BACKGROUND
An artificial intelligence-based algorithm has shown a powerful ability for coding the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) in discharge notes. However, its performance still requires improvement compared with human experts. The major disadvantage of the previous algorithm is its lack of understanding medical terminologies.
OBJECTIVE
We propose some methods based on human-learning process and conduct a series of experiments to validate their improvements.
METHODS
We compared two data sources for training the word-embedding model: English Wikipedia and PubMed journal abstracts. Moreover, the fixed, changeable, and double-channel embedding tables were used to test their performance. Some additional tricks were also applied to improve accuracy. We used these methods to identify the three-chapter-level ICD-10-CM diagnosis codes in a set of discharge notes. Subsequently, 94,483-labeled discharge notes from June 1, 2015 to June 30, 2017 were used from the Tri-Service General Hospital in Taipei, Taiwan. To evaluate performance, 24,762 discharge notes from July 1, 2017 to December 31, 2017, from the same hospital were used. Moreover, 74,324 additional discharge notes collected from other seven hospitals were also tested. The F-measure is the major global measure of effectiveness.
RESULTS
In understanding medical terminologies, the PubMed-embedding model (Pearson correlation = 0.60/0.57) shows a better performance compared with the Wikipedia-embedding model (Pearson correlation = 0.35/0.31). In the accuracy of ICD-10-CM coding, the changeable model both used the PubMed- and Wikipedia-embedding model has the highest testing mean F-measure (0.7311 and 0.6639 in Tri-Service General Hospital and other seven hospitals, respectively). Moreover, a proposed method called a hybrid sampling method, an augmentation trick to avoid algorithms identifying negative terms, was found to additionally improve the model performance.
CONCLUSIONS
The proposed model architecture and training method is named as ICD10Net, which is the first expert level model practically applied to daily work. This model can also be applied in unstructured information extraction from free-text medical writing. We have developed a web app to demonstrate our work (https://linchin.ndmctsgh.edu.tw/app/ICD10/).
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