Natural Language Processing to Detect Cognitive Concerns in Electronic Health Records Using Deep Learning
Massachusetts General Hospital（麻省总医院）
Zhuoqiao Hong, Colin G. Magdamo, Yi-han Sheu, Prathamesh Mohite, Ayush Noori, Elissa M. Ye, Wendong Ge, Haoqi Sun, Laura Brenner, Gregory Robbins, Shibani Muker… 展开作者
Zhuoqiao Hong, Colin G. Magdamo, Yi-han Sheu, Prathamesh Mohite, Ayush Noori, Elissa M. Ye, Wendong Ge, Haoqi Sun, Laura Brenner, Gregory Robbins, Shibani Mukerji, Sahar Zafar, Nicole Benson, Lidia Moura, John Hsu, Bradley T. Hyman, Michael B. Westover, Deborah Blacker, Sudeshna Das
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Machine Learning for Health (ML4H) at NeurIPS 2020 - Extended Abstract
Dementia is under-recognized in the community, under-diagnosed by healthcare professionals, and under-coded in claims data. Information on cognitive dysfunction, however, is often found in unstructured clinician notes within medical records but manual review by experts is time consuming and often prone to errors. Automated mining of these notes presents a potential opportunity to label patients with cognitive concerns who could benefit from an evaluation or be referred to specialist care. In order to identify patients with cognitive concerns in electronic medical records, we applied natural language processing (NLP) algorithms and compared model performance to a baseline model that used structured diagnosis codes and medication data only. An attention-based deep learning model outperformed the baseline model and other simpler models.
University of Cambridge（剑桥大学）；CM Insight；Imperial College London（帝国理工学院）
In recent years, we have seen deep learning and distributed representations of words and sentences make impact on a number of natural language processing tasks, such as similarity, entailment and sentiment analysis. Here we introduce a new task: understanding of mental health concepts derived from Cognitive Behavioural Therapy (CBT). We define a mental health ontology based on the CBT principles, annotate a large corpus where this phenomena is exhibited and perform understanding using deep learning and distributed representations. Our results show that the performance of deep learning models c…
Tokyo Metropolitan University（东京都立大学）；RIKEN（理化学研究所）；National Hospital Organization（国立医院机构）；Kitami Institute of Technology（北见工业大学）
Automated summarization of clinical texts can reduce the burden of medical professionals. "Discharge summaries" are one promising application of the summarization, because they can be generated from daily inpatient records. Our preliminary experiment suggests that 20-31% of the descriptions in discharge summaries overlap with the content of the inpatient records. However, it remains unclear how the summaries should be generated from the unstructured source. To decompose the physician's summarization process, this study aimed to identify the optimal granularity in summarization. We first define…
Extractive summarization is very useful for physicians to better manage and digest Electronic Health Records (EHRs). However, the training of a supervised model requires disease-specific medical background and is thus very expensive. We studied how to utilize the intrinsic correlation between multiple EHRs to generate pseudo-labels and train a supervised model with no external annotation. Experiments on real-patient data validate that our model is effective in summarizing crucial disease-specific information for patients.
