Kaleb E Smith

Amin Dada, Aokun Chen, Cheng Peng et al.

Traditionally, large language models have been either trained on general web crawls or domain-specific data. However, recent successes of generative large language models, have shed light on the benefits of cross-domain datasets. To examine the significance of prioritizing data diversity over quality, we present a German dataset comprising texts from five domains, along with another dataset aimed at containing high-quality data. Through training a series of models ranging between 122M and 750M parameters on both datasets, we conduct a comprehensive benchmark on multiple downstream tasks. Our findings demonstrate that the models trained on the cross-domain dataset outperform those trained on quality data alone, leading to improvements up to $4.45\%$ over the previous state-of-the-art. The models are available at https://huggingface.co/ikim-uk-essen

Cheng Peng, Xi Yang, Kaleb E Smith et al.

Objective To develop soft prompt-based learning algorithms for large language models (LLMs), examine the shape of prompts, prompt-tuning using frozen/unfrozen LLMs, transfer learning, and few-shot learning abilities. Methods We developed a soft prompt-based LLM model and compared 4 training strategies including (1) fine-tuning without prompts; (2) hard-prompt with unfrozen LLMs; (3) soft-prompt with unfrozen LLMs; and (4) soft-prompt with frozen LLMs. We evaluated 7 pretrained LLMs using the 4 training strategies for clinical concept and relation extraction on two benchmark datasets. We evaluated the transfer learning ability of the prompt-based learning algorithms in a cross-institution setting. We also assessed the few-shot learning ability. Results and Conclusion When LLMs are unfrozen, GatorTron-3.9B with soft prompting achieves the best strict F1-scores of 0.9118 and 0.8604 for concept extraction, outperforming the traditional fine-tuning and hard prompt-based models by 0.6~3.1% and 1.2~2.9%, respectively; GatorTron-345M with soft prompting achieves the best F1-scores of 0.8332 and 0.7488 for end-to-end relation extraction, outperforming the other two models by 0.2~2% and 0.6~11.7%, respectively. When LLMs are frozen, small (i.e., 345 million parameters) LLMs have a big gap to be competitive with unfrozen models; scaling LLMs up to billions of parameters makes frozen LLMs competitive with unfrozen LLMs. For cross-institute evaluation, soft prompting with a frozen GatorTron-8.9B model achieved the best performance. This study demonstrates that (1) machines can learn soft prompts better than humans, (2) frozen LLMs have better few-shot learning ability and transfer learning ability to facilitate muti-institution applications, and (3) frozen LLMs require large models.

Amin Dada, Marie Bauer, Amanda Butler Contreras et al.

Large Language Models (LLMs) are expected to significantly contribute to patient care, diagnostics, and administrative processes. Emerging biomedical LLMs aim to address healthcare-specific challenges, including privacy demands and computational constraints. Assessing the models' suitability for this sensitive application area is of the utmost importance. However, biomedical training has not been systematically evaluated on medical tasks. This study investigates the effect of biomedical training in the context of six practical medical tasks evaluating $25$ models. In contrast to previous evaluations, our results reveal a performance decline in nine out of twelve biomedical models after fine-tuning, particularly on tasks involving hallucinations, ICD10 coding, and instruction adherence. General-domain models like Meta-Llama-3.1-70B-Instruct outperformed their biomedical counterparts, indicating a trade-off between domain-specific fine-tuning and general medical task performance. We open-source all evaluation scripts and datasets at https://github.com/TIO-IKIM/CLUE to support further research in this critical area.

Cheng Peng, Xi Yang, Aokun Chen et al.

