--- title: "Reliable Automated Triage in Spanish Clinical Notes: A Hybrid" description: "They introduce a post-hoc hybrid selective screening framework that can also defer a case to a human expert. 6 references." authors: ["Rodrigo Morales-Sánchez", "Soto Montalvo", "Raquel Martínez"] year: 2026 venue: "BioNLP 2026" source: "https://aclanthology.org/2026.bionlp-1.8/" doi: "10.18653/v1/2026.bionlp-1.8" licence: "CC BY 4.0 (ACL Anthology)" licence_url: "https://creativecommons.org/licenses/by/4.0/" summary_licence: "Elamur Cosmic License" canonical: "https://research.elamur.ai/free/en/papers/sanchez-2026-reliable-automated-triage-spanish-clinical/" --- [Elamur Research](https://md.research.elamur.ai/free/en/) · [this page in HTML](https://research.elamur.ai/free/en/papers/sanchez-2026-reliable-automated-triage-spanish-clinical/) [home](https://md.research.elamur.ai/free/en/) / [papers](https://md.research.elamur.ai/free/en/papers/) / [2026](https://md.research.elamur.ai/free/en/papers/2026/page/41/) / Reliable Automated Triage in Spanish Clinical Notes: A Hybrid Framework for Risk-Aware HIV Suspicion Identification # Reliable Automated Triage in Spanish Clinical Notes: A Hybrid Framework for Risk-Aware HIV Suspicion Identification **Authors:** Rodrigo Morales-Sánchez, [Soto Montalvo](https://md.research.elamur.ai/free/en/authors/soto-montalvo/) and Raquel Martínez · **Year:** 2026 · **Venue:** [BioNLP 2026](https://md.research.elamur.ai/free/en/venues/bionlp/) ([BioNLP 2026](https://md.research.elamur.ai/free/en/venues/bionlp/2026/)) · **Publisher:** [Association for Computational Linguistics](https://md.research.elamur.ai/free/en/publishers/association-for-computational-linguistics/) · **Licence:** [CC BY 4.0 (ACL Anthology)](https://creativecommons.org/licenses/by/4.0/) **Links:** [Publisher's page](https://aclanthology.org/2026.bionlp-1.8/) · [PDF](https://aclanthology.org/2026.bionlp-1.8.pdf) · [DOI 10.18653/v1/2026.bionlp-1.8](https://doi.org/10.18653/v1/2026.bionlp-1.8) · [OpenAlex](https://openalex.org/W7166869694) **Citations:** 0 citations (OpenAlex, 2026-10-14) ## Summary Clinical NLP classifiers that must assign a hard label to every case tend to be overconfident on ambiguous or atypical records, which is unsafe in medical triage. The authors address this for early detection of documented HIV suspicion in Spanish electronic health records. They introduce a post-hoc hybrid selective screening framework that can also defer a case to a human expert. It handles two kinds of uncertainty separately. Aleatoric ambiguity is managed with temperature-scaled Mondrian Conformal Prediction (MCP). Epistemic, out-of-distribution inputs are caught by a Multi-Centroid Mahalanobis Distance (MCMD) veto in a spectrally normalized latent space. A case is automated only if it passes both checks. On a single-hospital cohort, conventional uncertainty methods lost most of their coverage under strict reliability targets. The hybrid policy kept high accuracy on a large automated share of patients. The deferral threshold works as an adjustable dial that trades safety against workload. The authors argue that this decoupling of uncertainty sources is needed before clinical NLP can be deployed responsibly. ## Key points - **Data:** proprietary, anonymized EHRs from Hospital Universitario Fundación Alcorcón (HUFA, Madrid). - 13,642 patients, 63,802 notes, written 1998–2023. - 2,072 suspects, giving a class ratio of about 1:5.5. - Evaluation used 10-fold cross-validation plus a held-out test set. - **Labels and leakage control:** - Suspects are patients with a requested HIV serology, further filtered by EuroTEST indicator