通过多视角一致性学习,从嘈杂病历标签中提取可靠临床表示。
WISTERIA: Learning Clinical Representations from Noisy Supervision via Multi-View Consistency in Electronic Health Records

- 将临床标签视为潜在状态的随机观测,构建多监督信号保持一致。
- 在多个基准上提升预测性能,且对标签噪声和跨机构数据更鲁棒。
- 适合处理标注不全、不一的医疗数据,尤其适用于真实临床场景。
电子健康记录(EHR)中的表示学习长期沿用自然语言处理范式,依赖序列建模与重构目标,并将临床标签视为真实标签。然而真实世界中的临床标注本质上是弱监督的,源于异构、噪声大且机构特异的标注过程,如费用编码、启发式表型和不完整注释。本文提出WISTERIA,一种弱监督表示学习框架,将标签视为潜在临床状态的随机观测。不以单一监督信号为优化目标,而是构建多个弱监督算子,通过强制其生成的标签分布间的一致性来学习表示。该多视角设定隐含去噪机制,使模型能通过调和不同标注者间的矛盾,恢复临床有意义的结构。进一步在标签空间引入本体感知正则化,施加语义结构。实验表明,WISTERIA在标准EHR基准上表现更优,对标签噪声更具鲁棒性,并显著优于基于序列的预训练目标,在跨机构泛化上表现更佳。结果表明,显式建模监督过程而非将标签视为固定目标,为从EHR数据中学习鲁棒、临床可解释表示提供了更合适的归纳偏置。
原文摘要 · Abstract (English)
Representation learning in electronic health records (EHR) has largely followed paradigms inherited from natural language processing, relying on sequence modeling and reconstruction based objectives that treat clinical labels as ground truth. However, real world clinical supervision is inherently weak, arising from heterogeneous, noisy, and institution specific labeling processes such as billing codes, heuristic phenotypes, and incomplete annotations. In this work, we propose WISTERIA, a weakly supervised representation learning framework that models labels as stochastic observations of an underlying latent clinical state. Instead of optimizing against a single supervision signal, WISTERIA constructs multiple weak supervision operators and learns representations by enforcing consistency across their induced label distributions. This multi view formulation induces an implicit denoising mechanism, allowing the model to recover clinically meaningful structure by reconciling disagreement between noisy labelers. We further incorporate ontology aware regularization in the label space to impose semantic structure over supervision signals. Empirically, WISTERIA improves predictive performance across standard EHR benchmarks, demonstrates strong robustness to label noise, and exhibits superior cross institutional generalization compared to sequence based pretraining objectives. These results suggest that explicitly modeling the supervision process rather than treating labels as fixed targets provides a more appropriate inductive bias for learning robust and clinically meaningful representations from EHR data.
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