Adapting Generative Large Language Models for Information Extraction from Unstructured Electronic Health Records in Residential Aged Care: A Comparative Analysis of Training Approaches.

Information extraction (IE) of unstructured electronic health records is challenging due to the semantic complexity of textual data. Generative large language models (LLMs) offer promising solutions to address this challenge. However, identifying the best training methods to adapt LLMs for IE in residential aged care settings remains underexplored. This research addresses this challenge by evaluating the effects of zero-shot and few-shot learning, both with and without parameter-efficient fine-tuning (PEFT) and retrieval-augmented generation (RAG) using Llama 3.1-8B. The study performed named entity recognition (NER) to nursing notes from Australian aged care facilities (RACFs), focusing on agitation in dementia and malnutrition risk factors. Performance evaluation includes accuracy, macro-averaged precision, recall, and F1 score. We used non-parametric statistical methods to compare if the differences were statistically significant. Results show that zero-shot and few-shot learning, whether combined with PEFT or RAG, achieve comparable performance across the clinical domains when the same prompting template is used. Few-shot learning significantly outperforms zero-shot learning when neither PEFT nor RAG is applied. Notably, PEFT significantly improves model performance in both zero-shot and few-shot learning; however, RAG significantly improves performance only in few-shot learning. After PEFT, the performance of zero-shot learning reaches a comparable level with few-shot learning. However, few-shot learning with RAG significantly outperforms zero-shot learning with RAG. We also found a similar level of performance between few-shot learning with RAG and zero-shot learning with PEFT. These findings provide valuable insights for researchers, practitioners, and stakeholders to optimize the use of generative LLMs in clinical IE. Supplementary Information: The online version contains supplementary material available at 10.1007/s41666-025-00190-z.