Zina Ibrahim

Thomas Searle, Zina Ibrahim, James Teo et al.

Brief Hospital Course (BHC) summaries are succinct summaries of an entire hospital encounter, embedded within discharge summaries, written by senior clinicians responsible for the overall care of a patient. Methods to automatically produce summaries from inpatient documentation would be invaluable in reducing clinician manual burden of summarising documents under high time-pressure to admit and discharge patients. Automatically producing these summaries from the inpatient course, is a complex, multi-document summarisation task, as source notes are written from various perspectives (e.g. nursing, doctor, radiology), during the course of the hospitalisation. We demonstrate a range of methods for BHC summarisation demonstrating the performance of deep learning summarisation models across extractive and abstractive summarisation scenarios. We also test a novel ensemble extractive and abstractive summarisation model that incorporates a medical concept ontology (SNOMED) as a clinical guidance signal and shows superior performance in 2 real-world clinical data sets.

Linglong Qian, Tao Wang, Jun Wang et al.

We present a comprehensive analysis of deep learning approaches for Electronic Health Record (EHR) time-series imputation, examining how architectural and framework biases combine to influence model performance. Our investigation reveals varying capabilities of deep imputers in capturing complex spatiotemporal dependencies within EHRs, and that model effectiveness depends on how its combined biases align with medical time-series characteristics. Our experimental evaluation challenges common assumptions about model complexity, demonstrating that larger models do not necessarily improve performance. Rather, carefully designed architectures can better capture the complex patterns inherent in clinical data. The study highlights the need for imputation approaches that prioritise clinically meaningful data reconstruction over statistical accuracy. Our experiments show imputation performance variations of up to 20\% based on preprocessing and implementation choices, emphasising the need for standardised benchmarking methodologies. Finally, we identify critical gaps between current deep imputation methods and medical requirements, highlighting the importance of integrating clinical insights to achieve more reliable imputation approaches for healthcare applications.

Linglong Qian, Joseph Arul Raj, Hugh Logan Ellis et al.

We introduce the Conditional Self-Attention Imputation (CSAI) model, a novel recurrent neural network architecture designed to address the challenges of complex missing data patterns in multivariate time series derived from hospital electronic health records (EHRs). CSAI extends state-of-the-art neural network-based imputation by introducing key modifications specific to EHR data: a) attention-based hidden state initialisation to capture both long- and short-range temporal dependencies prevalent in EHRs, b) domain-informed temporal decay to mimic clinical data recording patterns, and c) a non-uniform masking strategy that models non-random missingness by calibrating weights according to both temporal and cross-sectional data characteristics. Comprehensive evaluation across four EHR benchmark datasets demonstrates CSAI's effectiveness compared to state-of-the-art architectures in data restoration and downstream tasks. CSAI is integrated into PyPOTS, an open-source Python toolbox designed for machine learning tasks on partially observed time series. This work significantly advances the state of neural network imputation applied to EHRs by more closely aligning algorithmic imputation with clinical realities.

Wenjie Du, Jun Wang, Linglong Qian et al.

Effective imputation is a crucial preprocessing step for time series analysis. Despite the development of numerous deep learning algorithms for time series imputation, the community lacks standardized and comprehensive benchmark platforms to effectively evaluate imputation performance across different settings. Moreover, although many deep learning forecasting algorithms have demonstrated excellent performance, whether their modelling achievements can be transferred to time series imputation tasks remains unexplored. To bridge these gaps, we develop TSI-Bench, the first (to our knowledge) comprehensive benchmark suite for time series imputation utilizing deep learning techniques. The TSI-Bench pipeline standardizes experimental settings to enable fair evaluation of imputation algorithms and identification of meaningful insights into the influence of domain-appropriate missing rates and patterns on model performance. Furthermore, TSI-Bench innovatively provides a systematic paradigm to tailor time series forecasting algorithms for imputation purposes. Our extensive study across 34,804 experiments, 28 algorithms, and 8 datasets with diverse missingness scenarios demonstrates TSI-Bench's effectiveness in diverse downstream tasks and potential to unlock future directions in time series imputation research and analysis. All source code and experiment logs are released at https://github.com/WenjieDu/AwesomeImputation.

