Extracting longitudinal anticancer treatments at scale using deep natural language processing and temporal reasoning.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18747-e18747
Author(s):  
Meng Ma ◽  
Kyeryoung Lee ◽  
Yun Mai ◽  
Christopher Gilman ◽  
Zongzhi Liu ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Natural Language Processing ◽  
Targeted Therapy ◽  
Natural Language ◽  
Language Processing ◽  
Temporal Reasoning ◽  
Cancer Drug ◽  
Cancer Treatments ◽  
Clinical Notes ◽  
Patients With Cancer

e18747 Background: Accurate longitudinal cancer treatments are vital for establishing primary endpoints such as outcome as well as for the investigation of adverse events. However, many longitudinal therapeutic regimens are not well captured in structured electronic health records (EHRs). Thus, their recognition in unstructured data such as clinical notes is critical to gain an accurate description of the real-world patient treatment journey. Here, we demonstrate a scalable approach to extract high-quality longitudinal cancer treatments from lung cancer patients' clinical notes using a Bidirectional Long Short Term Memory (BiLSTM) and Conditional Random Fields (CRF) based natural language processing (NLP) pipeline. Methods: The lung cancer (LC) cohort of 4,698 patients was curated from the Mount Sinai Healthcare system (2003-2020). Two domain experts developed a structured framework of entities and semantics that captured treatment and its temporality. The framework included therapy type (chemotherapy, targeted therapy, immunotherapy, etc.), status (on, off, hold, planned, etc.) and temporal reasoning entities and relations (admin_date, duration, etc.) We pre-annotated 149 FDA-approved cancer drugs and longitudinal timelines of treatment on the training corpus. A NLP pipeline was implemented with BiLSTM-CRF-based deep learning models to train and then apply the resulting models to the clinical notes of LC cohort. A postprocessor was developed to subsequently post-coordinate and refine the output. We performed both cross-evaluation and independent evaluation to assess the pipeline performance. Results: We applied the NLP pipeline to the 853,755 clinical notes, and identified 1,155 distinct entities for 194 cancer generic drugs, including 74 chemotherapy drugs, 21 immunotherapy drugs, and 99 targeted therapy drugs. We identified chemotherapy, immunotherapy, or targeted therapy data for 3,509 patients in the LC cohort from the clinical notes. Compared to only 2,395 patients with cancer treatments in structured EHR, this pipeline identified cancer treatments from notes for additional 2,303 patients who did not have any available cancer treatment data in the structured EHR. Our evaluation schema indicates that the longitudinal cancer drug recognition pipeline delivers strong performance (named entity recognization for drugs and temporal: F1 = 95%; drug-temporal relation recognition: F1 = 90%). Conclusions: We developed a high-performance BiLSTM-CRF based NLP pipeline to recognize longitudinal cancer treatments. The pipeline recovers and encodes as twice as many patients with cancer treatments compared with structured EHR. Our study indicates deep NLP with temporal reasoning could substantially accelerate the extraction of treatment profiles at scale. The pipeline is adjustable and can be applied across different cancers.

Natural Language Processing to Identify Cancer Treatments With Electronic Medical Records

2021 ◽  
pp. 379-393
Author(s):  
Jiaming Zeng ◽  
Imon Banerjee ◽  
A. Solomon Henry ◽  
Douglas J. Wood ◽  
Ross D. Shachter ◽  
...  
Keyword(s):  
Natural Language Processing ◽  
Natural Language ◽  
Electronic Medical Records ◽  
Language Processing ◽  
Medical Records ◽  
Structured Data ◽  
Free Text ◽  
Esophagus Cancer ◽  
Clinical Notes ◽  
Patients With Cancer

PURPOSE Knowing the treatments administered to patients with cancer is important for treatment planning and correlating treatment patterns with outcomes for personalized medicine study. However, existing methods to identify treatments are often lacking. We develop a natural language processing approach with structured electronic medical records and unstructured clinical notes to identify the initial treatment administered to patients with cancer. METHODS We used a total number of 4,412 patients with 483,782 clinical notes from the Stanford Cancer Institute Research Database containing patients with nonmetastatic prostate, oropharynx, and esophagus cancer. We trained treatment identification models for each cancer type separately and compared performance of using only structured, only unstructured ( bag-of-words, doc2vec, fasttext), and combinations of both ( structured + bow, structured + doc2vec, structured + fasttext). We optimized the identification model among five machine learning methods (logistic regression, multilayer perceptrons, random forest, support vector machines, and stochastic gradient boosting). The treatment information recorded in the cancer registry is the gold standard and compares our methods to an identification baseline with billing codes. RESULTS For prostate cancer, we achieved an f1-score of 0.99 (95% CI, 0.97 to 1.00) for radiation and 1.00 (95% CI, 0.99 to 1.00) for surgery using structured + doc2vec. For oropharynx cancer, we achieved an f1-score of 0.78 (95% CI, 0.58 to 0.93) for chemoradiation and 0.83 (95% CI, 0.69 to 0.95) for surgery using doc2vec. For esophagus cancer, we achieved an f1-score of 1.0 (95% CI, 1.0 to 1.0) for both chemoradiation and surgery using all combinations of structured and unstructured data. We found that employing the free-text clinical notes outperforms using the billing codes or only structured data for all three cancer types. CONCLUSION Our results show that treatment identification using free-text clinical notes greatly improves upon the performance using billing codes and simple structured data. The approach can be used for treatment cohort identification and adapted for longitudinal cancer treatment identification.

