Automatic medical coding has the potential to ease documentation and billing processes. For this task, transparency plays an important role for medical coders and regulatory bodies, which can be achieved using explainability methods. However, the evaluation of these approaches has been mostly limited to short text and binary settings due to a scarcity of annotated data. Recent efforts by Cheng et al. (2023) have introduced the MDACE dataset, which provides a valuable resource containing code evidence in clinical records. In this work, we conduct an in-depth analysis of the MDACE dataset and perform plausibility evaluation of current explainable medical coding systems from an applied perspective. With this, we contribute to a deeper understanding of automatic medical coding and evidence extraction. Our findings reveal that ground truth evidence aligns with code descriptions to a certain degree. An investigation into state-of-the-art approaches shows a high overlap with ground truth evidence. We propose match measures and highlight success and failure cases. Based on our findings, we provide recommendations for developing and evaluating explainable medical coding systems.

Electronic healthcare records are vital for patient safety as they document conditions, plans, and procedures in both free text and medical codes. Language models have significantly enhanced the processing of such records, streamlining workflows and reducing manual data entry, thereby saving healthcare providers significant resources. However, the black-box nature of these models often leaves healthcare professionals hesitant to trust them. State-of-the-art explainability methods increase model transparency but rely on human-annotated evidence spans, which are costly. In this study, we propose an approach to produce plausible and faithful explanations without needing such annotations. We demonstrate on the automated medical coding task that adversarial robustness training improves explanation plausibility and introduce AttInGrad, a new explanation method superior to previous ones. By combining both contributions in a fully unsupervised setup, we produce explanations of comparable quality, or better, to that of a supervised approach. We release our code and model weights.

Existing Machine Learning approaches for local citation recommendation directly map or translate a query, which is typically a claim or an entity mention, to citation-worthy research papers. Within such a formulation, it is challenging to pinpoint why one should cite a specific research paper for a particular query, leading to limited recommendation interpretability. To alleviate this, we introduce the evidence-grounded local citation recommendation task, where the target latent space comprises evidence spans for recommending specific papers. Using a distantly-supervised evidence retrieval and multi-step re-ranking framework, our proposed system, ILCiteR, recommends papers to cite for a query grounded on similar evidence spans extracted from the existing research literature. Unlike past formulations that simply output recommendations, ILCiteR retrieves ranked lists of evidence span and recommended paper pairs. Secondly, previously proposed neural models for citation recommendation require expensive training on massive labeled data, ideally after every significant update to the pool of candidate papers. In contrast, ILCiteR relies solely on distant supervision from a dynamic evidence database and pre-trained Transformer-based Language Models without any model training. We contribute a novel dataset for the evidence-grounded local citation recommendation task and demonstrate the efficacy of our proposed conditional neural rank-ensembling approach for re-ranking evidence spans.

We introduce a dataset for evidence/rationale extraction on an extreme multi-label classification task over long medical documents. One such task is Computer-Assisted Coding (CAC) which has improved significantly in recent years, thanks to advances in machine learning technologies. Yet simply predicting a set of final codes for a patient encounter is insufficient as CAC systems are required to provide supporting textual evidence to justify the billing codes. A model able to produce accurate and reliable supporting evidence for each code would be a tremendous benefit. However, a human annotated code evidence corpus is extremely difficult to create because it requires specialized knowledge. In this paper, we introduce MDACE, the first publicly available code evidence dataset, which is built on a subset of the MIMIC-III clinical records. The dataset -- annotated by professional medical coders -- consists of 302 Inpatient charts with 3,934 evidence spans and 52 Profee charts with 5,563 evidence spans. We implemented several evidence extraction methods based on the EffectiveCAN model (Liu et al., 2021) to establish baseline performance on this dataset. MDACE can be used to evaluate code evidence extraction methods for CAC systems, as well as the accuracy and interpretability of deep learning models for multi-label classification. We believe that the release of MDACE will greatly improve the understanding and application of deep learning technologies for medical coding and document classification.

Reviewing contracts is a time-consuming procedure that incurs large expenses to companies and social inequality to those who cannot afford it. In this work, we propose "document-level natural language inference (NLI) for contracts", a novel, real-world application of NLI that addresses such problems. In this task, a system is given a set of hypotheses (such as "Some obligations of Agreement may survive termination.") and a contract, and it is asked to classify whether each hypothesis is "entailed by", "contradicting to" or "not mentioned by" (neutral to) the contract as well as identifying "evidence" for the decision as spans in the contract. We annotated and release the largest corpus to date consisting of 607 annotated contracts. We then show that existing models fail badly on our task and introduce a strong baseline, which (1) models evidence identification as multi-label classification over spans instead of trying to predict start and end tokens, and (2) employs more sophisticated context segmentation for dealing with long documents. We also show that linguistic characteristics of contracts, such as negations by exceptions, are contributing to the difficulty of this task and that there is much room for improvement.

Achieving human-level performance on some of Machine Reading Comprehension (MRC) datasets is no longer challenging with the help of powerful Pre-trained Language Models (PLMs). However, it is necessary to provide both answer prediction and its explanation to further improve the MRC system's reliability, especially for real-life applications. In this paper, we propose a new benchmark called ExpMRC for evaluating the explainability of the MRC systems. ExpMRC contains four subsets, including SQuAD, CMRC 2018, RACE$^+$, and C$^3$ with additional annotations of the answer's evidence. The MRC systems are required to give not only the correct answer but also its explanation. We use state-of-the-art pre-trained language models to build baseline systems and adopt various unsupervised approaches to extract evidence without a human-annotated training set. The experimental results show that these models are still far from human performance, suggesting that the ExpMRC is challenging. Resources will be available through https://github.com/ymcui/expmrc

Textbook Question Answering (TQA) is a task that one should answer a diagram/non-diagram question given a large multi-modal context consisting of abundant essays and diagrams. We argue that the explainability of this task should place students as a key aspect to be considered. To address this issue, we devise a novel architecture towards span-level eXplanations of the TQA (XTQA) based on our proposed coarse-to-fine grained algorithm, which can provide not only the answers but also the span-level evidences to choose them for students. This algorithm first coarsely chooses top $M$ paragraphs relevant to questions using the TF-IDF method, and then chooses top $K$ evidence spans finely from all candidate spans within these paragraphs by computing the information gain of each span to questions. Experimental results shows that XTQA significantly improves the state-of-the-art performance compared with baselines. The source code is available at https://github.com/keep-smile-001/opentqa