A Systematic Review of Natural Language Processing for Knowledge Management in Healthcare

Driven by the visions of Data Science, recent years have seen a paradigm shift in Natural Language Processing (NLP). NLP has set the milestone in text processing and proved to be the preferred choice for researchers in the healthcare domain. The objective of this paper is to identify the potential of NLP, especially, how NLP is used to support the knowledge management process in the healthcare domain, making data a critical and trusted component in improving health outcomes. This paper provides a comprehensive survey of the state-of-the-art NLP research with a particular focus on how knowledge is created, captured, shared, and applied in the healthcare domain. Our findings suggest, first, the techniques of NLP those supporting knowledge management extraction and knowledge capture processes in healthcare. Second, we propose a conceptual model for the knowledge extraction process through NLP. Finally, we discuss a set of issues, challenges, and proposed future research areas

A Systematic Review of Natural Language Processing for Knowledge Management in Healthcare

Driven by the visions of Data Science, recent years have seen a paradigm shift in Natural Language Processing (NLP). NLP has set the milestone in text processing and proved to be the preferred choice for researchers in the healthcare domain. The objective of this paper is to identify the potential of NLP, especially, how NLP is used to support the knowledge management process in the healthcare domain, making data a critical and trusted component in improving the health outcomes. This paper provides a comprehensive survey of the state-of-the-art NLP research with a particular focus on how knowledge is created, captured, shared, and applied in the healthcare domain. Our findings suggest, first, the techniques of NLP those supporting knowledge management extraction and knowledge capture processes in healthcare. Second, we propose a conceptual model for the knowledge extraction process through NLP. Finally, we discuss a set of issues, challenges, and proposed future research areas

Zero-shot information extraction from radiological reports using ChatGPT

Electronic health records contain an enormous amount of valuable information, but many are recorded in free text. Information extraction is the strategy to transform the sequence of characters into structured data, which can be employed for secondary analysis. However, the traditional information extraction components, such as named entity recognition and relation extraction, require annotated data to optimize the model parameters, which has become one of the major bottlenecks in building information extraction systems. With the large language models achieving good performances on various downstream NLP tasks without parameter tuning, it becomes possible to use large language models for zero-shot information extraction. In this study, we aim to explore whether the most popular large language model, ChatGPT, can extract useful information from the radiological reports. We first design the prompt template for the interested information in the CT reports. Then, we generate the prompts by combining the prompt template with the CT reports as the inputs of ChatGPT to obtain the responses. A post-processing module is developed to transform the responses into structured extraction results. We conducted the experiments with 847 CT reports collected from Peking University Cancer Hospital. The experimental results indicate that ChatGPT can achieve competitive performances for some extraction tasks compared with the baseline information extraction system, but some limitations need to be further improved

Clinical text data in machine learning: Systematic review

Background: Clinical narratives represent the main form of communication within healthcare providing a personalized account of patient history and assessments, offering rich information for clinical decision making. Natural language processing (NLP) has repeatedly demonstrated its feasibility to unlock evidence buried in clinical narratives. Machine learning can facilitate rapid development of NLP tools by leveraging large amounts of text data. Objective: The main aim of this study is to provide systematic evidence on the properties of text data used to train machine learning approaches to clinical NLP. We also investigate the types of NLP tasks that have been supported by machine learning and how they can be applied in clinical practice. Methods: Our methodology was based on the guidelines for performing systematic reviews. In August 2018, we used PubMed, a multi-faceted interface, to perform a literature search against MEDLINE. We identified a total of 110 relevant studies and extracted information about the text data used to support machine learning, the NLP tasks supported and their clinical applications. The data properties considered included their size, provenance, collection methods, annotation and any relevant statistics. Results: The vast majority of datasets used to train machine learning models included only hundreds or thousands of documents. Only 10 studies used tens of thousands of documents with a handful of studies utilizing more. Relatively small datasets were utilized for training even when much larger datasets were available. The main reason for such poor data utilization is the annotation bottleneck faced by supervised machine learning algorithms. Active learning was explored to iteratively sample a subset of data for manual annotation as a strategy for minimizing the annotation effort while maximizing predictive performance of the model. Supervised learning was successfully used where clinical codes integrated with free text notes into electronic health records were utilized as class labels. Similarly, distant supervision was used to utilize an existing knowledge base to automatically annotate raw text. Where manual annotation was unavoidable, crowdsourcing was explored, but it remains unsuitable due to sensitive nature of data considered. Beside the small volume, training data were typically sourced from a small number of institutions, thus offering no hard evidence about the transferability of machine learning models. The vast majority of studies focused on the task of text classification. Most commonly, the classification results were used to support phenotyping, prognosis, care improvement, resource management and surveillance. Conclusions: We identified the data annotation bottleneck as one of the key obstacles to machine learning approaches in clinical NLP. Active learning and distant supervision were explored as a way of saving the annotation efforts. Future research in this field would benefit from alternatives such as data augmentation and transfer learning, or unsupervised learning, which does not require data annotation

