Accurate diagnostic coding of medical notes is crucial for enhancing patient care, medical research, and error-free billing in healthcare organizations. Manual coding is a time-consuming task for providers, and diagnostic codes often exhibit low sensitivity and specificity, whereas the free text in medical notes can be a more precise description of a patients status. Thus, accurate automated diagnostic coding of medical notes has become critical for a learning healthcare system. Recent developments in long-document transformer architectures have enabled attention-based deep-learning models to adjudicate medical notes. In addition, contrastive loss functions have been used to jointly pre-train large language and image models with noisy labels. To further improve the automated adjudication of medical notes, we developed an approach based on i) models for ICD-10 diagnostic code sequences using a large real-world data set, ii) large language models for medical notes, and iii) contrastive pre-training to build an integrated model of both ICD-10 diagnostic codes and corresponding medical text. We demonstrate that a contrastive approach for pre-training improves performance over prior state-of-the-art models for the MIMIC-III-50, MIMIC-III-rare50, and MIMIC-III-full diagnostic coding tasks.

Heart failure is a syndrome which occurs when the heart is not able to pump blood and oxygen to support other organs in the body. Identifying the underlying themes in the diagnostic codes and procedure reports of patients admitted for heart failure could reveal the clinical phenotypes associated with heart failure and to group patients based on their similar characteristics which could also help in predicting patient outcomes like length of stay. These clinical phenotypes usually have a probabilistic latent structure and hence, as there has been no previous work on identifying phenotypes in clinical notes of heart failure patients using a probabilistic framework and to predict length of stay of these patients using data-driven artificial intelligence-based methods, we apply natural language processing technique, topic modeling, to identify the themes present in diagnostic codes and in procedure reports of 1,200 patients admitted for heart failure at the University of Illinois Hospital and Health Sciences System (UI Health). Topic modeling identified twelve themes each in diagnostic codes and procedure reports which revealed information about different phenotypes related to various perspectives about heart failure, to study patients' profiles and to discover new relationships among medical concepts. Each theme had a set of keywords and each clinical note was labeled with two themes - one corresponding to its diagnostic code and the other corresponding to its procedure reports along with their percentage contribution. We used these themes and their percentage contribution to predict length of stay. We found that the themes discovered in diagnostic codes and procedure reports using topic modeling together were able to predict length of stay of the patients with an accuracy of 61.1% and an Area under the Receiver Operating Characteristic Curve (ROC AUC) value of 0.828.

Early diagnosis of disease can lead to improved health outcomes, including higher survival rates and lower treatment costs. With the massive amount of information available in electronic health records (EHRs), there is great potential to use machine learning (ML) methods to model disease progression aimed at early prediction of disease onset and other outcomes. In this work, we employ recent innovations in neural ODEs combined with rich semantic embeddings of clinical codes to harness the full temporal information of EHRs. We propose ICE-NODE (Integration of Clinical Embeddings with Neural Ordinary Differential Equations), an architecture that temporally integrates embeddings of clinical codes and neural ODEs to learn and predict patient trajectories in EHRs. We apply our method to the publicly available MIMIC-III and MIMIC-IV datasets, and we find improved prediction results compared to state-of-the-art methods, specifically for clinical codes that are not frequently observed in EHRs. We also show that ICE-NODE is more competent at predicting certain medical conditions, like acute renal failure, pulmonary heart disease and birth-related problems, where the full temporal information could provide important information. Furthermore, ICE-NODE is also able to produce patient risk trajectories over time that can be exploited for further detailed predictions of disease evolution.

The coding of medical diagnosis and treatment has always been a challenging issue. Translating a patient's complex symptoms, and a clinician's efforts to address them, into a clear and unambiguous classification code was difficult even in simpler times. Now, however, hospitals and health insurance companies want very detailed information on what was wrong with a patient and the steps taken to treat them-- for clinical record-keeping, for hospital operations review and planning, and perhaps most importantly, for financial reimbursement purposes. The current international standard for medical coding is ICD-10 (the tenth version of International Classification of Disease codes), from the World Health Organization (WHO). ICD‑10 has over 14,000 codes for diagnoses.

Can a machine-learning algorithm detect the intimations of mortality among a group of cancer patients, telling doctors and patients who should be having conversations about the end? A particular machine-learning computer model can do so, based on the factors found in electronic health records (EHRs), according to a new paper by University of Pennsylvania School of Medicine researchers in the journal JAMA Network Open. "In this cohort study, machine learning algorithms based on structured electronic health record data accurately identified patients with cancer at risk of short-term mortality," they wrote. Of the patients flagged as being "high priority" by the machine, 51% died within a 180-day window, according to the authors. Less than 4% of the patients deemed "lower priority" died in the same time frame, according to the findings.

Though suicide is a major public health problem in the US, machine learning methods are not commonly used to predict an individual's risk of attempting/committing suicide. In the present work, starting with an anonymized collection of electronic health records for 522,056 unique, California-resident adolescents, we develop neural network models to predict suicide attempts. We frame the problem as a binary classification problem in which we use a patient's data from 2006-2009 to predict either the presence (1) or absence (0) of a suicide attempt in 2010. After addressing issues such as severely imbalanced classes and the variable length of a patient's history, we build neural networks with depths varying from two to eight hidden layers. For test set observations where we have at least five ED/hospital visits' worth of data on a patient, our depth-4 model achieves a sensitivity of 0.703, specificity of 0.980, and AUC of 0.958.