Zeljko Kraljevic, Thomas Searle, Anthony Shek et al.

Electronic health records (EHR) contain large volumes of unstructured text, requiring the application of Information Extraction (IE) technologies to enable clinical analysis. We present the open-source Medical Concept Annotation Toolkit (MedCAT) that provides: a) a novel self-supervised machine learning algorithm for extracting concepts using any concept vocabulary including UMLS/SNOMED-CT; b) a feature-rich annotation interface for customising and training IE models; and c) integrations to the broader CogStack ecosystem for vendor-agnostic health system deployment. We show improved performance in extracting UMLS concepts from open datasets (F1:0.448-0.738 vs 0.429-0.650). Further real-world validation demonstrates SNOMED-CT extraction at 3 large London hospitals with self-supervised training over ~8.8B words from ~17M clinical records and further fine-tuning with ~6K clinician annotated examples. We show strong transferability (F1 > 0.94) between hospitals, datasets, and concept types indicating cross-domain EHR-agnostic utility for accelerated clinical and research use cases.

Thomas Searle, Zina Ibrahim, Richard JB Dobson

Clinical coding is currently a labour-intensive, error-prone, but critical administrative process whereby hospital patient episodes are manually assigned codes by qualified staff from large, standardised taxonomic hierarchies of codes. Automating clinical coding has a long history in NLP research and has recently seen novel developments setting new state of the art results. A popular dataset used in this task is MIMIC-III, a large intensive care database that includes clinical free text notes and associated codes. We argue for the reconsideration of the validity MIMIC-III's assigned codes that are often treated as gold-standard, especially when MIMIC-III has not undergone secondary validation. This work presents an open-source, reproducible experimental methodology for assessing the validity of codes derived from EHR discharge summaries. We exemplify the methodology with MIMIC-III discharge summaries and show the most frequently assigned codes in MIMIC-III are under-coded up to 35%.

Jinge Wu, Yunsoo Kim, Eva C. Keller et al.

This paper proposes one of the first clinical applications of multimodal large language models (LLMs) as an assistant for radiologists to check errors in their reports. We created an evaluation dataset from real-world radiology datasets (including X-rays and CT scans). A subset of original reports was modified to contain synthetic errors by introducing three types of mistakes: "insert", "remove", and "substitute". The evaluation contained two difficulty levels: SIMPLE for binary error-checking and COMPLEX for identifying error types. At the SIMPLE level, our fine-tuned model significantly enhanced performance by 47.4% and 25.4% on MIMIC-CXR and IU X-ray data, respectively. This performance boost is also observed in unseen modality, CT scans, as the model performed 19.46% better than the baseline model. The model also surpassed the domain expert's accuracy in the MIMIC-CXR dataset by 1.67%. Notably, among the subsets (N=21) of the test set where a clinician did not achieve the correct conclusion, the LLaVA ensemble mode correctly identified 71.4% of these cases. However, all models performed poorly in identifying mistake types, underscoring the difficulty of the COMPLEX level. This study marks a promising step toward utilizing multimodal LLMs to enhance diagnostic accuracy in radiology. The ensemble model demonstrated comparable performance to clinicians, even capturing errors overlooked by humans.

Joseph Arul Raj, Linglong Qian, Zina Ibrahim

Secondary research use of Electronic Health Records (EHRs) is often hampered by the abundance of missing data in this valuable resource. Missingness in EHRs occurs naturally as a result of the data recording practices during routine clinical care, but handling it is crucial to the precision of medical analysis and the decision-making that follows. The literature contains a variety of imputation methodologies based on deep neural networks. Those aim to overcome the dynamic, heterogeneous and multivariate missingness patterns of EHRs, which cannot be handled by classical and statistical imputation methods. However, all existing deep imputation methods rely on end-to-end pipelines that incorporate both imputation and downstream analyses, e.g. classification. This coupling makes it difficult to assess the quality of imputation and takes away the flexibility of re-using the imputer for a different task. Furthermore, most end-to-end deep architectures tend to use complex networks to perform the downstream task, in addition to the already sophisticated deep imputation network. We, therefore ask if the high performance reported in the literature is due to the imputer or the classifier and further ask if an optimised state-of-the-art imputer is used, a simpler classifier can achieve comparable performance. This paper explores the development of a modular, deep learning-based imputation and classification pipeline, specifically built to leverage the capabilities of state-of-the-art imputation models for downstream classification tasks. Such a modular approach enables a) objective assessment of the quality of the imputer and classifier independently, and b) enables the exploration of the performance of simpler classification architectures using an optimised imputer.

