Chloe O'Connell

Niklas Mannhardt, Elizabeth Bondi-Kelly, Barbara Lam et al. · microsoft-research

Large language models (LLMs) have immense potential to make information more accessible, particularly in medicine, where complex medical jargon can hinder patient comprehension of clinical notes. We developed a patient-facing tool using LLMs to make clinical notes more readable by simplifying, extracting information from, and adding context to the notes. We piloted the tool with clinical notes donated by patients with a history of breast cancer and synthetic notes from a clinician. Participants (N=200, healthy, female-identifying patients) were randomly assigned three clinical notes in our tool with varying levels of augmentations and answered quantitative and qualitative questions evaluating their understanding of follow-up actions. Augmentations significantly increased their quantitative understanding scores. In-depth interviews were conducted with participants (N=7, patients with a history of breast cancer), revealing both positive sentiments about the augmentations and concerns about AI. We also performed a qualitative clinician-driven analysis of the model's error modes.

Monica Agrawal, Chloe O'Connell, Yasmin Fatemi et al.

Clinical studies often require understanding elements of a patient's narrative that exist only in free text clinical notes. To transform notes into structured data for downstream use, these elements are commonly extracted and normalized to medical vocabularies. In this work, we audit the performance of and indicate areas of improvement for state-of-the-art systems. We find that high task accuracies for clinical entity normalization systems on the 2019 n2c2 Shared Task are misleading, and underlying performance is still brittle. Normalization accuracy is high for common concepts (95.3%), but much lower for concepts unseen in training data (69.3%). We demonstrate that current approaches are hindered in part by inconsistencies in medical vocabularies, limitations of existing labeling schemas, and narrow evaluation techniques. We reformulate the annotation framework for clinical entity extraction to factor in these issues to allow for robust end-to-end system benchmarking. We evaluate concordance of annotations from our new framework between two annotators and achieve a Jaccard similarity of 0.73 for entity recognition and an agreement of 0.83 for entity normalization. We propose a path forward to address the demonstrated need for the creation of a reference standard to spur method development in entity recognition and normalization.