Jeffrey N. Chiang

Rosemary Y. He, Jeffrey N. Chiang

Trajectory forecasting in healthcare data has been an important area of research in precision care and clinical integration for computational methods. In recent years, generative AI models have demonstrated promising results in capturing short and long range dependencies in time series data. While these models have also been applied in healthcare, most of them only predict one value at a time, which is unrealistic in a clinical setting where multiple measures are taken at once. In this work, we extend the framework temporal fusion transformer (TFT), a multi-horizon time series prediction tool, and propose TFT-multi, an end-to-end framework that can predict multiple vital trajectories simultaneously. We apply TFT-multi to forecast 5 vital signs recorded in the intensive care unit: blood pressure, pulse, SpO2, temperature and respiratory rate. We hypothesize that by jointly predicting these measures, which are often correlated with one another, we can make more accurate predictions, especially in variables with large missingness. We validate our model on the public MIMIC dataset and an independent institutional dataset, and demonstrate that this approach outperforms state-of-the-art univariate prediction tools including the original TFT and Prophet, as well as vector regression modeling for multivariate prediction. Furthermore, we perform a study case analysis by applying our pipeline to forecast blood pressure changes in response to actual and hypothetical pressor administration.

Simon A. Lee, Sujay Jain, Alex Chen et al.

In this work, we introduce the Multiple Embedding Model for EHR (MEME), an approach that serializes multimodal EHR tabular data into text using pseudo-notes, mimicking clinical text generation. This conversion not only preserves better representations of categorical data and learns contexts but also enables the effective employment of pretrained foundation models for rich feature representation. To address potential issues with context length, our framework encodes embeddings for each EHR modality separately. We demonstrate the effectiveness of MEME by applying it to several decision support tasks within the Emergency Department across multiple hospital systems. Our findings indicate that MEME outperforms traditional machine learning, EHR-specific foundation models, and general LLMs, highlighting its potential as a general and extendible EHR representation strategy.

Simon A. Lee, Anthony Wu, Jeffrey N. Chiang

We introduce Clinical ModernBERT, a transformer based encoder pretrained on large scale biomedical literature, clinical notes, and medical ontologies, incorporating PubMed abstracts, MIMIC IV clinical data, and medical codes with their textual descriptions. Building on ModernBERT the current state of the art natural language text encoder featuring architectural upgrades such as rotary positional embeddings (RoPE), Flash Attention, and extended context length up to 8,192 tokens our model adapts these innovations specifically for biomedical and clinical domains. Clinical ModernBERT excels at producing semantically rich representations tailored for long context tasks. We validate this both by analyzing its pretrained weights and through empirical evaluation on a comprehensive suite of clinical NLP benchmarks.

Simon A. Lee, John Lee, Jeffrey N. Chiang

In this study, we introduce FEET, a standardized protocol designed to guide the development and benchmarking of foundation models. While numerous benchmark datasets exist for evaluating these models, we propose a structured evaluation protocol across three distinct scenarios to gain a comprehensive understanding of their practical performance. We define three primary use cases: frozen embeddings, few-shot embeddings, and fully fine-tuned embeddings. Each scenario is detailed and illustrated through two case studies: one in sentiment analysis and another in the medical domain, demonstrating how these evaluations provide a thorough assessment of foundation models' effectiveness in research applications. We recommend this protocol as a standard for future research aimed at advancing representation learning models.