Objective To solve major clinical natural language processing (NLP) tasks using a unified text-to-text learning architecture based on a generative large language model (LLM) via prompt tuning. Methods We formulated 7 key clinical NLP tasks as text-to-text learning and solved them using one unified generative clinical LLM, GatorTronGPT, developed using GPT-3 architecture and trained with up to 20 billion parameters. We adopted soft prompts (i.e., trainable vectors) with frozen LLM, where the LLM parameters were not updated (i.e., frozen) and only the vectors of soft prompts were updated, known as prompt tuning. We added additional soft prompts as a prefix to the input layer, which were optimized during the prompt tuning. We evaluated the proposed method using 7 clinical NLP tasks and compared them with previous task-specific solutions based on Transformer models. Results and Conclusion The proposed approach achieved state-of-the-art performance for 5 out of 7 major clinical NLP tasks using one unified generative LLM. Our approach outperformed previous task-specific transformer models by ~3% for concept extraction and 7% for relation extraction applied to social determinants of health, 3.4% for clinical concept normalization, 3.4~10% for clinical abbreviation disambiguation, and 5.5~9% for natural language inference. Our approach also outperformed a previously developed prompt-based machine reading comprehension (MRC) model, GatorTron-MRC, for clinical concept and relation extraction. The proposed approach can deliver the ``one model for all`` promise from training to deployment using a unified generative LLM.

Cheng Peng, Zehao Yu, Kaleb E Smith et al.

The progress in natural language processing (NLP) using large language models (LLMs) has greatly improved patient information extraction from clinical narratives. However, most methods based on the fine-tuning strategy have limited transfer learning ability for cross-domain applications. This study proposed a novel approach that employs a soft prompt-based learning architecture, which introduces trainable prompts to guide LLMs toward desired outputs. We examined two types of LLM architectures, including encoder-only GatorTron and decoder-only GatorTronGPT, and evaluated their performance for the extraction of social determinants of health (SDoH) using a cross-institution dataset from the 2022 n2c2 challenge and a cross-disease dataset from the University of Florida (UF) Health. The results show that decoder-only LLMs with prompt tuning achieved better performance in cross-domain applications. GatorTronGPT achieved the best F1 scores for both datasets, outperforming traditional fine-tuned GatorTron by 8.9% and 21.8% in a cross-institution setting, and 5.5% and 14.5% in a cross-disease setting.

Cheng Peng, Xi Yang, Aokun Chen et al.

There is enormous enthusiasm and concerns in using large language models (LLMs) in healthcare, yet current assumptions are all based on general-purpose LLMs such as ChatGPT. This study develops a clinical generative LLM, GatorTronGPT, using 277 billion words of mixed clinical and English text with a GPT-3 architecture of 20 billion parameters. GatorTronGPT improves biomedical natural language processing for medical research. Synthetic NLP models trained using GatorTronGPT generated text outperform NLP models trained using real-world clinical text. Physicians Turing test using 1 (worst) to 9 (best) scale shows that there is no significant difference in linguistic readability (p = 0.22; 6.57 of GatorTronGPT compared with 6.93 of human) and clinical relevance (p = 0.91; 7.0 of GatorTronGPT compared with 6.97 of human) and that physicians cannot differentiate them (p < 0.001). This study provides insights on the opportunities and challenges of LLMs for medical research and healthcare.

Xi Yang, Aokun Chen, Nima PourNejatian et al.

There is an increasing interest in developing artificial intelligence (AI) systems to process and interpret electronic health records (EHRs). Natural language processing (NLP) powered by pretrained language models is the key technology for medical AI systems utilizing clinical narratives. However, there are few clinical language models, the largest of which trained in the clinical domain is comparatively small at 110 million parameters (compared with billions of parameters in the general domain). It is not clear how large clinical language models with billions of parameters can help medical AI systems utilize unstructured EHRs. In this study, we develop from scratch a large clinical language model - GatorTron - using >90 billion words of text (including >82 billion words of de-identified clinical text) and systematically evaluate it on 5 clinical NLP tasks including clinical concept extraction, medical relation extraction, semantic textual similarity, natural language inference (NLI), and medical question answering (MQA). We examine how (1) scaling up the number of parameters and (2) scaling up the size of the training data could benefit these NLP tasks. GatorTron models scale up the clinical language model from 110 million to 8.9 billion parameters and improve 5 clinical NLP tasks (e.g., 9.6% and 9.5% improvement in accuracy for NLI and MQA), which can be applied to medical AI systems to improve healthcare delivery. The GatorTron models are publicly available at: https://catalog.ngc.nvidia.com/orgs/nvidia/teams/clara/models/gatortron_og.