# Multi-lingual Multi-institutional Electronic Health Record based Predictive Model

arXiv: https://arxiv.org/abs/2604.00027 · HTML: https://mlsanity.com/paper/2604.00027/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 17 of its 42 references that are in the map.
- First posted on arXiv 11 Mar 2026.

## Builds on (most cited first, 17 of 17)

- [BERT: Pre-training of Deep Bidirectional Transformers for Language Understanding](https://mlsanity.com/paper/1810.04805/) (2018)
- [Unsupervised Cross-lingual Representation Learning at Scale](https://mlsanity.com/paper/1911.02116/) (2019)
- [BioBERT: a pre-trained biomedical language representation model for biomedical text mining](https://mlsanity.com/paper/1901.08746/) (2019)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [Publicly Available Clinical BERT Embeddings](https://mlsanity.com/paper/1904.03323/) (2019)
- [How multilingual is Multilingual BERT?](https://mlsanity.com/paper/1906.01502/) (2019)
- [Scalable and accurate deep learning for electronic health records](https://mlsanity.com/paper/1801.07860/) (2018)
- [Doctor AI: Predicting Clinical Events via Recurrent Neural Networks](https://mlsanity.com/paper/1511.05942/) (2015)
- [EHRSHOT: An EHR Benchmark for Few-Shot Evaluation of Foundation Models](https://mlsanity.com/paper/2307.02028/) (2023)
- [GAMENet: Graph Augmented MEmory Networks for Recommending Medication Combination](https://mlsanity.com/paper/1809.01852/) (2018)
- [HiRID-ICU-Benchmark -- A Comprehensive Machine Learning Benchmark on High-resolution ICU Data](https://mlsanity.com/paper/2111.08536/) (2021)
- [GenHPF: General Healthcare Predictive Framework with Multi-task Multi-source Learning](https://mlsanity.com/paper/2207.09858/) (2022)
- [A Multi-Center Study on the Adaptability of a Shared Foundation Model for Electronic Health Records](https://mlsanity.com/paper/2311.11483/) (2023)
- [Unifying Heterogeneous Electronic Health Records Systems via Text-Based Code Embedding](https://mlsanity.com/paper/2108.03625/) (2021)
- [General-Purpose Retrieval-Enhanced Medical Prediction Model Using Near-Infinite History](https://mlsanity.com/paper/2310.20204/) (2023)
- [CLIN-X: pre-trained language models and a study on cross-task transfer for concept extraction in the clinical domain](https://mlsanity.com/paper/2112.08754/) (2021)
- [KBioXLM: A Knowledge-anchored Biomedical Multilingual Pretrained Language Model](https://mlsanity.com/paper/2311.11564/) (2023)

## Built on by (most cited first, 1 of 1)

- [PORTER: Language-Grounded Event Representations for Portable Structured EHR Foundation Models](https://mlsanity.com/paper/2606.24102/) (2026)

## Abstract (arXiv)

Large-scale EHR prediction across institutions is hindered by substantial heterogeneity in schemas and code systems. Although Common Data Models (CDMs) can standardize records for multi-institutional learning, the manual harmonization and vocabulary mapping are costly and difficult to scale. Text-based harmonization provides an alternative by converting raw EHR into a unified textual form, enabling pooled learning without explicit standardization. However, applying this paradigm to multi-national datasets introduces an additional layer of heterogeneity, which is "language" that must be addressed for truly scalable EHRs learning. In this work, we investigate multilingual multi-institutional learning for EHR prediction, aiming to enable pooled training across multinational ICU datasets without manual standardization. We compare two practical strategies for handling language barriers: (i) directly modeling multilingual records with multilingual encoders, and (ii) translating non-English records into English via LLM-based word-level translation. Across seven public ICU datasets, ten clinical tasks with multiple prediction windows, translation-based lingual alignment yields more reliable cross-dataset performance than multilingual encoders. The multi-institutional learning model consistently outperforms strong baselines that require manual feature selection and harmonization, and also surpasses single-dataset training. We further demonstrate that text-based framework with lingual alignment effectively performs transfer learning via few-shot fine-tuning, with additional gains. To our knowledge, this is the first study to aggregate multilingual multinational ICU EHR datasets into one predictive model, providing a scalable path toward language-agnostic clinical prediction and future global multi-institutional EHR research.