Linglong Qian, Zina Ibrahim, Richard Dobson

Missingness is ubiquitous in multivariate time series and poses an obstacle to reliable downstream analysis. Although recurrent network imputation achieved the SOTA, existing models do not scale to deep architectures that can potentially alleviate issues arising in complex data. Moreover, imputation carries the risk of biased estimations of the ground truth. Yet, confidence in the imputed values is always unmeasured or computed post hoc from model output. We propose DEep Attention Recurrent Imputation (DEARI), which jointly estimates missing values and their associated uncertainty in heterogeneous multivariate time series. By jointly representing feature-wise correlations and temporal dynamics, we adopt a self attention mechanism, along with an effective residual component, to achieve a deep recurrent neural network with good imputation performance and stable convergence. We also leverage self-supervised metric learning to boost performance by optimizing sample similarity. Finally, we transform DEARI into a Bayesian neural network through a novel Bayesian marginalization strategy to produce stochastic DEARI, which outperforms its deterministic equivalent. Experiments show that DEARI surpasses the SOTA in diverse imputation tasks using real-world datasets, namely air quality control, healthcare and traffic.

Thomas Searle, Zina Ibrahim, James Teo et al.

The current mode of use of Electronic Health Record (EHR) elicits text redundancy. Clinicians often populate new documents by duplicating existing notes, then updating accordingly. Data duplication can lead to a propagation of errors, inconsistencies and misreporting of care. Therefore, quantifying information redundancy can play an essential role in evaluating innovations that operate on clinical narratives. This work is a quantitative examination of information redundancy in EHR notes. We present and evaluate two strategies to measure redundancy: an information-theoretic approach and a lexicosyntactic and semantic model. We evaluate the measures by training large Transformer-based language models using clinical text from a large openly available US-based ICU dataset and a large multi-site UK based Trust. By comparing the information-theoretic content of the trained models with open-domain language models, the language models trained using clinical text have shown ~1.5x to ~3x less efficient than open-domain corpora. Manual evaluation shows a high correlation with lexicosyntactic and semantic redundancy, with averages ~43 to ~65%.

Thomas Searle, Zina Ibrahim, Richard Dobson

Alzheimer's Dementia (AD) is an incurable, debilitating, and progressive neurodegenerative condition that affects cognitive function. Early diagnosis is important as therapeutics can delay progression and give those diagnosed vital time. Developing models that analyse spontaneous speech could eventually provide an efficient diagnostic modality for earlier diagnosis of AD. The Alzheimer's Dementia Recognition through Spontaneous Speech task offers acoustically pre-processed and balanced datasets for the classification and prediction of AD and associated phenotypes through the modelling of spontaneous speech. We exclusively analyse the supplied textual transcripts of the spontaneous speech dataset, building and comparing performance across numerous models for the classification of AD vs controls and the prediction of Mental Mini State Exam scores. We rigorously train and evaluate Support Vector Machines (SVMs), Gradient Boosting Decision Trees (GBDT), and Conditional Random Fields (CRFs) alongside deep learning Transformer based models. We find our top performing models to be a simple Term Frequency-Inverse Document Frequency (TF-IDF) vectoriser as input into a SVM model and a pre-trained Transformer based model `DistilBERT' when used as an embedding layer into simple linear models. We demonstrate test set scores of 0.81-0.82 across classification metrics and a RMSE of 4.58.

