Ramakanth Kavuluru@BioNLProc
Ramakanth Kavuluru
RT @AI4Pathology: Can an EHR model trained at one hospital read another hospital's records?
Excited to introduce our new paper, "Discrete Neural Interlingua for Ontology-Agnostic EHR Modeling," accepted at NeurIPS 2026. See you in Sydney 🦘🏖️!
Paper:
Code:
Model:
Video: See👇
The same clinical concept can be an ICD code, a SNOMED term, a local identifier, or free text, and standard EHR tokenizers treat each one as an unrelated symbol. A model trained on MIMIC-III with a closed vocabulary can use only 13% of eICU events. It isn't only a cross-hospital problem. For example, inside one hospital, "acute kidney injury" can be a billing code, a flowsheet identifier, and free text in a note, and the vocabulary shifts again with every coding transition and EHR migration. The redundancy is there before a model ever leaves the building.
MEDIATOR is a discrete, ontology-agnostic tokenizer. Any clinical concept written as text maps to one of 100,000 shared tokens, so "acute kidney failure" (ICD-9), "AKI" (a local code), and "acute kidney injury" (free text) become the same token. It is trained on cross-ontology synonyms from UMLS and guided by LLM-enriched descriptions, code co-occurrence, and a medical relation graph. It is a drop-in token interface for standard EHR Transformers: no manual code mapping, and new code systems can be tokenized without retraining.
Main results:
• In-domain: +4.0 AUPRC points (8% relative) over SOTA, across 20 MIMIC-III tasks. Merging within-dataset redundancy pays off before you transfer anything.
• Zero-shot transfer: on eICU with no vocabulary alignment, MEDIATOR uses all 3.58 million events and improves AUPRC over MedTok by 8.6 points (29% relative) across 14 tasks, up to +21.2 on subarachnoid hemorrhage. Restricted to the same inputs as the closed-vocabulary baselines, it is still the best tokenizer.
• Transferable attribution: one shared token space means attributions compare directly across hospitals. For cirrhosis mortality, token importance is rank-correlated between MIMIC-III and eICU at Spearman ρ = 0.92.
Tokenizing a dataset's entire vocabulary is a one-time step of about 70 seconds on one GPU. Code and weights are public, and the co-occurrence teacher can be rebuilt from public data with near-identical results.
Congradulations to Caiwei Tian Tong Ding and everyone else.
#NeurIPS2026 #ClinicalInformatics #EHR #MachineLearning
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