conditions. - Explicit HIV acronyms and testing recommendations were removed from the text to prevent leakage. - **MCMD design:** - The number of centroids per class is chosen by k-means with a 0.05 relative-inertia-gain cutoff. - All classes share one global precision matrix estimated with OAS. - Distance thresholds are class-specific, set at the 99th percentile. - **Results:** - At α = 0.01, Clear F2 is 0.982 with 67.7% of patients automated. - At α = 0.05, 91.3% are automated, Clear F2 is 0.913, and 10.2% of true positives are deferred. - Risk-aware metrics include Custom Risk-Kappa and True Positive Deferral Rate. - **Interpretability and code:** - Feature attribution shows that epistemic deferrals are driven by out-of-distribution terms such as psychiatric conditions. - Code is available at github.com/romorale/mil_uq_public. *Our summary of the paper, in our own words — not its text. The work belongs to its authors; read it at the links above.* ## Institutions - [Universidad Nacional de Educación a Distancia](https://md.research.elamur.ai/free/en/universities/universidad-nacional-de-educacion-a-distancia/) — University, Madrid, Spain · 6 works · 269 citations - [Universidad Rey Juan Carlos](https://md.research.elamur.ai/free/en/universities/universidad-rey-juan-carlos/) — University, Madrid, Spain · 4 works · 4 citations 📚 Shelves (6): [🖥️ Computer Science](https://md.research.elamur.ai/free/en/shelves/computer-science/) · 16,667 works · [🤖 Artificial Intelligence](https://md.research.elamur.ai/free/en/shelves/computer-science/artificial-intelligence/) · 16,194 works · [🩺 Medicine](https://md.research.elamur.ai/free/en/shelves/medicine/) · 241 works · [🩺 Health Informatics](https://md.research.elamur.ai/free/en/shelves/medicine/health-informatics/) · 184 works · [🏥 Health Professions](https://md.research.elamur.ai/free/en/shelves/health-professions/) · 69 works · [🏥 Health Information Management](https://md.research.elamur.ai/free/en/shelves/health-professions/health-information-management/) · 50 works ## Cite Cite as: Rodrigo Morales-Sánchez, Soto Montalvo and Raquel Martínez. 2026. Reliable Automated Triage in Spanish Clinical Notes: A Hybrid Framework for Risk-Aware HIV Suspicion Identification. BioNLP 2026. The paper itself, not this page. BibTeX from the library's record of the work. ```bibtex @inproceedings{moralessanchez2026reliable, title = {{Reliable Automated Triage in Spanish Clinical Notes: A Hybrid Framework for Risk-Aware HIV Suspicion Identification}}, author = {Rodrigo Morales-Sánchez, Soto Montalvo and Raquel Martínez}, booktitle = {BioNLP 2026}, year = {2026}, doi = {10.18653/v1/2026.bionlp-1.8}, url = {https://doi.org/10.18653/v1/2026.bionlp-1.8} } ``` - [← previous RelEx-PT: A Portuguese Sentence-Level Relation Extraction Dataset](https://md.research.elamur.ai/free/en/papers/pinto-2026-relex-pt-portuguese-sentence-level/) - [next → Reliable Use of Lemmas via Eligibility Reasoning and Section-Aware Reinforcement Learning](https://md.research.elamur.ai/free/en/papers/xu-2026-reliable-use-lemmas-eligibility-reasoning/) - [↑ back to papers of 2026](https://md.research.elamur.ai/free/en/papers/2026/page/41/) ## References 6 references, 0 of them with a card of ours. ↗ leads to the work, «find» searches for one we have no id for yet. 1. 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JMLR.org. \#\# Ethical Considerations [find](https://scholar.google.com/scholar?q=Yarin+Gal+and+Zoubin+Ghahramani%2E+2016%2E+Dropout+as+a+bayesian+approximation%3A+representing+model+uncertainty+in+deep+learning%2E+In+Proceedings+of+the+33rd+International+Conference+on+Machine+Learning%2C+vo) *Updated 1 November 2026*