Zina Ibrahim, Honghan Wu, Richard Dobson

Many areas of research are characterised by the deluge of large-scale highly-dimensional time-series data. However, using the data available for prediction and decision making is hampered by the current lag in our ability to uncover and quantify true interactions that explain the outcomes.We are interested in areas such as intensive care medicine, which are characterised by i) continuous monitoring of multivariate variables and non-uniform sampling of data streams, ii) the outcomes are generally governed by interactions between a small set of rare events, iii) these interactions are not necessarily definable by specific values (or value ranges) of a given group of variables, but rather, by the deviations of these values from the normal state recorded over time, iv) the need to explain the predictions made by the model. Here, while numerous data mining models have been formulated for outcome prediction, they are unable to explain their predictions. We present a model for uncovering interactions with the highest likelihood of generating the outcomes seen from highly-dimensional time series data. Interactions among variables are represented by a relational graph structure, which relies on qualitative abstractions to overcome non-uniform sampling and to capture the semantics of the interactions corresponding to the changes and deviations from normality of variables of interest over time. Using the assumption that similar templates of small interactions are responsible for the outcomes (as prevalent in the medical domains), we reformulate the discovery task to retrieve the most-likely templates from the data.

Rebecca Bendayan, Honghan Wu, Zeljko Kraljevic et al.

Multimorbidity research in mental health services requires data from physical health conditions which is traditionally limited in mental health care electronic health records. In this study, we aimed to extract data from physical health conditions from clinical notes using SemEHR. Data was extracted from Clinical Record Interactive Search (CRIS) system at South London and Maudsley Biomedical Research Centre (SLaM BRC) and the cohort consisted of all individuals who had received a primary or secondary diagnosis of severe mental illness between 2007 and 2018. Three pairs of annotators annotated 2403 documents with an average Cohen's Kappa of 0.757. Results show that the NLP performance varies across different diseases areas (F1 0.601 - 0.954) suggesting that the language patterns or terminologies of different condition groups entail different technical challenges to the same NLP task.

Ehtesham Iqbal, Risha Govind, Alvin Romero et al.

Objective: Mining the data contained within Electronic Health Records (EHRs) can potentially generate a greater understanding of medication effects in the real world, complementing what we know from Randomised control trials (RCTs). We Propose a text mining approach to detect adverse events and medication episodes from the clinical text to enhance our understanding of adverse effects related to Clozapine, the most effective antipsychotic drug for the management of treatment-resistant schizophrenia, but underutilised due to concerns over its side effects. Material and Methods: We used data from de-identified EHRs of three mental health trusts in the UK (>50 million documents, over 500,000 patients, 2835 of which were prescribed Clozapine). We explored the prevalence of 33 adverse effects by age, gender, ethnicity, smoking status and admission type three months before and after the patients started Clozapine treatment. We compared the prevalence of adverse effects with those reported in the Side Effects Resource (SIDER) where possible. Results: Sedation, fatigue, agitation, dizziness, hypersalivation, weight gain, tachycardia, headache, constipation and confusion were amongst the highest recorded Clozapine adverse effect in the three months following the start of treatment. Higher percentages of all adverse effects were found in the first month of Clozapine therapy. Using a significance level of (p< 0.05) out chi-square tests show a significant association between most of the ADRs in smoking status and hospital admissions and some in gender and age groups. Further, the data was combined from three trusts, and chi-square tests were applied to estimate the average effect of ADRs in each monthly interval. Conclusion: A better understanding of how the drug works in the real world can complement clinical trials and precision medicine.

Zina Ibrahim, Honghan Wu, Ahmed Hamoud et al.

Current machine learning models aiming to predict sepsis from Electronic Health Records (EHR) do not account for the heterogeneity of the condition, despite its emerging importance in prognosis and treatment. This work demonstrates the added value of stratifying the types of organ dysfunction observed in patients who develop sepsis in the ICU in improving the ability to recognise patients at risk of sepsis from their EHR data. Using an ICU dataset of 13,728 records, we identify clinically significant sepsis subpopulations with distinct organ dysfunction patterns. Classification experiments using Random Forest, Gradient Boost Trees and Support Vector Machines, aiming to distinguish patients who develop sepsis in the ICU from those who do not, show that features selected using sepsis subpopulations as background knowledge yield a superior performance regardless of the classification model used. Our findings can steer machine learning efforts towards more personalised models for complex conditions including sepsis.