Prediction of medical codes from clinical notes is a practical and essential need for every healthcare delivery organization within current medical systems. Automating annotation will save significant time and excessive effort that human coders spend today. However, the biggest challenge is directly identifying appropriate medical codes from several thousands of high-dimensional codes from unstructured free-text clinical notes. This complex medical codes prediction problem from clinical notes has received substantial interest in the NLP community, and several recent studies have shown the state-of-the-art code prediction results of full-fledged deep learning-based methods. This progress raises the fundamental question of how far automated machine learning systems are from human coders' working performance, as well as the important question of how well current explainability methods apply to advanced neural network models such as transformers. This is to predict correct codes and present references in clinical notes that support code prediction, as this level of explainability and accuracy of the prediction outcomes is critical to gaining trust from professional medical coders.
The medical codes prediction problem from clinical notes has received substantial interest in the NLP community, and several recent studies have shown the state-of-the-art (SOTA) code prediction results of full-fledged deep learning-based methods. However, most previous SOTA works based on deep learning are still in early stages in terms of providing textual references and explanations of the predicted codes, despite the fact that this level of explainability of the prediction outcomes is critical to gaining trust from professional medical coders. This raises the important question of how well current explainability methods apply to advanced neural network models such as transformers to predict correct codes and present references in clinical notes that support code prediction. First, we present an explainable Read, Attend, and Code (xRAC) framework and assess two approaches, attention score-based xRAC-ATTN and model-agnostic knowledge-distillation-based xRAC-KD, through simplified but thorough human-grounded evaluations with SOTA transformer-based model, RAC. We find that the supporting evidence text highlighted by xRAC-ATTN is of higher quality than xRAC-KD whereas xRAC-KD has potential advantages in production deployment scenarios. More importantly, we show for the first time that, given the current state of explainability methodologies, using the SOTA medical codes prediction system still requires the expertise and competencies of professional coders, even though its prediction accuracy is superior to that of human coders. This, we believe, is a very meaningful step toward developing explainable and accurate machine learning systems for fully autonomous medical code prediction from clinical notes.
Method: We develop CNN-based methods for automatic ICD coding based on clinical text from intensive care unit (ICU) stays. We come up with the Shallow and Wide Attention convolutional Mechanism (SWAM), which allows our model to learn local and low-level features for each label. The key idea behind our model design is to look for the presence of informative snippets in the clinical text that correlated with each code, and we infer that there exists a correspondence between "informative snippet" and convolution filter. Results: We evaluate our approach on MIMIC-III, an open-access dataset of ICU medical records. Our approach substantially outperforms previous results on top-50 medical code prediction on MIMIC-III dataset. We attribute this improvement to SWAM, by which the wide architecture gives the model ability to more extensively learn the unique features of different codes, and we prove it by ablation experiment. Besides, we perform manual analysis of the performance imbalance between different codes, and preliminary conclude the characteristics that determine the difficulty of learning specific codes. Conclusions: We present SWAM, an explainable CNN approach for multi-label document classification, which employs a wide convolution layer to learn local and low-level features for each label, yields strong improvements over previous metrics on the ICD-9 code prediction task, while providing satisfactory explanations for its internal mechanics.