Automatic symptoms identification from a massive volume of unstructured medical consultations using deep neural and BERT models

Automatic symptom identification plays a crucial role in assisting doctors during the diagnosis process in Telemedicine. In general, physicians spend considerable time on clinical documentation and symptom identification, which is unfeasible due to their full schedule. With text-based consultation services in telemedicine, the identification of symptoms from a user’s consultation is a sophisticated process and time-consuming. Moreover, at Altibbi, which is an Arabic telemedicine platform and the context of this work, users consult doctors and describe their conditions in different Arabic dialects which makes the problem more complex and challenging. Therefore, in this work, an advanced deep learning approach is developed consultations with multi-dialects. The approach is formulated as a multi-label multi-class classification using features extracted based on AraBERT and fine-tuned on the bidirectional long short-term memory (BiLSTM) network. The Fine-tuning of BiLSTM relies on features engineered based on different variants of the bidirectional encoder representations from transformers (BERT). Evaluating the models based on precision, recall, and a customized hit rate showed a successful identification of symptoms from Arabic texts with promising accuracy. Hence, this paves the way toward deploying an automated symptom identification model in production at Altibbi which can help general practitioners in telemedicine in providing more efficient and accurate consultations

Deep learning for electronic health records: risk prediction, explainability, and uncertainty

Background: Risk models are essential for care planning and disease prevention. The unsatisfactory performance of the established clinical models has raised broad awareness and concerns. An accurate, explainable, and reliable risk model is highly beneficial but remains a challenge. Objective: This thesis aims to develop deep learning models that can make more accurate risk predictions with the provision of uncertainty estimation and the ability to provide medical explanations using a large and representative electronic health records (EHR) dataset. Methods: We investigated three directions in this thesis: risk prediction, explainability, and uncertainty estimation. For risk prediction, we investigated deep learning tools that can incorporate the minimal processed EHR for modelling and comprehensively compared them with the established machine learning and clinical models. Additionally, the post-hoc explanations were applied to deep learning models for medical information retrieval, and we specifically looked into explanations in risk association and counterfactual reasoning. Uncertainty estimation was qualitatively investigated using probabilistic modelling techniques. Our analyses relied on Clinical Practice Research Datalink, which contains anonymised EHR collected from primary care, secondary care, and death registration and is representative of the UK population. Results: We introduced a deep learning model, named BEHRT, that can incorporate minimal processed EHR for risk prediction. Without expert engagement, it learned meaningful representations that can automatically cluster highly correlated diseases. Compared to the established machine learning and clinical models that relied on expert- selected predictors, our proposed deep learning model showed superior performance on a wide range of risk prediction tasks and highlighted the necessity of recalibration when applying a risk model to a population with severe prior distribution shifts, and the importance of regular model updating to preserve the model’s discrimination performance under temporal data shifts. Additionally, we showed that the deep learning model explanation is an excellent tool for discovering risk factors. By explaining the deep learning model, we not only identified factors that were highly consistent with the established evidence but also those that have not been considered in expert-driven studies. Furthermore, the deep learning model also captured the interplay between risk and treated risk and the differential association of medications across different years, which would be difficult if the temporal context was not included in the modelling. Besides the explanations in terms of association, we introduced a framework that can achieve accurate risk prediction, while enabling counterfactual reasoning under hypothetical interventions. This offers counterfactual explanations that could inform clinicians for selection of those who will benefit the most. We demonstrated the benefit of the proposed framework using two exemplary case studies. Furthermore, transforming a deterministic deep learning model to probabilistic can make predictions with an uncertainty range. We showed that such information has many potential implications in practice, such as quantifying the confidence of a decision, indicating data insufficiency, distinguishing the correct and incorrect predictions, and indicating risk associations. Conclusions: Deep learning models led to substantially improved performance for risk prediction. The ability of uncertainty estimation can quantify the confidence of risk prediction to further inform clinical decision-making. Deep learning model explanation can generate hypotheses to guide medical research and provide counterfactual analysis to assist clinical decision-making. This encouraging evidence supports the great potential of incorporating deep learning methods into electronic health records to inform a wide range of health applications such as care planning, disease prevention, and medical study design

Using machine learning for automated de-identification and clinical coding of free text data in electronic medical records

