Clinical information extraction applications: A literature review.

A review of approaches to identifying patient phenotype cohorts using electronic health records

The continuously increasing cost of the US healthcare system has received significant attention. Central to the ideas aimed at curbing this trend is the use of technology in the form of the mandate to implement electronic health records (EHRs). EHRs consist of patient information such as demographics, medications, laboratory test results, diagnosis codes, and procedures. Mining EHRs could lead to improvement in patient health management as EHRs contain detailed information related to disease prognosis for large patient populations. In this article, we provide a structured and comprehensive overview of data mining techniques for modeling EHRs. We first provide a detailed understanding of the major application areas to which EHR mining has been applied and then discuss the nature of EHR data and its accompanying challenges. Next, we describe major approaches used for EHR mining, the metrics associated with EHRs, and the various study designs. With this foundation, we then provide a systematic and methodological organization of existing data mining techniques used to model EHRs and discuss ideas for future research.

pdf/mining-electronic-health-records-ehrs-a-survey-1p6yla8u7c.pdf

Mining Electronic Health Records (EHRs): A Survey

Importance Natural language processing (NLP) has the potential to accelerate translation of cancer treatments from the laboratory to the clinic and will be a powerful tool in the era of personalized medicine. This technology can harvest important clinical variables trapped in the free-text narratives within electronic medical records. Observations Natural language processing can be used as a tool for oncological evidence-based research and quality improvement. Oncologists interested in applying NLP for clinical research can play pivotal roles in building NLP systems and, in doing so, contribute to both oncological and clinical NLP research. Herein, we provide an introduction to NLP and its potential applications in oncology, a description of specific tools available, and a review on the state of the current technology with respect to cancer case identification, staging, and outcomes quantification. Conclusions and Relevance More automated means of leveraging unstructured data from daily clinical practice is crucial as therapeutic options and access to individual-level health information increase. Research-minded oncologists may push the avenues of evidence-based research by taking advantage of the new technologies available with clinical NLP. As continued progress is made with applying NLP toward oncological research, incremental gains will lead to large impacts, building a cost-effective infrastructure for advancing cancer care.

Natural Language Processing in Oncology A Review

Objective Electronic health records (EHRs) are a promising source of data for health outcomes research in oncology. A challenge in using EHR data is that selecting cohorts of patients often requires information in unstructured parts of the record. Machine learning has been used to address this, but even high-performing algorithms may select patients in a non-random manner and bias the resulting cohort. To improve the efficiency of cohort selection while measuring potential bias, we introduce a technique called Model-Assisted Cohort Selection (MACS) with Bias Analysis and apply it to the selection of metastatic breast cancer (mBC) patients. Materials and Methods We trained a model on 17,263 patients using term-frequency inverse-document-frequency (TF-IDF) and logistic regression. We used a test set of 17,292 patients to measure algorithm performance and perform Bias Analysis. We compared the cohort generated by MACS to the cohort that would have been generated without MACS as reference standard, first by comparing distributions of an extensive set of clinical and demographic variables and then by comparing the results of two analyses addressing existing example research questions. Results Our algorithm had an area under the curve (AUC) of 0.976, a sensitivity of 96.0%, and an abstraction efficiency gain of 77.9%. During Bias Analysis, we found no large differences in baseline characteristics and no differences in the example analyses. Conclusion MACS with bias analysis can significantly improve the efficiency of cohort selection on EHR data while instilling confidence that outcomes research performed on the resulting cohort will not be biased.

Model-assisted cohort selection with bias analysis for generating large-scale cohorts from the EHR for oncology research.

We sought to determine the accuracy of two electronic methods of identifying pancreatic cancer in a cohort of pancreatic cyst patients, and to examine the reasons for identification failure. We used the International Classification of Diseases, 9(th) Edition (ICD-9) codes and natural language processing (NLP) technology to identify pancreatic cancer in these patients. We compared both methods to a human-validated gold-standard surgical database. Both ICD-9 codes and NLP technology achieved high sensitivity for identifying pancreatic cancer, but the ICD-9 code method achieved markedly lower specificity and PPV compared to the NLP method. The NLP method required only slightly greater expenditures of time and effort compared to the ICD-9 code method. We identified several variables influencing the accuracy of ICD-9 codes to identify cancer patients including: the identification algorithm, kind of cancer to be identified, presence of other conditions similar to cancer, and presence of conditions that are precancerous.

Comparing Methods for Identifying Pancreatic Cancer Patients Using Electronic Data Sources

In this study we have developed a rule-based natural language processing (NLP) system to identify patients with family history of pancreatic cancer. The algorithm was developed in a Unstructured Information Management Architecture (UIMA) framework and consisted of section segmentation, relation discovery, and negation detection. The system was evaluated on data from two institutions. The family history identification precision was consistent across the institutions shifting from 88.9% on Indiana University (IU) dataset to 87.8% on Mayo Clinic dataset. Customizing the algorithm on the the Mayo Clinic data, increased its precision to 88.1%. The family member relation discovery achieved precision, recall, and F-measure of 75.3%, 91.6% and 82.6% respectively. Negation detection resulted in precision of 99.1%. The results show that rule-based NLP approaches for specific information extraction tasks are portable across institutions; however customization of the algorithm on the new dataset improves its performance.

Identification of Patients with Family History of Pancreatic Cancer--Investigation of an NLP System Portability.

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Comparing Methods for Identifying Pancreatic Cancer Patients Using Electronic Data Sources

Identification of Patients with Family History of Pancreatic Cancer--Investigation of an NLP System Portability.