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How Robust is Your Automatic Diagnosis Model?
Abstract
Automatic diagnosis based on clinical notes has become a popular research field recently, and many proposed deep learning models have achieved competitive performance in diseases inference. However, previous research reveals that deep learning models are susceptible to negligibly perturbed inputs named adversarial examples, which contradicts with the safety and reliability requirements of the medical domain. To analyze the vulnerability and robustness of current automatic diagnosis models, we investigate in the generation of adversarial text examples. The main challenges for generating adversarial text examples are divided into three parts. First, the word embedding space is discrete, which makes it hard to perturb as small as adversarial image examples generation. Second, previous adversarial example generation methods focus mainly on multi-class classification models, while automatic diagnosis is a multi-label classification task. Third, the semantic and medical meaning of clinical notes are vital in disease inference, and even small perturbations can change them to a large extent. In this paper, we address the three main challenges and propose Clinical-Attacker, a general framework for both white-box and black-box adversarial text examples generation against automatic diagnosis models. Experimental results on MIMIC-III dataset demonstrate that our framework can easily alter the predictions of automatic diagnosis models with the semantic and medical meaning preserved.
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Only one study addressed adversarial attacks for clinical notes by applying transformations such as medical concept substitution, word replacement, or adverb removal.
“Only one study addressed adversarial attacks for clinical notes by applying transformations such as medical concept substitution, word replacement, or adverb removal30.”
From A scoping review of robustness concepts for machine learning in healthcare (2025) · cites this paper as [30]
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Research works printed but not linked: 25
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A scoping review of robustness concepts for machine learning in healthcare
Balendran, A., Beji, C., Bouvier, F., Khalifa, O., Evgeniou, T., Ravaud, P., & Porcher, R. (2025) · npj Digital Medicine · doi:10.1038/s41746-024-01420-1 · Cited by 43
“Only one study addressed adversarial attacks for clinical notes by applying transformations such as medical concept substitution, word replacement, or adverb removal 30 .”
Metadata
- Authors
- Wang, K., Wang, G., Chen, N., & Chen, T.
- Affiliations
- Beijing National Research Center for Information Science and Technology (CN)
- Venue
- 2019 IEEE International Conference on Bioinformatics and Biomedicine (BIBM)
- Publisher
- IEEE
- Published
- 2019-11
- Pages
- 877-884
- OpenAlex
- W3004458411
- Cited by
- 3
- References
- 0
- Citations by year
- 2025: 1 · 2023: 1 · 2021: 1
- FWCI
- 0.10
- Type
- conference paper
- Language
- en
- Open access
- closed
- Locations
- IEEE International Conference on Bioinformatics and Biomedicine (BIBM) (publishedVersion)
- Topics
- Physical Sciences › Computer Science › Artificial Intelligence › Adversarial Robustness in Machine Learning
- Physical Sciences › Computer Science › Artificial Intelligence › Machine Learning in Healthcare
- Physical Sciences › Computer Science › Artificial Intelligence › Privacy-Preserving Technologies in Data
- Keywords
- adversarial examples, adversarial text generation, automated diagnosis, clinical notes, model robustness, multi-label classification, word embeddings, white-box and black-box attacks, MIMIC-III
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