The widespread adoption of Electronic Medical Records (EMRs) in hospitals continues to increase the amount of patient data that are digitally stored. Although the primary use of the EMR is to support patient care by making all relevant information accessible, governments and health organisations are looking for ways to unleash the potential of these data for secondary purposes, including clinical research, disease surveillance and automation of healthcare processes and workflows. EMRs include large quantities of free text documents that contain valuable information. The greatest challenges in using the free text data in EMRs include the removal of personally identifiable information and the extraction of relevant information for specific tasks such as clinical coding. Machine learning-based automated approaches can potentially address these challenges. This thesis aims to explore and improve the performance of machine learning models for automated de-identification and clinical coding of free text data in EMRs, as captured in hospital discharge summaries, and facilitate the applications of these approaches in real-world use cases. It does so by 1) implementing an end-to-end de-identification framework using an ensemble of deep learning models; 2) developing a web-based system for de-identification of free text (DEFT) with an interactive learning loop; 3) proposing and implementing a hierarchical label-wise attention transformer model (HiLAT) for explainable International Classification of Diseases (ICD) coding; and 4) investigating the use of extreme multi-label long text transformer-based models for automated ICD coding. The key findings include: 1) An end-to-end framework using an ensemble of deep learning base-models achieved excellent performance on the de-identification task. 2) A new web-based de-identification software system (DEFT) can be readily and easily adopted by data custodians and researchers to perform de-identification of free text in EMRs. 3) A novel domain-specific transformer-based model (HiLAT) achieved state-of-the-art (SOTA) results for predicting ICD codes on a Medical Information Mart for Intensive Care (MIMIC-III) dataset comprising the discharge summaries (n=12,808) that are coded with at least one of the most 50 frequent diagnosis and procedure codes. In addition, the label-wise attention scores for the tokens in the discharge summary presented a potential explainability tool for checking the face validity of ICD code predictions. 4) An optimised transformer-based model, PLM-ICD, achieved the latest SOTA results for ICD coding on all the discharge summaries of the MIMIC-III dataset (n=59,652). The segmentation method, which split the long text consecutively into multiple small chunks, addressed the problem of applying transformer-based models to long text datasets. However, using transformer-based models on extremely large label sets needs further research. These findings demonstrate that the de-identification and clinical coding tasks can benefit from the application of machine learning approaches, present practical tools for implementing these approaches, and highlight priorities for further research

Front-Line Physicians' Satisfaction with Information Systems in Hospitals

Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.Peer reviewe

Foundation, Implementation and Evaluation of the MorphoSaurus System: Subword Indexing, Lexical Learning and Word Sense Disambiguation for Medical Cross-Language Information Retrieval

Im medizinischen Alltag, zu welchem viel Dokumentations- und Recherchearbeit gehört, ist mittlerweile der überwiegende Teil textuell kodierter Information elektronisch verfügbar. Hiermit kommt der Entwicklung leistungsfähiger Methoden zur effizienten Recherche eine vorrangige Bedeutung zu. Bewertet man die Nützlichkeit gängiger Textretrievalsysteme aus dem Blickwinkel der medizinischen Fachsprache, dann mangelt es ihnen an morphologischer Funktionalität (Flexion, Derivation und Komposition), lexikalisch-semantischer Funktionalität und der Fähigkeit zu einer sprachübergreifenden Analyse großer Dokumentenbestände. In der vorliegenden Promotionsschrift werden die theoretischen Grundlagen des MorphoSaurus-Systems (ein Akronym für Morphem-Thesaurus) behandelt. Dessen methodischer Kern stellt ein um Morpheme der medizinischen Fach- und Laiensprache gruppierter Thesaurus dar, dessen Einträge mittels semantischer Relationen sprachübergreifend verknüpft sind. Darauf aufbauend wird ein Verfahren vorgestellt, welches (komplexe) Wörter in Morpheme segmentiert, die durch sprachunabhängige, konzeptklassenartige Symbole ersetzt werden. Die resultierende Repräsentation ist die Basis für das sprachübergreifende, morphemorientierte Textretrieval. Neben der Kerntechnologie wird eine Methode zur automatischen Akquise von Lexikoneinträgen vorgestellt, wodurch bestehende Morphemlexika um weitere Sprachen ergänzt werden. Die Berücksichtigung sprachübergreifender Phänomene führt im Anschluss zu einem neuartigen Verfahren zur Auflösung von semantischen Ambiguitäten. Die Leistungsfähigkeit des morphemorientierten Textretrievals wird im Rahmen umfangreicher, standardisierter Evaluationen empirisch getestet und gängigen Herangehensweisen gegenübergestellt

