Multi-step Transfer Learning in Natural Language Processing for the Health Domain

The restricted access to data in healthcare facilities due to patient privacy and confidentiality policies has led to the application of general natural language processing (NLP) techniques advancing relatively slowly in the health domain. Additionally, because clinical data is unique to various institutions and laboratories, there are not enough standards and conventions for data annotation. In places without robust death registration systems, the cause of death (COD) is determined through a verbal autopsy (VA) report. A non-clinician field agent completes a VA report using a set of standardized questions as guide to identify the symptoms of a COD. The narrative text of the VA report is used as a case study to examine the difficulties of applying NLP techniques to the healthcare domain. This paper presents a framework that leverages knowledge across multiple domains via two domain adaptation techniques: feature extraction and fine-tuning. These techniques aim to improve VA text representations for COD classification tasks in the health domain. The framework is motivated by multi-step learning, where a final learning task is realized via a sequence of intermediate learning tasks. The framework builds upon the strengths of the Bidirectional Encoder Representations from Transformers (BERT) and Embeddings from Language Models (ELMo) models pretrained on the general English and biomedical domains. These models are employed to extract features from the VA narratives. Our results demonstrate improved performance when initializing the learning of BERT embeddings with ELMo embeddings. The benefit of incorporating character-level information for learning word embeddings in the English domain, coupled with word-level information for learning word embeddings in the biomedical domain, is also evident.