Clinical note generation aims to produce free-text summaries of a patient's condition and diagnostic process, with discharge instructions being a representative long-form example. While recent LLM-based methods pre-trained on general clinical corpora show promise in clinical text generation, they fall short in producing long-form notes from limited patient information. In this paper, we propose ReinRAG, a reinforced reasoning augmented generation (RAG) for long-form discharge instructions based on pre-admission information. ReinRAG retrieves reasoning paths from a medical knowledge graph to provide explicit semantic guidance to the LLM. To bridge the information gap, we propose group-based retriever optimization (GRO) which improves retrieval quality with group-normalized rewards, encouraging reasoning leaps for deeper inference by the LLM. Comprehensive experiments on the real-world dataset show that ReinRAG outperforms baselines in both clinical efficacy and natural language generation metrics. Further analysis reveals that ReinRAG fills semantic gaps in sparse input scenarios, and retrieved reasoning paths help LLMs avoid clinical misinterpretation by focusing on key evidence and following coherent reasoning.

Large Language Models (LLMs) have demonstrated impressive capabilities in role-playing scenarios, particularly in simulating domain-specific experts using tailored prompts. This ability enables LLMs to adopt the persona of individuals with specific backgrounds, offering a cost-effective and efficient alternative to traditional, resource-intensive user studies. By mimicking human behavior, LLMs can anticipate responses based on concrete demographic or professional profiles. In this paper, we evaluate the effectiveness of LLMs in simulating individuals with diverse backgrounds and analyze the consistency of these simulated behaviors compared to real-world outcomes. In particular, we explore the potential of LLMs to interpret and respond to discharge summaries provided to patients leaving the Intensive Care Unit (ICU). We evaluate and compare with human responses the comprehensibility of discharge summaries among individuals with varying educational backgrounds, using this analysis to assess the strengths and limitations of LLM-driven simulations. Notably, when LLMs are primed with educational background information, they deliver accurate and actionable medical guidance 88% of the time. However, when other information is provided, performance significantly drops, falling below random chance levels. This preliminary study shows the potential benefits and pitfalls of automatically generating patient-specific health information from diverse populations. While LLMs show promise in simulating health personas, our results highlight critical gaps that must be addressed before they can be reliably used in clinical settings. Our findings suggest that a straightforward query-response model could outperform a more tailored approach in delivering health information. This is a crucial first step in understanding how LLMs can be optimized for personalized health communication while maintaining accuracy.

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.

Clinical documentation is an important aspect of clinicians' daily work and often demands a significant amount of time. The BioNLP 2024 Shared Task on Streamlining Discharge Documentation (Discharge Me!) aims to alleviate this documentation burden by automatically generating discharge summary sections, including brief hospital course and discharge instruction, which are often time-consuming to synthesize and write manually. We approach the generation task by fine-tuning multiple open-sourced language models (LMs), including both decoder-only and encoder-decoder LMs, with various configurations on input context. We also examine different setups for decoding algorithms, model ensembling or merging, and model specialization. Our results show that conditioning on the content of discharge summary prior to the target sections is effective for the generation task. Furthermore, we find that smaller encoder-decoder LMs can work as well or even slightly better than larger decoder based LMs fine-tuned through LoRA. The model checkpoints from our team (aehrc) are openly available.

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.

Large language models have shown success as a tutor in education in various fields. Educating patients about their clinical visits plays a pivotal role in patients' adherence to their treatment plans post-discharge. This paper presents EHRTutor, an innovative multi-component framework leveraging the Large Language Model (LLM) for patient education through conversational question-answering. EHRTutor first formulates questions pertaining to the electronic health record discharge instructions. It then educates the patient through conversation by administering each question as a test. Finally, it generates a summary at the end of the conversation. Evaluation results using LLMs and domain experts have shown a clear preference for EHRTutor over the baseline. Moreover, EHRTutor also offers a framework for generating synthetic patient education dialogues that can be used for future in-house system training.

Patient portal allows discharged patients to access their personalized discharge instructions in electronic health records (EHRs). However, many patients have difficulty understanding or memorizing their discharge instructions. In this paper, we present PaniniQA, a patient-centric interactive question answering system designed to help patients understand their discharge instructions. PaniniQA first identifies important clinical content from patients' discharge instructions and then formulates patient-specific educational questions. In addition, PaniniQA is also equipped with answer verification functionality to provide timely feedback to correct patients' misunderstandings. Our comprehensive automatic and human evaluation results demonstrate our PaniniQA is capable of improving patients' mastery of their medical instructions through effective interactions