Syndromic surveillance: reports from a national conference, 2003

Overview of Syndromic Surveillance -- What is Syndromic Surveillance? -- Linking Better Surveillance to Better Outcomes -- Review of the 2003 National Syndromic Surveillance Conference - Lessons Learned and Questions To Be Answered -- -- System Descriptions -- New York City Syndromic Surveillance Systems -- Syndrome and Outbreak Detection Using Chief-Complaint Data - Experience of the Real-Time Outbreak and Disease Surveillance Project -- Removing a Barrier to Computer-Based Outbreak and Disease Surveillance - The RODS Open Source Project -- National Retail Data Monitor for Public Health Surveillance -- National Bioterrorism Syndromic Surveillance Demonstration Program -- Daily Emergency Department Surveillance System - Bergen County, New Jersey -- Hospital Admissions Syndromic Surveillance - Connecticut, September 2001-November 2003 -- BioSense - A National Initiative for Early Detection and Quantification of Public Health Emergencies -- Syndromic Surveillance at Hospital Emergency Departments - Southeastern Virginia -- -- Research Methods -- Bivariate Method for Spatio-Temporal Syndromic Surveillance -- Role of Data Aggregation in Biosurveillance Detection Strategies with Applications from ESSENCE -- Scan Statistics for Temporal Surveillance for Biologic Terrorism -- Approaches to Syndromic Surveillance When Data Consist of Small Regional Counts -- Algorithm for Statistical Detection of Peaks - Syndromic Surveillance System for the Athens 2004 Olympic Games -- Taming Variability in Free Text: Application to Health Surveillance -- Comparison of Two Major Emergency Department-Based Free-Text Chief-Complaint Coding Systems -- How Many Illnesses Does One Emergency Department Visit Represent? Using a Population-Based Telephone Survey To Estimate the Syndromic Multiplier -- Comparison of Office Visit and Nurse Advice Hotline Data for Syndromic Surveillance - Baltimore-Washington, D.C., Metropolitan Area, 2002 -- Progress in Understanding and Using Over-the-Counter Pharmaceuticals for Syndromic Surveillance -- -- Evaluation -- Evaluation Challenges for Syndromic Surveillance - Making Incremental Progress -- Measuring Outbreak-Detection Performance By Using Controlled Feature Set Simulations -- Evaluation of Syndromic Surveillance Systems - Design of an Epidemic Simulation Model -- Benchmark Data and Power Calculations for Evaluating Disease Outbreak Detection Methods -- Bio-ALIRT Biosurveillance Detection Algorithm Evaluation -- ESSENCE II and the Framework for Evaluating Syndromic Surveillance Systems -- Conducting Population Behavioral Health Surveillance by Using Automated Diagnostic and Pharmacy Data Systems -- Evaluation of an Electronic General-Practitioner-Based Syndromic Surveillance System -- National Symptom Surveillance Using Calls to a Telephone Health Advice Service - United Kingdom, December 2001-February 2003 -- Field Investigations of Emergency Department Syndromic Surveillance Signals - New York City -- Should We Be Worried? Investigation of Signals Generated by an Electronic Syndromic Surveillance System - Westchester County, New York -- -- Public Health Practice -- Public Health Information Network - Improving Early Detection by Using a Standards-Based Approach to Connecting Public Health and Clinical Medicine -- Information System Architectures for Syndromic Surveillance -- Perspective of an Emergency Physician Group as a Data Provider for Syndromic Surveillance -- SARS Surveillance Project - Internet-Enabled Multiregion Surveillance for Rapidly Emerging Disease -- Health Information Privacy and Syndromic Surveillance SystemsPapers from the second annual National Syndromic Surveillance Conference convened by the New York City Department of Health and Mental Hygiene, the New York Academy of Medicine, and the CDC in New York City during Oct. 23-24, 2003. Published as the September 24, 2004 supplement to vol. 53 of MMWR. Morbidity and mortality weekly report.1571461