Mingcheng Zhu

Siqi Li, Xin Li, Kunyu Yu et al.

Clinical and biomedical research in low-resource settings often faces significant challenges due to the need for high-quality data with sufficient sample sizes to construct effective models. These constraints hinder robust model training and prompt researchers to seek methods for leveraging existing knowledge from related studies to support new research efforts. Transfer learning (TL), a machine learning technique, emerges as a powerful solution by utilizing knowledge from pre-trained models to enhance the performance of new models, offering promise across various healthcare domains. Despite its conceptual origins in the 1990s, the application of TL in medical research has remained limited, especially beyond image analysis. In our review of TL applications in structured clinical and biomedical data, we screened 3,515 papers, with 55 meeting the inclusion criteria. Among these, only 2% (one out of 55) utilized external studies, and 7% (four out of 55) addressed scenarios involving multi-site collaborations with privacy constraints. To achieve actionable TL with structured medical data while addressing regional disparities, inequality, and privacy constraints in healthcare research, we advocate for the careful identification of appropriate source data and models, the selection of suitable TL frameworks, and the validation of TL models with proper baselines.

Mingcheng Zhu, Zhiyao Luo, Yu Liu et al.

By processing electronic health records (EHRs) as natural language sequences, large language models (LLMs) have shown potential in clinical prediction tasks such as mortality prediction and phenotyping. However, longitudinal or highly frequent EHRs often yield excessively long token sequences that result in high computational costs and even reduced performance. Existing solutions either add modules for compression or remove less important tokens, which introduce additional inference latency or risk losing clinical information. To achieve lossless compression of token sequences without additional cost or loss of performance, we propose Medical Token-Pair Encoding (MedTPE), a layered method that extends standard tokenisation for EHR sequences. MedTPE merges frequently co-occurring medical token pairs into composite tokens, providing lossless compression while preserving the computational complexity through a dependency-aware replacement strategy. Only the embeddings of the newly introduced tokens of merely 0.5-1.0% of the LLM's parameters are fine-tuned via self-supervised learning. Experiments on real-world datasets for two clinical scenarios demonstrate that MedTPE reduces input token length by up to 31% and inference latency by 34-63%, while maintaining or even improving both predictive performance and output format compliance across multiple LLMs and four clinical prediction tasks. Furthermore, MedTPE demonstrates robustness across different input context lengths and generalisability to scientific and financial domains and different languages.

Mingcheng Zhu, Yu Liu, Zhiyao Luo et al.

The widespread adoption of electronic health records (EHRs) enables the acquisition of heterogeneous clinical data, spanning lab tests, vital signs, medications, and procedures, which offer transformative potential for artificial intelligence in healthcare. Although traditional modelling approaches have typically relied on multivariate time series, they often struggle to accommodate the inherent sparsity and irregularity of real-world clinical workflows. Consequently, research has shifted toward event stream representation, which treats patient records as continuous sequences, thereby preserving the precise temporal structure of the patient journey. However, the existing literature remains fragmented, characterised by inconsistent definitions, disparate modelling architectures, and varying training protocols. To address these gaps, this review establishes a unified definition of EHR event streams and introduces a novel taxonomy that categorises models based on their handling of event time, type, and value. We systematically review training strategies, ranging from supervised learning to self-supervised methods, and provide a comprehensive discussion of applications across clinical scenarios. Finally, we identify open critical challenges and future directions, with the aim of clarifying the current landscape and guiding the development of next-generation healthcare models.

Mingcheng Zhu, Yu Liu, Tingting Zhu

Uncertainty estimation is important for deploying LLMs in high-stakes applications such as healthcare and finance, where hallucinations can appear fluent and plausible while being factually incorrect, making it difficult for users to judge whether an output should be trusted. Existing methods require one or more full autoregressive generations to estimate uncertainty, which introduces substantial inference cost and often delays uncertainty assessment. In this paper, we investigate whether effective uncertainty estimation can be achieved with partial generation or even input-only information. Specifically, we first develop a unified framework that formulates uncertainty estimation as an early estimation problem over the autoregressive generation process of LLMs. This framework organises existing and proposed estimators by the information they observe, ranging from multi-generation to input-only prediction, and clarifies the performance-cost trade-off underlying different uncertainty estimation methods. Building on this view, we study two largely underexplored low-cost settings: estimating uncertainty with part of the generation, and predicting uncertainty from the input prompt. We propose Logit Magnitude, which uses top-M logit evidence to estimate uncertainty from an early-stopped generation prefix, and MetaUE, which distils generation-based uncertainty into a lightweight input-only estimator trained with uncertainty scores. Extensive experiments on general and domain-specific benchmarks show that Logit Magnitude achieves strong performance, and partial generations of LLMs are often sufficient for effective uncertainty estimation. MetaUE further provides a competitive input-only approximation in several settings. These findings suggest that effective uncertainty estimation requires less generation than commonly assumed, enabling unreliable responses to be identified earlier.

Mingcheng Zhu, Yu Liu, Zhiyao Luo et al.

Artificial Intelligence has revolutionised critical care for common conditions. Yet, rare conditions in the intensive care unit (ICU), including recognised rare diseases and low-prevalence conditions in the ICU, remain underserved due to data scarcity and intra-condition heterogeneity. To bridge such gaps, we developed KnowRare, a domain adaptation-based deep learning framework for predicting clinical outcomes for rare conditions in the ICU. KnowRare mitigates data scarcity by initially learning condition-agnostic representations from diverse electronic health records through self-supervised pre-training. It addresses intra-condition heterogeneity by selectively adapting knowledge from clinically similar conditions with a developed condition knowledge graph. Evaluated on two ICU datasets across five clinical prediction tasks (90-day mortality, 30-day readmission, ICU mortality, remaining length of stay, and phenotyping), KnowRare consistently outperformed existing state-of-the-art models. Additionally, KnowRare demonstrated superior predictive performance compared to established ICU scoring systems, including APACHE IV and IV-a. Case studies further demonstrated KnowRare's flexibility in adapting its parameters to accommodate dataset-specific and task-specific characteristics, its generalisation to common conditions under limited data scenarios, and its rationality in selecting source conditions. These findings highlight KnowRare's potential as a robust and practical solution for supporting clinical decision-making and improving care for rare conditions in the ICU.

Tianyi Chen, Mingcheng Zhu, Zhiyao Luo et al.

Electronic Health Records (EHRs) enable deep learning for clinical predictions, but the optimal method for representing patient data remains unclear due to inconsistent evaluation practices. We present the first systematic benchmark to compare EHR representation methods, including multivariate time-series, event streams, and textual event streams for LLMs. This benchmark standardises data curation and evaluation across two distinct clinical settings: the MIMIC-IV dataset for ICU tasks (mortality, phenotyping) and the EHRSHOT dataset for longitudinal care (30-day readmission, 1-year pancreatic cancer). For each paradigm, we evaluate appropriate modelling families--including Transformers, MLP, LSTMs and Retain for time-series, CLMBR and count-based models for event streams, 8-20B LLMs for textual streams--and analyse the impact of feature pruning based on data missingness. Our experiments reveal that event stream models consistently deliver the strongest performance. Pre-trained models like CLMBR are highly sample-efficient in few-shot settings, though simpler count-based models can be competitive given sufficient data. Furthermore, we find that feature selection strategies must be adapted to the clinical setting: pruning sparse features improves ICU predictions, while retaining them is critical for longitudinal tasks. Our results, enabled by a unified and reproducible pipeline, provide practical guidance for selecting EHR representations based on the clinical context and data regime.