Tuned Embedding Classification (PTEC). This improves performance significantly, while also reducing computational costs during inference. In our industrial application, the training data is skewed towards well-known companies. We confirm that the model's performance is consistent across both well-known and less-known companies. Our overall results indicate the continuing need to adapt state-of-the-art methods to domain-specific tasks, even in the era of PLMs with strong generalization abilities. We release our codebase and a benchmarking dataset at https://github.com/EQTPartners/PTEC.

Characterizing WASP-43b's interior structure: unveiling tidal decay and apsidal motion

Context. Recent developments in exoplanetary research highlight the importance of Love numbers in understanding their internal dynamics, formation, migration history and their potential habitability. Love numbers represent crucial parameters that gauge how exoplanets respond to external forces such as tidal interactions and rotational effects. By measuring these responses, we can gain insights into the internal structure, composition, and density distribution of exoplanets. The rate of apsidal precession of a planetary orbit is directly linked to the second-order fluid Love number, thus we can gain valuable insights into the mass distribution of the planet. Aims. In this context, we aim to re-determine the orbital parameters of WASP-43b-in particular, orbital period, eccentricity, and argument of the periastron-and its orbital evolution. We study the outcomes of the tidal interaction with the host star:whether tidal decay and periastron precession are occurring in the system. Method. We observed the system with HARPS, whose data we present for the first time, and we also analyse the newly acquired JWST full-phase light curve. We fit jointly archival and new radial velocity and transit and occultation mid-times, including tidal decay, periastron precession and long-term acceleration in the system. Results. We detected a tidal decay rate of \dotP_a=(-1.99pm0.50) and a periastron precession rate of \dotomega=(0.1851+0.0070-0.0077)=(0.1727+0.0083-0.0089)deg/d=(621.72+29.88-32.04)arcsec/d. This is the first time that both periastron precession and tidal decay are simultaneously detected in an exoplanetary system. The observed tidal interactions can neither be explained by the tidal contribution to apsidal motion of a non-aligned stellar or planetary rotation axis nor by assuming non-synchronous rotation for the planet, and a value for the planetary Love number cannot be derived. [...]

Progress Note Understanding -- Assessment and Plan Reasoning: Overview of the 2022 N2C2 Track 3 Shared Task

Daily progress notes are common types in the electronic health record (EHR) where healthcare providers document the patient's daily progress and treatment plans. The EHR is designed to document all the care provided to patients, but it also enables note bloat with extraneous information that distracts from the diagnoses and treatment plans. Applications of natural language processing (NLP) in the EHR is a growing field with the majority of methods in information extraction. Few tasks use NLP methods for downstream diagnostic decision support. We introduced the 2022 National NLP Clinical Challenge (N2C2) Track 3: Progress Note Understanding - Assessment and Plan Reasoning as one step towards a new suite of tasks. The Assessment and Plan Reasoning task focuses on the most critical components of progress notes, Assessment and Plan subsections where health problems and diagnoses are contained. The goal of the task was to develop and evaluate NLP systems that automatically predict causal relations between the overall status of the patient contained in the Assessment section and its relation to each component of the Plan section which contains the diagnoses and treatment plans. The goal of the task was to identify and prioritize diagnoses as the first steps in diagnostic decision support to find the most relevant information in long documents like daily progress notes. We present the results of 2022 n2c2 Track 3 and provide a description of the data, evaluation, participation and system performance.

A Corpus for Detecting High-Context Medical Conditions in Intensive Care Patient Notes Focusing on Frequently Readmitted Patients

A crucial step within secondary analysis of electronic health records (EHRs) is to identify the patient cohort under investigation. While EHRs contain medical billing codes that aim to represent the conditions and treatments patients may have, much of the information is only present in the patient notes. Therefore, it is critical to develop robust algorithms to infer patients' conditions and treatments from their written notes. In this paper, we introduce a dataset for patient phenotyping, a task that is defined as the identification of whether a patient has a given medical condition (also referred to as clinical indication or phenotype) based on their patient note. Nursing Progress Notes and Discharge Summaries from the Intensive Care Unit of a large tertiary care hospital were manually annotated for the presence of several high-context phenotypes relevant to treatment and risk of re-hospitalization. This dataset contains 1102 Discharge Summaries and 1000 Nursing Progress Notes. Each Discharge Summary and Progress Note has been annotated by at least two expert human annotators (one clinical researcher and one resident physician). Annotated phenotypes include treatment non-adherence, chronic pain, advanced/metastatic cancer, as well as 10 other phenotypes. This dataset can be utilized for academic and industrial research in medicine and computer science, particularly within the field of medical natural language processing.