Leveraging LLMs for Predicting Unknown Diagnoses from Clinical Notes
This addresses a specific issue for clinical decision-making and research by improving diagnosis prediction in EHRs, though it is incremental as it builds on existing LLM methods with a new ensemble approach.
This study tackled the problem of incomplete diagnosis links in Electronic Health Records by using large language models (LLMs) to predict implicitly mentioned diagnoses from clinical notes and link them to medications, achieving 75% accuracy with majority voting across diverse LLM configurations, outperforming the best single configuration at 66%.
Electronic Health Records (EHRs) often lack explicit links between medications and diagnoses, making clinical decision-making and research more difficult. Even when links exist, diagnosis lists may be incomplete, especially during early patient visits. Discharge summaries tend to provide more complete information, which can help infer accurate diagnoses, especially with the help of large language models (LLMs). This study investigates whether LLMs can predict implicitly mentioned diagnoses from clinical notes and link them to corresponding medications. We address two research questions: (1) Does majority voting across diverse LLM configurations outperform the best single configuration in diagnosis prediction? (2) How sensitive is majority voting accuracy to LLM hyperparameters such as temperature, top-p, and summary length? To evaluate, we created a new dataset of 240 expert-annotated medication-diagnosis pairs from 20 MIMIC-IV notes. Using GPT-3.5 Turbo, we ran 18 prompting configurations across short and long summary lengths, generating 8568 test cases. Results show that majority voting achieved 75 percent accuracy, outperforming the best single configuration at 66 percent. No single hyperparameter setting dominated, but combining deterministic, balanced, and exploratory strategies improved performance. Shorter summaries generally led to higher accuracy.In conclusion, ensemble-style majority voting with diverse LLM configurations improves diagnosis prediction in EHRs and offers a promising method to link medications and diagnoses in clinical texts.