Massachusetts General Hospital（麻省总医院）；McCance Center for Brain Health（McCance脑健康中心）
Dementia is a neurodegenerative disorder that causes cognitive decline and affects more than 50 million people worldwide. Dementia is under-diagnosed by healthcare professionals - only one in four people who suffer from dementia are diagnosed. Even when a diagnosis is made, it may not be entered as a structured International Classification of Diseases (ICD) diagnosis code in a patient's charts. Information relevant to cognitive impairment (CI) is often found within electronic health records (EHR), but manual review of clinician notes by experts is both time consuming and often prone to errors.…
Clinicians spend a significant amount of time inputting free-form textual notes into Electronic Health Records (EHR) systems. Much of this documentation work is seen as a burden, reducing time spent with patients and contributing to clinician burnout. With the aspiration of AI-assisted note-writing, we propose a new language modeling task predicting the content of notes conditioned on past data from a patient's medical record, including patient demographics, labs, medications, and past notes. We train generative models using the public, de-identified MIMIC-III dataset and compare generated not…
McLean Hospital（麦克莱恩医院）；Harvard Medical School（哈佛医学院）；Brandeis University（布兰迪斯大学）
Readmission after discharge from a hospital is disruptive and costly, regardless of the reason. However, it can be particularly problematic for psychiatric patients, so predicting which patients may be readmitted is critically important but also very difficult. Clinical narratives in psychiatric electronic health records (EHRs) span a wide range of topics and vocabulary; therefore, a psychiatric readmission prediction model must begin with a robust and interpretable topic extraction component. We created a data pipeline for using document vector similarity metrics to perform topic extraction o…
In cognitive psychology, automatic and self-reinforcing irrational thought patterns are known as cognitive distortions. Left unchecked, patients exhibiting these types of thoughts can become stuck in negative feedback loops of unhealthy thinking, leading to inaccurate perceptions of reality commonly associated with anxiety and depression. In this paper, we present a machine learning framework for the automatic detection and classification of 15 common cognitive distortions in two novel mental health free text datasets collected from both crowdsourcing and a real-world online therapy program. W…
Electronic Health Records (EHRs) have become the primary form of medical data-keeping across the United States. Federal law restricts the sharing of any EHR data that contains protected health information (PHI). De-identification, the process of identifying and removing all PHI, is crucial for making EHR data publicly available for scientific research. This project explores several deep learning-based named entity recognition (NER) methods to determine which method(s) perform better on the de-identification task. We trained and tested our models on the i2b2 training dataset, and qualitatively …
Massachusetts General Hospital（麻省总医院）；McCance Center for Brain Health（麦坎斯大脑健康中心）
Dementia related cognitive impairment (CI) is a neurodegenerative disorder, affecting over 55 million people worldwide and growing rapidly at the rate of one new case every 3 seconds. 75% cases go undiagnosed globally with up to 90% in low-and-middle-income countries, leading to an estimated annual worldwide cost of USD 1.3 trillion, forecasted to reach 2.8 trillion by 2030. With no cure, a recurring failure of clinical trials, and a lack of early diagnosis, the mortality rate is 100%. Information in electronic health records (EHR) can provide vital clues for early detection of CI, but a manua…
PATIENT-Ψ: Using Large Language Models to Simulate Patients for Training Mental Health Professionals
School of Computer Science, Carnegie Mellon University（卡内基梅隆大学计算机科学学院）；Department of Psychology, Princeton University（普林斯顿大学心理学系）；School of Social Work, University of Pittsburgh（匹兹堡大学社会工作学院）；Department of Psychiatry and Behavioral Sciences, Stanford University（斯坦福大学精神病学与行为科学系）
Data Science Institute, Imperial College London（帝国理工学院数据科学研究所）
The extraction of phenotype information which is naturally contained in electronic health records (EHRs) has been found to be useful in various clinical informatics applications such as disease diagnosis. However, due to imprecise descriptions, lack of gold standards and the demand for efficiency, annotating phenotypic abnormalities on millions of EHR narratives is still challenging. In this work, we propose a novel unsupervised deep learning framework to annotate the phenotypic abnormalities from EHRs via semantic latent representations. The proposed framework takes the advantage of Human Phe…
Identifying Mentions of Pain in Mental Health Records Text: A Natural Language Processing Approach
Institute of Psychiatry, Psychology and Neurosciences, King’s College London（伦敦国王学院精神病学、心理学与神经科学研究所）；Health Data Research UK（英国健康数据研究中心）；South London and Maudsley Biomedical Research Centre（南伦敦和莫兹利生物医学研究中心）；The South London and Maudsley NHS Foundation Trust（南伦敦和莫兹利国民保健信托基金会）
University of Exeter（埃克塞特大学）；University of Pisa（比萨大学）；ISTI-CNR（意大利国家研究委员会信息科学与技术研究所）
Writing messages is key to expressing feelings. This study adopts cognitive network science to reconstruct how individuals report their feelings in clinical narratives like suicide notes or mental health posts. We achieve this by reconstructing syntactic/semantic associations between conceptsin texts as co-occurrences enriched with affective data. We transform 142 suicide notes and 77,000 Reddit posts from the r/anxiety, r/depression, r/schizophrenia, and r/do-it-your-own (r/DIY) forums into 5 cognitive networks, each one expressing meanings and emotions as reported by authors. These networks …
University of Massachusetts（马萨诸塞大学）；Bedford VAMC and CHOIR（贝德福德退伍军人医疗中心与CHOIR）
Sequence labeling for extraction of medical events and their attributes from unstructured text in Electronic Health Record (EHR) notes is a key step towards semantic understanding of EHRs. It has important applications in health informatics including pharmacovigilance and drug surveillance. The state of the art supervised machine learning models in this domain are based on Conditional Random Fields (CRFs) with features calculated from fixed context windows. In this application, we explored various recurrent neural network frameworks and show that they significantly outperformed the CRF models.
