Explainable clinical decision support from text

Abstract

Clinical prediction models often use structured variables and provide outcomes that are not readily interpretable by clinicians. Further, free-text medical notes may contain information not immediately available in structured variables. We propose a hierarchical CNN-transformer model with explicit attention as an interpretable, multi-task clinical language model, which achieves an AUROC of 0.75 and 0.78 on sepsis and mortality prediction on the English MIMIC-III dataset, respectively. We also explore the relationships between learned features from structured and unstructured variables using projection-weighted canonical correlation analysis. Finally, we outline a protocol to evaluate model usability in a clinical decision support context. From domain-expert evaluations, our model generates informative rationales that have promising real-life applications.