Prediction of medical codes from clinical notes is both a practical and essential need for every healthcare delivery organization within current medical systems. Automating annotation will save significant time and excessive effort spent by human coders today. However, the biggest challenge is directly identifying appropriate medical codes out of several thousands of high-dimensional codes from unstructured free-text clinical notes. In the past three years, with Convolutional Neural Networks (CNN) and Long Short-Term Memory (LTSM) networks, there have been vast improvements in tackling the most challenging benchmark of the MIMIC-III-full-label inpatient clinical notes dataset. This progress raises the fundamental question of how far automated machine learning (ML) systems are from human coders' working performance. We assessed the baseline of human coders' performance on the same subsampled testing set. We also present our Read, Attend, and Code (RAC) model for learning the medical code assignment mappings. By connecting convolved embeddings with self-attention and code-title guided attention modules, combined with sentence permutation-based data augmentations and stochastic weight averaging training, RAC establishes a new state of the art (SOTA), considerably outperforming the current best Macro-F1 by 18.7%, and reaches past the human-level coding baseline. This new milestone marks a meaningful step toward fully autonomous medical coding (AMC) in machines reaching parity with human coders' performance in medical code prediction.
ICD coding from electronic clinical records is a manual, time-consuming and expensive process. Code assignment is, however, an important task for billing purposes and database organization. While many works have studied the problem of automated ICD coding from free text using machine learning techniques, most use records in the English language, especially from the MIMIC-III public dataset. This work presents results for a dataset with Brazilian Portuguese clinical notes. We develop and optimize a Logistic Regression model, a Convolutional Neural Network (CNN), a Gated Recurrent Unit Neural Network and a CNN with Attention (CNN-Att) for prediction of diagnosis ICD codes. We also report our results for the MIMIC-III dataset, which outperform previous work among models of the same families, as well as the state of the art. Compared to MIMIC-III, the Brazilian Portuguese dataset contains far fewer words per document, when only discharge summaries are used. We experiment concatenating additional documents available in this dataset, achieving a great boost in performance. The CNN-Att model achieves the best results on both datasets, with micro-averaged F1 score of 0.537 on MIMIC-III and 0.485 on our dataset with additional documents.
In multi-label text classification, each textual document can be assigned with one or more labels. Due to this nature, the multi-label text classification task is often considered to be more challenging compared to the binary or multi-class text classification problems. As an important task with broad applications in biomedicine such as assigning diagnosis codes, a number of different computational methods (e.g. training and combining binary classifiers for each label) have been proposed in recent years. However, many suffered from modest accuracy and efficiency, with only limited success in practical use. We propose ML-Net, a novel deep learning framework, for multi-label classification of biomedical texts. As an end-to-end system, ML-Net combines a label prediction network with an automated label count prediction mechanism to output an optimal set of labels by leveraging both predicted confidence score of each label and the contextual information in the target document. We evaluate ML-Net on three independent, publicly-available corpora in two kinds of text genres: biomedical literature and clinical notes. For evaluation, example-based measures such as precision, recall and f-measure are used. ML-Net is compared with several competitive machine learning baseline models. Our benchmarking results show that ML-Net compares favorably to the state-of-the-art methods in multi-label classification of biomedical texts. ML-NET is also shown to be robust when evaluated on different text genres in biomedicine. Unlike traditional machine learning methods, ML-Net does not require human efforts in feature engineering and is highly efficient and scalable approach to tasks with a large set of labels (no need to build individual classifiers for each separate label). Finally, ML-NET is able to dynamically estimate the label count based on the document context in a more systematic and accurate manner.
Background and Objective: Code assignment is of paramount importance in many levels in modern hospitals, from ensuring accurate billing process to creating a valid record of patient care history. However, the coding process is tedious and subjective, and it requires medical coders with extensive training. This study aims to evaluate the performance of deep-learning-based systems to automatically map clinical notes to ICD-9 medical codes. Methods: The evaluations of this research are focused on end-to-end learning methods without manually defined rules. Traditional machine learning algorithms, as well as state-of-the-art deep learning methods such as Recurrent Neural Networks and Convolution Neural Networks, were applied to the Medical Information Mart for Intensive Care (MIMIC-III) dataset. An extensive number of experiments was applied to different settings of the tested algorithm. Results: Findings showed that the deep learning-based methods outperformed other conventional machine learning methods. From our assessment, the best models could predict the top 10 ICD-9 codes with 0.6957 F1 and 0.8967 accuracy and could estimate the top 10 ICD-9 categories with 0.7233 F1 and 0.8588 accuracy. Our implementation also outperformed existing work under certain evaluation metrics. Conclusion: A set of standard metrics was utilized in assessing the performance of ICD-9 code assignment on MIMIC-III dataset. All the developed evaluation tools and resources are available online, which can be used as a baseline for further research.