Heriot-Watt University（赫瑞-瓦特大学）；University of Edinburgh（爱丁堡大学）
In order to make spoken dialogue systems (such as Amazon Alexa or Google Assistant) more accessible and naturally interactive for people with cognitive impairments, appropriate data must be obtainable. Recordings of multi-modal spontaneous conversations with vulnerable user groups are scarce however and this valuable data is challenging to collect. Researchers that call for this data are commonly inexperienced in ethical and legal issues around working with vulnerable participants. Additionally, standard recording equipment is insecure and should not be used to capture sensitive data. We spent…
Tsinghua University（清华大学）；Beijing Normal University（北京师范大学）
The growing demand for mental health support has highlighted the importance of conversational agents as human supporters worldwide and in China. These agents could increase availability and reduce the relative costs of mental health support. The provided support can be divided into two main types: cognitive and emotional support. Existing work on this topic mainly focuses on constructing agents that adopt Cognitive Behavioral Therapy (CBT) principles. Such agents operate based on pre-defined templates and exercises to provide cognitive support. However, research on emotional support using such…
Electronic health records (EHRs), digital collections of patient healthcare events and observations, are ubiquitous in medicine and critical to healthcare delivery, operations, and research. Despite this central role, EHRs are notoriously difficult to process automatically. Well over half of the information stored within EHRs is in the form of unstructured text (e.g. provider notes, operation reports) and remains largely untapped for secondary use. Recently, however, newer neural network and deep learning approaches to Natural Language Processing (NLP) have made considerable advances, outperfo…
The population is aging, and becoming more tech-savvy. The United Nations predicts that by 2050, one in six people in the world will be over age 65 (up from one in 11 in 2019), and this increases to one in four in Europe and Northern America. Meanwhile, the proportion of American adults over 65 who own a smartphone has risen 24 percentage points from 2013-2017, and the majority have Internet in their homes. Smart devices and smart home technology have profound potential to transform how people age, their ability to live independently in later years, and their interactions with their circle of …
In the electronic health record, using clinical notes to identify entities such as disorders and their temporality (e.g. the order of an event relative to a time index) can inform many important analyses. However, creating training data for clinical entity tasks is time consuming and sharing labeled data is challenging due to privacy concerns. The information needs of the COVID-19 pandemic highlight the need for agile methods of training machine learning models for clinical notes. We present Trove, a framework for weakly supervised entity classification using medical ontologies and expert-gene…
Text classification tasks which aim at harvesting and/or organizing information from electronic health records are pivotal to support clinical and translational research. However these present specific challenges compared to other classification tasks, notably due to the particular nature of the medical lexicon and language used in clinical records. Recent advances in embedding methods have shown promising results for several clinical tasks, yet there is no exhaustive comparison of such approaches with other commonly used word representations and classification models. In this work, we analyse…
Nanjing Medical University（南京医科大学）；the First Affiliated Hospital（第一附属医院）
Event extraction is an important work of medical text processing. According to the complex characteristics of medical text annotation, we use the end-to-end event extraction model to enhance the output formatting information of events. Through pre training and fine-tuning, we can extract the attributes of the four dimensions of medical text: anatomical position, subject word, description word and occurrence state. On the test set, the accuracy rate was 0.4511, the recall rate was 0.3928, and the F1 value was 0.42. The method of this model is simple, and it has won the second place in the task …
Validating transformers for redaction of text from electronic health records in real-world healthcare
