README.md

---
language:
- en
license: other
pipeline_tag: text-generation
library_name: transformers
tags:
- clinical-nlp
- medical-coding
- icd10
- icd-10-cm
- reasoning
- reinforcement-learning
- grpo
- healthcare
base_model:
- Qwen/Qwen2.5-7B-Instruct
---

# DeepICD-R1-7B

## Model Summary

**DeepICD-R1-7B** is a clinical reasoning language model for **ICD-10-CM diagnosis outcome prediction from admission notes**.  
It is derived from **Qwen2.5-7B-Instruct** and trained using the **DeepICD-R1 framework**, which combines structured reasoning traces with reinforcement learning and hierarchical reward signals.

The model is designed to predict a **single ICD-10-CM diagnosis code** from clinical text while producing an interpretable reasoning trace explaining the decision.

The training methodology follows the approach described in the paper:

**DeepICD-R1: Medical Reasoning through Hierarchical Rewards and Unsupervised Distillation**

This work frames clinical diagnosis prediction as a **reasoning task optimized through reinforcement learning**.

---

# Model Details

- **Model name:** DeepICD-R1-7B  
- **Organization:** DATEXIS  
- **Base model:** Qwen2.5-7B-Instruct  
- **Parameters:** ~7B  
- **Task:** Single ICD-10-CM diagnosis prediction from admission notes  
- **Training paradigm:** Supervised reasoning + reinforcement learning  
- **Framework:** VERL RL trainer  
- **Domain:** Clinical NLP / healthcare reasoning  

The Qwen2.5-7B-Instruct architecture is a **7-billion-parameter instruction-tuned language model designed for instruction following and long-form generation tasks**. :contentReference[oaicite:1]{index=1}

---

# Intended Use

This model is intended for **research purposes**, including:

- clinical reasoning research
- ICD-10-CM coding prediction
- reinforcement learning for language models
- reasoning trace generation
- structured prediction from clinical text

### Out-of-Scope Use

This model **must not be used for**:

- medical diagnosis
- clinical decision support
- patient triage
- automated medical coding without expert supervision
- billing or compliance workflows

---

# Training Methodology

The **DeepICD-R1 framework** treats diagnosis prediction as a reasoning problem.

Training combines:

### 1. Supervised reasoning traces
A dataset of reasoning chains explaining diagnosis predictions.

### 2. Reinforcement learning optimization

Training uses **Group Relative Policy Optimization (GRPO)** to improve reasoning and prediction accuracy.

### 3. Hierarchical reward signals

Rewards are aligned with the hierarchical structure of ICD codes.

The reward function combines:

- **format reward** — correct reasoning + diagnosis structure  
- **outcome reward** — correct diagnosis prediction  
- **hierarchical reward** — partial credit for correct ICD prefixes  

This design encourages models to produce both **accurate diagnoses and structured reasoning**.

---

# Training Data

The training task uses **clinical admission notes paired with ICD-10-CM diagnosis codes**, derived from de-identified electronic health record datasets such as **MIMIC-IV**.

Task formulation:

**Input**

Clinical admission note describing patient presentation.

**Output**

Structured reasoning trace and predicted ICD-10-CM code.

---

# Output Format

The model is trained to produce structured outputs separating reasoning from the final diagnosis.

### Example

```text
<think>
The patient presents with ...
Symptoms and clinical history suggest ...
...
</think>

<diagnosis>
M5116
</diagnosis>
```
## Training Configuration

The model was trained using the **VERL reinforcement learning trainer** with **Group Relative Policy Optimization (GRPO)**, following the DeepICD-R1 training framework.

### Core Training Parameters

| Parameter | Value |
|-----------|------|
| Algorithm | GRPO |
| Training framework | VERL (`verl.trainer.main_ppo`) |
| Base model | Qwen2.5-7B-Instruct |
| Training batch size | 64 |
| PPO mini batch size | 64 |
| PPO micro batch size per GPU | 16 |
| Learning rate | 1e-6 |
| LR warmup steps | 80 |
| Total epochs | 1 |
| Max prompt length | 2048 tokens |
| Max response length | 1024 tokens |

