arXiv:2607.22264cs.LG2026-07

让电子病历模型同时理解心电图、X光片等多模态数据,提升临床预测能力。

Autoregressive EHR Foundation Models with Multimodal Inputs

论文配图:Autoregressive EHR Foundation Models with Multimodal Inputs
图 1 · 摘自论文原文
  • 用压缩编码+时序对齐的交叉注意力融合多模态数据
  • 最佳压缩方案比原始序列和平均池化效果更好
  • 模型性能依赖于融合架构设计,非简单加数据就能提升

基于分词电子病历(EHR)的自回归基础模型可实现零样本临床预测,但多数仅使用结构化事件代码,未系统整合多模态信息。本文提出一种框架,通过模态专用潜在压缩与门控交叉注意力,在时序对齐基础上融合心电图波形、胸部X光片及临床笔记。研究两个关键设计:(1) 如何压缩长序列模态(如心电图时间序列)以降低计算开销并提升泛化;(2) 不同预训练编码器的选择对下游性能的影响。在MIMIC-IV上的可控消融实验表明,最优潜在压缩配置优于无压缩交叉注意力与均值池化;编码器选择具显著模态内影响,更强预训练编码器始终表现更优。进一步发现,单纯增加辅助模态并不能提升重症监护病房死亡率预测性能,说明融合架构设计与临床场景评估至关重要。

原文摘要 · Abstract (English)

Autoregressive foundation models trained on tokenized electronic health records (EHRs) can support zero-shot clinical prediction, yet most operate on structured event codes alone, and do not incorporate multiple modalities in a principled way. We present a framework for conditioning such models on auxiliary clinical modalities, including ECG waveforms, chest X-ray images, and clinical notes, using modality-specific latent compression and gated cross-attention with temporal alignment. We investigate two key design choices: (1) how to compress long per-modality sequences (e.g., ECG time series) before they enter the multi-modal cross-attention. This feature may be essential to reduce compute overheads and may be beneficial for generalization; (2) how the choice of pretrained encoder for each modality impacts downstream performance. Through controlled ablations on MIMIC-IV, we show that the best latent-compression configurations outperforms both uncompressed cross-attention and mean pooling. Encoder choice has a clear within-modality effect, with stronger pretrained encoders consistently outperforming weaker alternatives. We further show that merely adding auxiliary modalities does not guarantee improvement on ICU mortality prediction over an EHR-only baseline. This implies that careful design of the fusion architecture and an appropriate evaluation in the clinical context are required.

电子病历多模态自回归临床预测

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