Organizations: University of Texas at Austin · Technion-IIT · Johns Hopkins University
Abstract
Multimodal irregular time series (MITS) consist of asynchronous and irregularly sampled observations from heterogeneous numerical and textual channels. In healthcare, for example, patients' electronic health records (EHR) include irregular lab measurements and clinical notes. The irregular timing and channel patterns of observations carry predictive signal alongside the numerical values and textual content. LLMs are natural candidates for processing such heterogeneous data, given their extensive pretrained knowledge spanning textual and numerical domains. We introduce MILM (Multimodal Irregular time series Language Model), which represents MITS as time-ordered triplets in Extensible Markup Language (XML) format and fine-tunes an LLM through a two-stage strategy for MITS classification. The first stage trains on value-redacted MITS to predict from sampling patterns alone, and the second stage trains on full MITS to jointly model sampling patterns and observed values. Our two-stage model (MILM-2S) and its single-stage counterpart (MILM-Direct) achieve the best and second-best average performance on multiple EHR datasets. Further value redaction evaluations confirm that sampling patterns carry predictive signal and that MILM-2S learns to exploit them. In the value pending evaluation we introduce, where some values are unavailable at prediction time, MILM-2S outperforms MILM-Direct by a larger margin compared to standard evaluation. For MILM-2S, preserving the time and channel of value-pending observations as additional sampling information further improves in-hospital mortality prediction.
Feature engineering for Electronic Health Records (EHR) is complicated by irregular observation intervals, variable measurement frequencies, and structural sparsity inherent to clinical time series. Existing automated methods either lack clinical domain awareness or assume clean, regularly sampled inputs, limiting their applicability to real-world EHR data. We present \textbf{FeatEHR-LLM}, a framework that leverages Large Language Models (LLMs) to generate clinically meaningful tabular features from irregularly sampled EHR time series. To limit patient privacy exposure, the LLM operates exclusively on dataset schemas and task descriptions rather than raw patient records. A tool-augmented generation mechanism equips the LLM with specialized routines for querying irregular temporal data, enabling it to produce executable feature-extraction code that explicitly handles uneven observation patterns and informative sparsity. FeatEHR-LLM supports both univariate and multivariate feature generation through an iterative, validation-in-the-loop pipeline. Evaluated on eight clinical prediction tasks across four ICU datasets, our framework achieves the highest mean AUROC on 7 out of 8 tasks, with improvements of up to 6 percentage points over strong baselines. Code is available at github.com/hojjatkarami/FeatEHR-LLM.
Hojjat Karami, David Atienza, Jean-Philippe Thiran +1
Question answering (QA) over irregular clinical time series (ICTS) plays a pivotal role in a wide range of healthcare applications. Although recent multimodal time-series large language models (LLMs) have shown considerable promise in general-purpose time-series QA, they remain poorly equipped to model the sparsity, asynchrony, and irregular sampling patterns of clinical observations. To fill this gap, we propose ClinPRISM, a cost-effective multimodal LLM reasoning framework for question answering over ICTS data. First, we devise an irregularity-aware multi-scale encoder to capture sparse clinical evidence at diverse temporal scales. Then, we propose a temporal evidence distiller to integrate representations across these scales and compress them into a small number of LLM-compatible tokens. Moreover, we introduce a progressive alignment strategy that sequentially aligns the irregular trajectories with the LLM's textual embedding space. To facilitate training, we construct 30,000 clinical time series paired with multi-scale descriptions, together with 41,000 instruction-tuning instances spanning 11 tasks. Using a 4-billion-parameter LLM backbone, ClinPRISM achieves state-of-the-art performance on the held-out evaluation benchmark while using only 16 time-series tokens and achieving an average inference latency of 0.15 seconds per question.
Timeseries regression models often struggle to leverage large volumes of labeled multimodal data, particularly when the data are irregularly sampled or contain missing values. This is common in domains like healthcare and predictive maintenance, where data are collected from unreliable sources, and labeling requires expert knowledge or costly equipments. Transformer-based large language models have proven effective on structured data such as text through self-supervised learning (SSL) and generative pretraining (GPT) frameworks. However, such models lack the flexibility to efficiently process irregularly sampled multimodal timeseries data. In this paper, we introduce ITGPT, an attention-based architecture designed for handling multimodal, irregularly sampled timeseries by allowing training with both SSL losses and GPT-like objectives. We evaluate its performance on a healthcare task with the TIHM dataset, and a predictive maintenance task with the CompX dataset. Our results demonstrate that ITGPT achieves state-of-the-art performance without requiring resampling, feature fusion or explicit data imputation. Furthermore, when labels are scarce, ITGPT effectively leverages unlabeled data through SSL and GPT training, outperforming the purely supervised approach. This represents an important step towards efficiently using large and unstructured timeseries datasets for practical inference tasks.