Jinghui Liu

Aaron Nicolson, Jinghui Liu, Jason Dowling et al.

The Shared Task on Large-Scale Radiology Report Generation (RRG24) aims to expedite the development of assistive systems for interpreting and reporting on chest X-ray (CXR) images. This task challenges participants to develop models that generate the findings and impression sections of radiology reports from CXRs from a patient's study, using five different datasets. This paper outlines the e-Health CSIRO team's approach, which achieved multiple first-place finishes in RRG24. The core novelty of our approach lies in the addition of entropy regularisation to self-critical sequence training, to maintain a higher entropy in the token distribution. This prevents overfitting to common phrases and ensures a broader exploration of the vocabulary during training, essential for handling the diversity of the radiology reports in the RRG24 datasets. Our model is available on Hugging Face https://huggingface.co/aehrc/cxrmate-rrg24.

Jinghui Liu, Aaron Nicolson, Jason Dowling et al.

Clinical documentation is an important aspect of clinicians' daily work and often demands a significant amount of time. The BioNLP 2024 Shared Task on Streamlining Discharge Documentation (Discharge Me!) aims to alleviate this documentation burden by automatically generating discharge summary sections, including brief hospital course and discharge instruction, which are often time-consuming to synthesize and write manually. We approach the generation task by fine-tuning multiple open-sourced language models (LMs), including both decoder-only and encoder-decoder LMs, with various configurations on input context. We also examine different setups for decoding algorithms, model ensembling or merging, and model specialization. Our results show that conditioning on the content of discharge summary prior to the target sections is effective for the generation task. Furthermore, we find that smaller encoder-decoder LMs can work as well or even slightly better than larger decoder based LMs fine-tuned through LoRA. The model checkpoints from our team (aehrc) are openly available.

Jinghui Liu, Daniel Capurro, Anthony Nguyen et al.

Modeling text-based time-series to make prediction about a future event or outcome is an important task with a wide range of applications. The standard approach is to train and test the model using the same input window, but this approach neglects the data collected in longer input windows between the prediction time and the final outcome, which are often available during training. In this study, we propose to treat this neglected text as privileged information available during training to enhance early prediction modeling through knowledge distillation, presented as Learning using Privileged tIme-sEries Text (LuPIET). We evaluate the method on clinical and social media text, with four clinical prediction tasks based on clinical notes and two mental health prediction tasks based on social media posts. Our results show LuPIET is effective in enhancing text-based early predictions, though one may need to consider choosing the appropriate text representation and windows for privileged text to achieve optimal performance. Compared to two other methods using transfer learning and mixed training, LuPIET offers more stable improvements over the baseline, standard training. As far as we are concerned, this is the first study to examine learning using privileged information for time-series in the NLP context.

Jinghui Liu, Sarvesh Soni, Anthony Nguyen

Large language models (LLMs) can generate or synthesize clinical text for a wide range of applications, from improving clinical documentation to augmenting clinical text analytics. Yet evaluations typically focus on a narrow aspect -- such as similarity or utility comparisons -- even though these aspects are complementary and best viewed in parallel. In this study, we aim to conduct a systematic evaluation of LLM-generated clinical text, which includes intrinsic, extrinsic, and factuality evaluations of synthetic clinical notes rephrased from MIMIC databases at million-note scale. Our analysis demonstrates that synthetic notes preserve core clinical information and predictive utility for coarse-grained tasks despite substantial linguistic changes, but lose fine-grained details for task like ICD coding. We show this loss of detail can be substantially mitigated by rephrasing notes by chunks rather than by the whole note, but at the cost of reduced factual precision under incomplete context. Through fact-checking and error analysis, we further find that synthesis errors are dominated by misinterpretation of clinical context, alongside temporal confusion, measurement errors, and fabricated claims. Finally, we show that the synthetic notes -- despite their task-agnostic nature -- can effectively augment task-specific training for rare ICD codes.

Jinghui Liu, Anthony Nguyen

Clinical coding maps clinical documentation to standardized medical codes, an essential yet time-consuming administrative task that could benefit from automation. Current models on ICD coding are typically optimized for codes from a specific ICD version. However, in reality, ICD systems evolve continuously, and different versions are adopted across time periods and regions. Moreover, ICD coding suffers from the long-tail problem, and rare code performance can be a bottleneck for developing implementable models. We examine whether it is viable to train version-independent models by combining data annotated in different ICD versions, which may help address these challenges. We add ICD-9 data to the training of a modified label-wise attention model for ICD-10 prediction, and find that despite the version mismatch, adding ICD-9 yields a 27% increase in micro F1 for 18K rare ICD codes compared to training on ICD-10 alone. On 8K frequent ICD-10 codes, the multi-version training also substantially improves macro metrics, with far fewer model parameters.

Jinghui Liu, Anthony Nguyen

Clinical language models are important for many applications in healthcare, but their development depends on access to extensive clinical text for pretraining. However, obtaining clinical notes from electronic health records (EHRs) at scale is challenging due to patient privacy concerns. In this study, we rephrase existing clinical notes using LLMs to generate synthetic pretraining corpora, drawing inspiration from previous work on rephrasing web data. We examine four popular small-sized LLMs (<10B) to create synthetic clinical text to pretrain both decoder-based and encoder-based language models. The method yields better results in language modeling and downstream tasks than previous synthesis approaches without referencing real clinical text. We find that augmenting original clinical notes with synthetic corpora from different LLMs improves performances even at a small token budget, showing the potential of this method to support pretraining at the institutional level or be scaled to synthesize large-scale clinical corpora.