King’s College London（伦敦国王学院）；King’s College Hospital（国王学院医院）；Guy’s and St Thomas’ NHS Foundation Trust（盖伊和圣托马斯国民保健服务基金会信托）；University College London（伦敦大学学院）
Widespread adoption of electronic health records (EHRs) has fueled the development of using machine learning to build prediction models for various clinical outcomes. This process is often constrained by having a relatively small number of patient records for training the model. We demonstrate that using patient representation schemes inspired from techniques in natural language processing can increase the accuracy of clinical prediction models by transferring information learned from the entire patient population to the task of training a specific model, where only a subset of the population …
University of Illinois Urbana-Champaign（伊利诺伊大学厄巴纳-香槟分校）
Accessing longitudinal multimodal Electronic Healthcare Records (EHRs) is challenging due to privacy concerns, which hinders the use of ML for healthcare applications. Synthetic EHRs generation bypasses the need to share sensitive real patient records. However, existing methods generate single-modal EHRs by unconditional generation or by longitudinal inference, which falls short of low flexibility and makes unrealistic EHRs. In this work, we propose to formulate EHRs generation as a text-to-text translation task by language models (LMs), which suffices to highly flexible event imputation durin…
Hypoglycemia is common and potentially dangerous among those treated for diabetes. Electronic health records (EHRs) are important resources for hypoglycemia surveillance. In this study, we report the development and evaluation of deep learning-based natural language processing systems to automatically detect hypoglycemia events from the EHR narratives. Experts in Public Health annotated 500 EHR notes from patients with diabetes. We used this annotated dataset to train and evaluate HYPE, supervised NLP systems for hypoglycemia detection. In our experiment, the convolutional neural network model…
Medical entity extraction (EE) is a standard procedure used as a first stage in medical texts processing. Usually Medical EE is a two-step process: named entity recognition (NER) and named entity normalization (NEN). We propose a novel method of doing medical EE from electronic health records (EHR) as a single-step multi-label classification task by fine-tuning a transformer model pretrained on a large EHR dataset. Our model is trained end-to-end in an distantly supervised manner using targets automatically extracted from medical knowledge base. We show that our model learns to generalize for …
Austin Health（奥斯汀健康）；University of Melbourne（墨尔本大学）
We propose an approach for adapting the DeBERTa model for electronic health record (EHR) tasks using domain adaptation. We pretrain a small DeBERTa model on a dataset consisting of MIMIC-III discharge summaries, clinical notes, radiology reports, and PubMed abstracts. We compare this model's performance with a DeBERTa model pre-trained on clinical texts from our institutional EHR (MeDeBERTa) and an XGBoost model. We evaluate performance on three benchmark tasks for emergency department outcomes using the MIMIC-IV-ED dataset. We preprocess the data to convert it into text format and generate fo…
Georgia Institute of Technology（佐治亚理工学院）；Google Brain（谷歌大脑）；IBM Research（IBM研究院）；Sutter Health（萨特医疗）；HINT Consultants（HINT咨询公司）
Deep learning models exhibit state-of-the-art performance for many predictive healthcare tasks using electronic health records (EHR) data, but these models typically require training data volume that exceeds the capacity of most healthcare systems. External resources such as medical ontologies are used to bridge the data volume constraint, but this approach is often not directly applicable or useful because of inconsistencies with terminology. To solve the data insufficiency challenge, we leverage the inherent multilevel structure of EHR data and, in particular, the encoded relationships among…
Centers for Disease Control and Prevention（美国疾病控制与预防中心）
A variety of methods existing for generating synthetic electronic health records (EHRs), but they are not capable of generating unstructured text, like emergency department (ED) chief complaints, history of present illness or progress notes. Here, we use the encoder-decoder model, a deep learning algorithm that features in many contemporary machine translation systems, to generate synthetic chief complaints from discrete variables in EHRs, like age group, gender, and discharge diagnosis. After being trained end-to-end on authentic records, the model can generate realistic chief complaint text …