### Rollout / Generation Settings

| Parameter | Value |
|-----------|------|
| Rollout engine | vLLM |
| Samples per prompt (`n`) | 8 |
| Temperature | 0.9 |
| Top-k | disabled |
| dtype | bfloat16 |
| Tensor parallel size | 1 |
| GPU memory utilization | 0.4 |

### Optimization Details

| Parameter | Value |
|-----------|------|
| Entropy coefficient | 0.001 |
| KL controller coefficient | 0.001 |
| KL loss | disabled |
| Gradient checkpointing | enabled |
| Torch compile | enabled |
| FSDP param offload | disabled |
| FSDP optimizer offload | disabled |

### Hardware

| Component | Value |
|-----------|------|
| GPUs | 4 |
| Nodes | 1 |
| Precision | bfloat16 |

### Reward Function

Training uses a **custom batched reward function** combining several reward signals:

- **Outcome reward** — correct ICD-10 prediction
- **Format reward** — correct `<think>` and `<diagnosis>` structure
- **Hierarchical reward** — partial credit for ICD prefix matches
- **Reasoning reward** — encourages meaningful reasoning traces
- **LLM-based reward** — optional external judge scoring

These rewards align the model toward producing **both accurate diagnoses and structured reasoning traces**.

The reasoning trace provides transparency into how the diagnosis was derived from the clinical note.

---

## Evaluation

Evaluation follows the methodology described in the **DeepICD-R1 paper**.

Performance is measured using **macro-averaged F1 scores** at multiple levels of the ICD hierarchy.

| Level | Description |
|------|-------------|
| Chapter | Broad ICD category |
| Category | First three digits |
| Full code | Complete ICD-10 code |

Hierarchical evaluation allows partial credit when the model predicts the correct high-level diagnostic category even if the full code is incorrect.

---

## Limitations

Models following the **DeepICD-R1 framework** share several limitations.

### Dataset limitations

- Training data consists primarily of **English clinical notes**
- Distribution reflects **hospital-specific patient populations**
- ICD labels are **highly imbalanced**, affecting rare diagnoses

### Model limitations

- Reasoning traces may appear convincing while being incorrect
- Predictions may fail for rare or long-tail diagnoses
- Models may demonstrate **premature diagnostic closure**
- Reinforcement learning rewards are only proxies for expert feedback

---

## Ethical Considerations

This model is trained on **de-identified clinical data** and intended strictly for research.

### Potential risks

- propagation of dataset biases  
- overconfidence in generated reasoning  
- misuse in clinical decision making  

### Appropriate safeguards

- expert oversight  
- dataset bias evaluation  
- fairness audits  
- controlled deployment environments  

---

## Hardware and Training Setup

Typical training configuration for models in this family includes:

- **GPUs:** multi-GPU training (4–8 GPUs)  
- **Precision:** bfloat16  
- **Rollout engine:** vLLM  
- **Training framework:** VERL PPO / GRPO trainer  
- **Sampling:** multiple rollouts per prompt  

---

## Usage

### Transformers Example

```python
from transformers import AutoTokenizer, AutoModelForCausalLM

model_id = "DATEXIS/DeepICD-R1-7B"

tokenizer = AutoTokenizer.from_pretrained(model_id)
model = AutoModelForCausalLM.from_pretrained(
    model_id,
    device_map="auto",
    torch_dtype="auto"
)

prompt = """
You are a clinical reasoning model.

Given the following admission note,
produce reasoning in <think> tags
and a final ICD-10 diagnosis in <diagnosis> tags.

[ADMISSION NOTE]
"""

inputs = tokenizer(prompt, return_tensors="pt").to(model.device)

outputs = model.generate(
    **inputs,
    max_new_tokens=512
)

print(tokenizer.decode(outputs[0], skip_special_tokens=True))
```
## Recommended Inference Practices

- Use prompts consistent with the training format.
- Validate predicted ICD-10 codes against official code formats.
- Always review predictions with medical experts.
- Avoid exposing reasoning traces in safety-critical settings without verification.

---

## Citation

If you use this model, please cite:

```bibtex
@inproceedings{roehr2026deepicdr1,
  title={DeepICD-R1: Medical Reasoning through Hierarchical Rewards and Unsupervised Distillation},
  author={R{\"o}hr, Tom and Steffek, Thomas and Teucher, Roman and Bressem, Keno and others},
  booktitle={Proceedings of LREC-COLING},
  year={2026}
}