Mikkel Odgaard

Maria Elkjær Montgomery, Christian Igel, Mikkel Odgaard et al.

How do we encode numeric values in transformer-based sequence processing, particularly in electronic health record (EHR) data? We systematically compare discrete, continuous, and hybrid value encoding strategies using synthetic arithmetic tasks embedded within real-world EHR data, as well as real-world clinical prediction tasks. Our study reveals trade-offs between numeric precision, optimisation stability, and architectural flexibility. We find that approaches that explicitly model value-concept interactions perform best on precision-sensitive arithmetic tasks when architectural constraints permit. Hybrid token-based approaches that retain numeric values but apply binning prior to projection provide a more robust and broadly applicable alternative, with the optimal number of bins following a simple empirically derived power-law in dataset size. Across tasks, models consistently exhibit reliable "good enough" numeric computation rather than exact arithmetic, while clinical gains from incorporating laboratory values are task-dependent. This suggests that robustness and deployability often outweigh maximal numeric precision in practice, motivating hybrid token-based approaches as a practical default.

Mikkel Odgaard, Kiril Vadimovic Klein, Sanne Møller Thysen et al.

The widespread adoption of Electronic Health Records (EHR) has significantly increased the amount of available healthcare data. This has allowed models inspired by Natural Language Processing (NLP) and Computer Vision, which scale exceptionally well, to be used in EHR research. Particularly, BERT-based models have surged in popularity following the release of BEHRT and Med-BERT. Subsequent models have largely built on these foundations despite the fundamental design choices of these pioneering models remaining underexplored. Through incremental optimization, we study BERT-based EHR modeling and isolate the sources of improvement for key design choices, giving us insights into the effect of data representation, individual technical components, and training procedure. Evaluating this across a set of generic tasks (death, pain treatment, and general infection), we showed that improving data representation can increase the average downstream performance from 0.785 to 0.797 AUROC ($p<10^{-7}$), primarily when including medication and timestamps. Improving the architecture and training protocol on top of this increased average downstream performance to 0.801 AUROC ($p<10^{-7}$). We then demonstrated the consistency of our optimization through a rigorous evaluation across 25 diverse clinical prediction tasks. We observed significant performance increases in 17 out of 25 tasks and improvements in 24 tasks, highlighting the generalizability of our results. Our findings provide a strong foundation for future work and aim to increase the trustworthiness of BERT-based EHR models.