scholarly journals Interactive Exploration of Longitudinal Cancer Patient Histories Extracted From Clinical Text

2020 ◽  
pp. 412-420 ◽  
Author(s):  
Zhou Yuan ◽  
Sean Finan ◽  
Jeremy Warner ◽  
Guergana Savova ◽  
Harry Hochheiser
Keyword(s):  
Natural Language Processing ◽  
Natural Language ◽  
Language Processing ◽  
Data Model ◽  
Qualitative Inquiry ◽  
Clinical Text ◽  
Clinical Notes ◽  
Patients With Cancer ◽  
Interactive Tools ◽  
User Tasks

PURPOSE Retrospective cancer research requires identification of patients matching both categorical and temporal inclusion criteria, often on the basis of factors exclusively available in clinical notes. Although natural language processing approaches for inferring higher-level concepts have shown promise for bringing structure to clinical texts, interpreting results is often challenging, involving the need to move between abstracted representations and constituent text elements. Our goal was to build interactive visual tools to support the process of interpreting rich representations of histories of patients with cancer. METHODS Qualitative inquiry into user tasks and goals, a structured data model, and an innovative natural language processing pipeline were used to guide design. RESULTS The resulting information visualization tool provides cohort- and patient-level views with linked interactions between components. CONCLUSION Interactive tools hold promise for facilitating the interpretation of patient summaries and identification of cohorts for retrospective research.

Systematic review of current natural language processing methods and applications in cardiology

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319769
Author(s):  
Meghan Reading Turchioe ◽  
Alexander Volodarskiy ◽  
Jyotishman Pathak ◽  
Drew N Wright ◽  
James Enlou Tcheng ◽  
...  
Keyword(s):  
Systematic Review ◽  
Natural Language Processing ◽  
Natural Language ◽  
Language Processing ◽  
Clinical Care ◽  
Real World Data ◽  
Clinical Text ◽  
Clinical Notes ◽  
Artery Disease ◽  
Automated Methods

Natural language processing (NLP) is a set of automated methods to organise and evaluate the information contained in unstructured clinical notes, which are a rich source of real-world data from clinical care that may be used to improve outcomes and understanding of disease in cardiology. The purpose of this systematic review is to provide an understanding of NLP, review how it has been used to date within cardiology and illustrate the opportunities that this approach provides for both research and clinical care. We systematically searched six scholarly databases (ACM Digital Library, Arxiv, Embase, IEEE Explore, PubMed and Scopus) for studies published in 2015–2020 describing the development or application of NLP methods for clinical text focused on cardiac disease. Studies not published in English, lacking a description of NLP methods, non-cardiac focused and duplicates were excluded. Two independent reviewers extracted general study information, clinical details and NLP details and appraised quality using a checklist of quality indicators for NLP studies. We identified 37 studies developing and applying NLP in heart failure, imaging, coronary artery disease, electrophysiology, general cardiology and valvular heart disease. Most studies used NLP to identify patients with a specific diagnosis and extract disease severity using rule-based NLP methods. Some used NLP algorithms to predict clinical outcomes. A major limitation is the inability to aggregate findings across studies due to vastly different NLP methods, evaluation and reporting. This review reveals numerous opportunities for future NLP work in cardiology with more diverse patient samples, cardiac diseases, datasets, methods and applications.

