Large language models (LLMs) have shown remarkable abilities in generating natural texts for various tasks across different domains. However, applying LLMs to clinical settings still poses significant challenges, as it requires specialized knowledge, vocabulary, as well as reliability. In this work, we propose a novel method of instruction fine-tuning for adapting LLMs to the clinical domain, which leverages the instruction-following capabilities of LLMs and the availability of diverse real-world data sources. We generate instructions, inputs, and outputs covering a wide spectrum of clinical services, from primary cares to nursing, radiology, physician, and social work, and use them to fine-tune LLMs. We evaluated the fine-tuned LLM, LlamaCare, on various clinical tasks, such as generating discharge summaries, predicting mortality and length of stay, and more. Using both automatic and human metrics, we demonstrated that LlamaCare surpasses other LLM baselines in predicting clinical outcomes and producing more accurate and coherent clinical texts. We also discuss the challenges and limitations of LLMs that need to be addressed before they can be widely adopted in clinical settings.

Large language models (LLMs) can generate natural language texts for various domains and tasks, but their potential for clinical text mining, a domain with scarce, sensitive, and imbalanced medical data, is under-explored. We investigate whether LLMs can augment clinical data for detecting Alzheimer’s Disease (AD)-related signs and symptoms from electronic health records (EHRs), a challenging task that requires high expertise. We create a novel pragmatic taxonomy for AD sign and symptom progression based on expert knowledge and generated three datasets: (1) a gold dataset annotated by human experts on longitudinal EHRs of AD patients; (2) a silver dataset created by the data-to-label method, which labels sentences from a public EHR collection with AD-related signs and symptoms; and (3) a bronze dataset created by the label-to-data method which generates sentences with AD-related signs and symptoms based on the label definition. We train a system to detect AD-related signs and symptoms from EHRs. We find that the silver and bronze datasets improves the system performance, outperforming the system using only the gold dataset. This shows that LLMs can generate synthetic clinical data for a complex task by incorporating expert knowledge, and our label-to-data method can produce datasets that are free of sensitive information, while maintaining acceptable quality.