Seeking to Learn versus Seeking to Teach: Network Position and Timely Electronic Documentation in Healthcare Practice

Timely documentation of administered medications is enabled by electronic medical records (EMR) systems, but also made more difficult due to increased task interdependencies in EMR-enabled medication administration practice. We investigate how clinicians can use their advice networks to accomplish timely EMR documentation. We consider the novel social structures through which nurses actively solicit advice (“seeking-to-learn” network) versus actively contribute unsolicited insights (“seeking-to-teach” network) in the course of patient-care work. Results from 2-level hierarchical linear modeling showed that while clinicians are better off “seeking-to-learn” from positions of brokerage/gatekeeping over requests for advice (betweenness centrality), they are better off “seeking-to-teach” from positions where their indirect contacts are within relatively close reach (closeness centrality) and their direct contacts are highly influential or popular (Bonacich Power centrality). Our study contributes by providing a more nuanced conceptualization of advice networks as a novel way of addressing a major information systems issue in healthcare

J Biomed Inform

We followed a systematic approach based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify existing clinical natural language processing (NLP) systems that generate structured information from unstructured free text. Seven literature databases were searched with a query combining the concepts of natural language processing and structured data capture. Two reviewers screened all records for relevance during two screening phases, and information about clinical NLP systems was collected from the final set of papers. A total of 7149 records (after removing duplicates) were retrieved and screened, and 86 were determined to fit the review criteria. These papers contained information about 71 different clinical NLP systems, which were then analyzed. The NLP systems address a wide variety of important clinical and research tasks. Certain tasks are well addressed by the existing systems, while others remain as open challenges that only a small number of systems attempt, such as extraction of temporal information or normalization of concepts to standard terminologies. This review has identified many NLP systems capable of processing clinical free text and generating structured output, and the information collected and evaluated here will be important for prioritizing development of new approaches for clinical NLP.CC999999/ImCDC/Intramural CDC HHS/United States2019-11-20T00:00:00Z28729030PMC6864736694

The Revival of the Notes Field: Leveraging the Unstructured Content in Electronic Health Records

Problem: Clinical practice requires the production of a time- and resource-consuming great amount of notes. They contain relevant information, but their secondary use is almost impossible, due to their unstructured nature. Researchers are trying to address this problems, with traditional and promising novel techniques. Application in real hospital settings seems not to be possible yet, though, both because of relatively small and dirty dataset, and for the lack of language-specific pre-trained models.Aim: Our aim is to demonstrate the potential of the above techniques, but also raise awareness of the still open challenges that the scientific communities of IT and medical practitioners must jointly address to realize the full potential of unstructured content that is daily produced and digitized in hospital settings, both to improve its data quality and leverage the insights from data-driven predictive models.Methods: To this extent, we present a narrative literature review of the most recent and relevant contributions to leverage the application of Natural Language Processing techniques to the free-text content electronic patient records. In particular, we focused on four selected application domains, namely: data quality, information extraction, sentiment analysis and predictive models, and automated patient cohort selection. Then, we will present a few empirical studies that we undertook at a major teaching hospital specializing in musculoskeletal diseases.Results: We provide the reader with some simple and affordable pipelines, which demonstrate the feasibility of reaching literature performance levels with a single institution non-English dataset. In such a way, we bridged literature and real world needs, performing a step further toward the revival of notes fields

Medication-related information needs of point of care registered nurses during patient transfer

Medication errors are a major concern for the U.S. healthcare system with between 380,000 and 450,000 preventable adverse drug events in hospitals each year. Because half the medication errors occur at admission, transfer, or discharge, The Joint Commission requires collection of a medication history and performing medication reconciliation. The purpose of this study was to gain an understanding of registered nurses’ (RNs) information needs during medication processes throughout the patient intrahospital transfer process. The following research questions were examined: what are RNs’ perceptions of information needs while performing medication management throughout the patient intrahospital transfer process, what are the perceived facilitators and barriers to resolving RNs’ information needs while performing medication management throughout the patient intrahospital transfer process, and do perceived RN information needs affect resulting communication and decision-making while performing medication management throughout the patient intrahospital transfer process? A qualitative descriptive study design using content analysis methodology was implemented. Ten RNs participated in the study. Semi-structured interview questions focused on the components of medication use processes: obtaining a patient’s medication history, medication reconciliation, and administering the first dose of a medication order following a patient’s intrahospital transfer. Four themes and seven sub-themes emerged from the interviews. RNs have clinical knowledge and patient information needs during medication use processes,. Registered nurses also said trust was an important element when collecting a patient’s current medication list. Furthermore, colleagues were used as an information source to resolve information needs, depending on the colleague’s experience. There are facilitators and barriers to resolving information needs, such as the patient and electronic health record. An additional facilitator was the importance of assigning task responsibility in the processes. Information needs affected nurses’ decision-making abilities with respect to determining completion of patients’ current medication lists and determining the appropriateness of holding specific doses of medication. Finally, RNs shared experiences where communication served as potentially dangerous workarounds to resolving information needs.Nursin