There is an increasing interest in developing artificial intelligence (AI) systems to process and interpret electronic health records (EHRs). Natural language processing (NLP) powered by pretrained language models is the key technology for medical AI systems utilizing clinical narratives. However, there are few clinical language models, the largest of which trained in the clinical domain is comparatively small at 110 million parameters (compared with billions of parameters in the general domain). It is not clear how large clinical language models with billions of parameters can help medical AI systems utilize unstructured EHRs. In this study, we develop from scratch a large clinical language model—GatorTron—using >90 billion words of text (including >82 billion words of de-identified clinical text) and systematically evaluate it on five clinical NLP tasks including clinical concept extraction, medical relation extraction, semantic textual similarity, natural language inference (NLI), and medical question answering (MQA). We examine how (1) scaling up the number of parameters and (2) scaling up the size of the training data could benefit these NLP tasks. GatorTron models scale up the clinical language model from 110 million to 8.9 billion parameters and improve five clinical NLP tasks (e.g., 9.6% and 9.5% improvement in accuracy for NLI and MQA), which can be applied to medical AI systems to improve healthcare delivery. The GatorTron models are publicly available at:https://catalog.ngc.nvidia.com/orgs/nvidia/teams/clara/models/gatortron_og.

There are enormous enthusiasm and concerns in applying large language models (LLMs) to healthcare. Yet current assumptions are based on general-purpose LLMs such as ChatGPT, which are not developed for medical use. This study develops a generative clinical LLM, GatorTronGPT, using 277 billion words of text including (1) 82 billion words of clinical text from 126 clinical departments and approximately 2 million patients at the University of Florida Health and (2) 195 billion words of diverse general English text. We train GatorTronGPT using a GPT-3 architecture with up to 20 billion parameters and evaluate its utility for biomedical natural language processing (NLP) and healthcare text generation. GatorTronGPT improves biomedical natural language processing. We apply GatorTronGPT to generate 20 billion words of synthetic text. Synthetic NLP models trained using synthetic text generated by GatorTronGPT outperform models trained using real-world clinical text. Physicians’ Turing test using 1 (worst) to 9 (best) scale shows that there are no significant differences in linguistic readability (p = 0.22; 6.57 of GatorTronGPT compared with 6.93 of human) and clinical relevance (p = 0.91; 7.0 of GatorTronGPT compared with 6.97 of human) and that physicians cannot differentiate them (p < 0.001). This study provides insights into the opportunities and challenges of LLMs for medical research and healthcare.

Scaling up deep neural network capacity has been known as an effective approach to improving model quality for several different machine learning tasks. In many cases, increasing model capacity beyond the memory limit of a single accelerator has required developing special algorithms or infrastructure. These solutions are often architecture-specific and do not transfer to other tasks. To address the need for efficient and task-independent model parallelism, we introduce GPipe, a pipeline parallelism library that allows scaling any network that can be expressed as a sequence of layers. By pipelining different sub-sequences of layers on separate accelerators, GPipe provides the flexibility of scaling a variety of different networks to gigantic sizes efficiently. Moreover, GPipe utilizes a novel batch-splitting pipelining algorithm, resulting in almost linear speedup when a model is partitioned across multiple accelerators. We demonstrate the advantages of GPipe by training large-scale neural networks on two different tasks with distinct network architectures: (i) Image Classification: We train a 557-million-parameter AmoebaNet model and attain a top-1 accuracy of 84.4% on ImageNet-2012, (ii) Multilingual Neural Machine Translation: We train a single 6-billion-parameter, 128-layer Transformer model on a corpus spanning over 100 languages and achieve better quality than all bilingual models.

Objective: The goal of this study is to explore transformer-based models (eg, Bidirectional Encoder Representations from Transformers [BERT]) for clinical concept extraction and develop an open-source package with pretrained clinical models to facilitate concept extraction and other downstream natural language processing (NLP) tasks in the medical domain. Methods: We systematically explored 4 widely used transformer-based architectures, including BERT, RoBERTa, ALBERT, and ELECTRA, for extracting various types of clinical concepts using 3 public datasets from the 2010 and 2012 i2b2 challenges and the 2018 n2c2 challenge. We examined general transformer models pretrained using general English corpora as well as clinical transformer models pretrained using a clinical corpus and compared them with a long short-term memory conditional random fields (LSTM-CRFs) mode as a baseline. Furthermore, we integrated the 4 clinical transformer-based models into an open-source package. Results and Conclusion: The RoBERTa-MIMIC model achieved state-of-the-art performance on 3 public clinical concept extraction datasets with F1-scores of 0.8994, 0.8053, and 0.8907, respectively. Compared to the baseline LSTM-CRFs model, RoBERTa-MIMIC remarkably improved the F1-score by approximately 4% and 6% on the 2010 and 2012 i2b2 datasets. This study demonstrated the efficiency of transformer-based models for clinical concept extraction. Our methods and systems can be applied to other clinical tasks. The clinical transformer package with 4 pretrained clinical models is publicly available at https://github.com/uf-hobi-informatics-lab/ClinicalTransformerNER. We believe this package will improve current practice on clinical concept extraction and other tasks in the medical domain.

Neural Machine Translation (NMT) is an end-to-end learning approach for automated translation, with the potential to overcome many of the weaknesses of conventional phrase-based translation systems. Unfortunately, NMT systems are known to be computationally expensive both in training and in translation inference. Also, most NMT systems have difficulty with rare words. These issues have hindered NMT's use in practical deployments and services, where both accuracy and speed are essential. In this work, we present GNMT, Google's Neural Machine Translation system, which attempts to address many of these issues. Our model consists of a deep LSTM network with 8 encoder and 8 decoder layers using attention and residual connections. To improve parallelism and therefore decrease training time, our attention mechanism connects the bottom layer of the decoder to the top layer of the encoder. To accelerate the final translation speed, we employ low-precision arithmetic during inference computations. To improve handling of rare words, we divide words into a limited set of common sub-word units ("wordpieces") for both input and output. This method provides a good balance between the flexibility of "character"-delimited models and the efficiency of "word"-delimited models, naturally handles translation of rare words, and ultimately improves the overall accuracy of the system. Our beam search technique employs a length-normalization procedure and uses a coverage penalty, which encourages generation of an output sentence that is most likely to cover all the words in the source sentence. On the WMT'14 English-to-French and English-to-German benchmarks, GNMT achieves competitive results to state-of-the-art. Using a human side-by-side evaluation on a set of isolated simple sentences, it reduces translation errors by an average of 60% compared to Google's phrase-based production system.