We know from prior work that LLMs encode social biases, and that this manifests in clinical tasks. In this work we adopt tools from mechanistic interpretability to unveil sociodemographic representations and biases within LLMs in the context of healthcare. Specifically, we ask: Can we identify activations within LLMs that encode sociodemographic information (e.g., gender, race)? We find that gender information is highly localized in middle MLP layers and can be reliably manipulated at inference time via patching. Such interventions can surgically alter generated clinical vignettes for specific conditions, and also influence downstream clinical predictions which correlate with gender, e.g., patient risk of depression. We find that representation of patient race is somewhat more distributed, but can also be intervened upon, to a degree. To our knowledge, this is the first application of mechanistic interpretability methods to LLMs for healthcare.

Methods to ensure factual accuracy of text generated by large language models (LLM) in clinical medicine are lacking. VeriFact is an artificial intelligence system that combines retrieval-augmented generation and LLM-as-a-Judge to verify whether LLM-generated text is factually supported by a patient's medical history based on their electronic health record (EHR). To evaluate this system, we introduce VeriFact-BHC, a new dataset that decomposes Brief Hospital Course narratives from discharge summaries into a set of simple statements with clinician annotations for whether each statement is supported by the patient's EHR clinical notes. Whereas highest agreement between clinicians was 88.5%, VeriFact achieves up to 92.7% agreement when compared to a denoised and adjudicated average human clinician ground truth, suggesting that VeriFact exceeds the average clinician's ability to fact-check text against a patient's medical record. VeriFact may accelerate the development of LLM-based EHR applications by removing current evaluation bottlenecks.

This paper presents our proposed approach to the Discharge Me! shared task, collocated with the 23th Workshop on Biomedical Natural Language Processing (BioNLP). In this work, we develop an LLM-based framework for solving the Discharge Summary Documentation (DSD) task, i.e., generating the two critical target sections `Brief Hospital Course' and `Discharge Instructions' in the discharge summary. By streamlining the recent instruction-finetuning process on LLMs, we explore several prompting strategies for optimally adapting LLMs to specific generation task of DSD. Experimental results show that providing a clear output structure, complimented by a set of comprehensive Chain-of-Thoughts (CoT) questions, effectively improves the model's reasoning capability, and thereby, enhancing the structural correctness and faithfulness of clinical information in the generated text. Source code is available at: https://github.com/antangrocket1312/Discharge_LLM

Automatic generation of discharge summaries presents significant challenges due to the length of clinical documentation, the dispersed nature of patient information, and the diverse terminology used in healthcare. This paper presents a hybrid solution for generating discharge summary sections as part of our participation in the "Discharge Me!" Challenge at the BioNLP 2024 Shared Task. We developed a two-stage generation method using both extractive and abstractive techniques, in which we first apply name entity recognition (NER) to extract key clinical concepts, which are then used as input for a prompt-tuning-based GatorTronGPT model to generate coherent text for two important sections including "Brief Hospital Course" and "Discharge Instructions". Our system was ranked 5th in this challenge, achieving an overall score of 0.284. The results demonstrate the effectiveness of our hybrid solution in improving the quality of automated discharge section generation.

The BioNLP ACL'24 Shared Task on Streamlining Discharge Documentation aims to reduce the administrative burden on clinicians by automating the creation of critical sections of patient discharge letters. This paper presents our approach using the Llama3 8B quantized model to generate the "Brief Hospital Course" and "Discharge Instructions" sections. We employ a zero-shot method combined with Retrieval-Augmented Generation (RAG) to produce concise, contextually accurate summaries. Our contributions include the development of a curated template-based approach to ensure reliability and consistency, as well as the integration of RAG for word count prediction. We also describe several unsuccessful experiments to provide insights into our pathway for the competition. Our results demonstrate the effectiveness and efficiency of our approach, achieving high scores across multiple evaluation metrics.

In this paper, we present our approach to the shared task "Discharge Me!" at the BioNLP Workshop 2024. The primary goal of this task is to reduce the time and effort clinicians spend on writing detailed notes in the electronic health record (EHR). Participants develop a pipeline to generate the "Brief Hospital Course" and "Discharge Instructions" sections from the EHR. Our approach involves a first step of extracting the relevant sections from the EHR. We then add explanatory prompts to these sections and concatenate them with separate tokens to create the input text. To train a text generation model, we perform LoRA fine-tuning on the ClinicalT5-large model. On the final test data, our approach achieved a ROUGE-1 score of $0.394$, which is comparable to the top solutions.

This study aims to leverage state of the art language models to automate generating the "Brief Hospital Course" and "Discharge Instructions" sections of Discharge Summaries from the MIMIC-IV dataset, reducing clinicians' administrative workload. We investigate how automation can improve documentation accuracy, alleviate clinician burnout, and enhance operational efficacy in healthcare facilities. This research was conducted within our participation in the Shared Task Discharge Me! at BioNLP @ ACL 2024. Various strategies were employed, including few-shot learning, instruction tuning, and Dynamic Expert Selection (DES), to develop models capable of generating the required text sections. Notably, utilizing an additional clinical domain-specific dataset demonstrated substantial potential to enhance clinical language processing. The DES method, which optimizes the selection of text outputs from multiple predictions, proved to be especially effective. It achieved the highest overall score of 0.332 in the competition, surpassing single-model outputs. This finding suggests that advanced deep learning methods in combination with DES can effectively automate parts of electronic health record documentation. These advancements could enhance patient care by freeing clinician time for patient interactions. The integration of text selection strategies represents a promising avenue for further research.