Coding Electronic Health Records with Adversarial Reinforcement Path Generation
Bibliographic record
Abstract
Electronic Health Record (EHR) coding is the task of assigning one or more International Classification of Diseases (ICD) codes to every EHR. Most previous work either ignores the hierarchical nature of the ICD codes or only focuses on parent-child relations. Moreover, existing EHR coding methods predict ICD codes from the leaf level with the greatest ICD number and the most fine-grained categories, which makes it difficult for models to make correct decisions. In order to address these problems, we model EHR coding as a path generation task. For this approach, we need to address two main challenges: (1) How to model relations between EHR and ICD codes, and relations between ICD codes? (2) How to evaluate the quality of generated ICD paths in order to obtain a signal that can be used to supervise the learning? We propose a coarse-to-fine ICD path generation framework, named Reinforcement Path Generation Network (RPGNet), that implements EHR coding with a Path Generator (PG) and a Path Discriminator (PD). We address challenge (1) by introducing a Path Message Passing (PMP) module in the PG to encode three types of relation: between EHRs and ICD codes, between parent-child ICD codes, and between sibling ICD codes. To address challgenge (2), we propose a PD component that estimates the reward for each ICD code in a generated path. RPGNet is trained with Reinforcement Learning (RL) in an adversarial manner. Experiments on the MIMIC-III benchmark dataset show that RPGNet significantly outperforms state-of-the-art methods in terms of micro-averaged F1 and micro-averaged AUC.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".