Development of algorithm for classification smoking status from unstructured bilingual electronic health records based on natural language processing (Preprint)

2021 ◽  
Author(s):  
Ye Seul Bae ◽  
Kyung Hwan Kim ◽  
Han Kyul Kim ◽  
Sae Won Choi ◽  
Taehoon Ko ◽  
...  
Keyword(s):  
Natural Language Processing ◽  
Electronic Health Records ◽  
Natural Language ◽  
Language Processing ◽  
Smoking Status ◽  
Svm Classifier ◽  
Keyword Extraction ◽  
Health Records ◽  
Clinical Notes ◽  
Electronic Health

BACKGROUND Smoking is a major risk factor and important variable for clinical research, but there are few studies regarding automatic obtainment of smoking classification from unstructured bilingual electronic health records (EHR). OBJECTIVE We aim to develop an algorithm to classify smoking status based on unstructured EHRs using natural language processing (NLP). METHODS With acronym replacement and Python package Soynlp, we normalize 4,711 bilingual clinical notes. Each EHR notes was classified into 4 categories: current smokers, past smokers, never smokers, and unknown. Subsequently, SPPMI (Shifted Positive Point Mutual Information) is used to vectorize words in the notes. By calculating cosine similarity between these word vectors, keywords denoting the same smoking status are identified. RESULTS Compared to other keyword extraction methods (word co-occurrence-, PMI-, and NPMI-based methods), our proposed approach improves keyword extraction precision by as much as 20.0%. These extracted keywords are used in classifying 4 smoking statuses from our bilingual clinical notes. Given an identical SVM classifier, the extracted keywords improve the F1 score by as much as 1.8% compared to those of the unigram and bigram Bag of Words. CONCLUSIONS Our study shows the potential of SPPMI in classifying smoking status from bilingual, unstructured EHRs. Our current findings show how smoking information can be easily acquired and used for clinical practice and research.

scholarly journals P2.09-29 Automatic Lung Cancer Staging from Medical Reports Using Natural Language Processing

2018 ◽  
Vol 13 (10) ◽  
pp. S772
Author(s):  
X. Sui ◽  
T. Liu ◽  
Q. Huang ◽  
Y. Hou ◽  
Y. Wang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Natural Language Processing ◽  
Natural Language ◽  
Language Processing ◽  
Cancer Staging ◽  
Medical Reports

Identifying Heart Failure Symptoms and Poor Self-Management in Home Healthcare: A Natural Language Processing Study

2021 ◽  
Author(s):  
Sena Chae ◽  
Jiyoun Song ◽  
Marietta Ojo ◽  
Maxim Topaz
Keyword(s):  
Heart Failure ◽  
Natural Language Processing ◽  
Natural Language ◽  
Language Processing ◽  
Symptom Management ◽  
Home Healthcare ◽  
Self Management ◽  
Clinical Notes ◽  
Patients With Heart Failure

The goal of this natural language processing (NLP) study was to identify patients in home healthcare with heart failure symptoms and poor self-management (SM). The preliminary lists of symptoms and poor SM status were identified, NLP algorithms were used to refine the lists, and NLP performance was evaluated using 2.3 million home healthcare clinical notes. The overall precision to identify patients with heart failure symptoms and poor SM status was 0.86. The feasibility of methods was demonstrated to identify patients with heart failure symptoms and poor SM documented in home healthcare notes. This study facilitates utilizing key symptom information and patients’ SM status from unstructured data in electronic health records. The results of this study can be applied to better individualize symptom management to support heart failure patients’ quality-of-life.

scholarly journals A Natural Language Processing Approach to Automated Highlighting of New Information in Clinical Notes

2020 ◽  
Vol 10 (8) ◽  
pp. 2824
Author(s):  
Yu-Hsiang Su ◽  
Ching-Ping Chao ◽  
Ling-Chien Hung ◽  
Sheng-Feng Sung ◽  
Pei-Ju Lee
Keyword(s):  
Natural Language Processing ◽  
Natural Language ◽  
Task Performance ◽  
Language Processing ◽  
Automated Identification ◽  
Clinical Notes ◽  
New Information ◽  
Perceived Workload ◽  
The Impact ◽  
User Experiment

Electronic medical records (EMRs) have been used extensively in most medical institutions for more than a decade in Taiwan. However, information overload associated with rapid accumulation of large amounts of clinical narratives has threatened the effective use of EMRs. This situation is further worsened by the use of “copying and pasting”, leading to lots of redundant information in clinical notes. This study aimed to apply natural language processing techniques to address this problem. New information in longitudinal clinical notes was identified based on a bigram language model. The accuracy of automated identification of new information was evaluated using expert annotations as the reference standard. A two-stage cross-over user experiment was conducted to evaluate the impact of highlighting of new information on task demands, task performance, and perceived workload. The automated method identified new information with an F1 score of 0.833. The user experiment found a significant decrease in perceived workload associated with a significantly higher task performance. In conclusion, automated identification of new information in clinical notes is feasible and practical. Highlighting of new information enables healthcare professionals to grasp key information from clinical notes with less perceived workload.

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