Social and behavioral determinants of health in the era of artificial intelligence with electronic health records: A scoping review

Background: There is growing evidence that social and behavioral determinants of health (SBDH) play a substantial effect in a wide range of health outcomes. Electronic health records (EHRs) have been widely employed to conduct observational studies in the age of artificial intelligence (AI). However, there has been little research into how to make the most of SBDH information from EHRs. Methods: A systematic search was conducted in six databases to find relevant peer-reviewed publications that had recently been published. Relevance was determined by screening and evaluating the articles. Based on selected relevant studies, a methodological analysis of AI algorithms leveraging SBDH information in EHR data was provided. Results: Our synthesis was driven by an analysis of SBDH categories, the relationship between SBDH and healthcare-related statuses, and several NLP approaches for extracting SDOH from clinical literature. Discussion: The associations between SBDH and health outcomes are complicated and diverse; several pathways may be involved. Using Natural Language Processing (NLP) technology to support the extraction of SBDH and other clinical ideas simplifies the identification and extraction of essential concepts from clinical data, efficiently unlocks unstructured data, and aids in the resolution of unstructured data-related issues. Conclusion: Despite known associations between SBDH and disease, SBDH factors are rarely investigated as interventions to improve patient outcomes. Gaining knowledge about SBDH and how SBDH data can be collected from EHRs using NLP approaches and predictive models improves the chances of influencing health policy change for patient wellness, and ultimately promoting health and health equity. Keywords: Social and Behavioral Determinants of Health, Artificial Intelligence, Electronic Health Records, Natural Language Processing, Predictive ModelComment: 32 pages, 5 figure

The 2022 n2c2/UW Shared Task on Extracting Social Determinants of Health

Objective: The n2c2/UW SDOH Challenge explores the extraction of social determinant of health (SDOH) information from clinical notes. The objectives include the advancement of natural language processing (NLP) information extraction techniques for SDOH and clinical information more broadly. This paper presents the shared task, data, participating teams, performance results, and considerations for future work. Materials and Methods: The task used the Social History Annotated Corpus (SHAC), which consists of clinical text with detailed event-based annotations for SDOH events such as alcohol, drug, tobacco, employment, and living situation. Each SDOH event is characterized through attributes related to status, extent, and temporality. The task includes three subtasks related to information extraction (Subtask A), generalizability (Subtask B), and learning transfer (Subtask C). In addressing this task, participants utilized a range of techniques, including rules, knowledge bases, n-grams, word embeddings, and pretrained language models (LM). Results: A total of 15 teams participated, and the top teams utilized pretrained deep learning LM. The top team across all subtasks used a sequence-to-sequence approach achieving 0.901 F1 for Subtask A, 0.774 F1 Subtask B, and 0.889 F1 for Subtask C. Conclusions: Similar to many NLP tasks and domains, pretrained LM yielded the best performance, including generalizability and learning transfer. An error analysis indicates extraction performance varies by SDOH, with lower performance achieved for conditions, like substance use and homelessness, that increase health risks (risk factors) and higher performance achieved for conditions, like substance abstinence and living with family, that reduce health risks (protective factors)

SDOH-NLI: a Dataset for Inferring Social Determinants of Health from Clinical Notes

Social and behavioral determinants of health (SDOH) play a significant role in shaping health outcomes, and extracting these determinants from clinical notes is a first step to help healthcare providers systematically identify opportunities to provide appropriate care and address disparities. Progress on using NLP methods for this task has been hindered by the lack of high-quality publicly available labeled data, largely due to the privacy and regulatory constraints on the use of real patients' information. This paper introduces a new dataset, SDOH-NLI, that is based on publicly available notes and which we release publicly. We formulate SDOH extraction as a natural language inference (NLI) task, and provide binary textual entailment labels obtained from human raters for a cross product of a set of social history snippets as premises and SDOH factors as hypotheses. Our dataset differs from standard NLI benchmarks in that our premises and hypotheses are obtained independently. We evaluate both "off-the-shelf" entailment models as well as models fine-tuned on our data, and highlight the ways in which our dataset appears more challenging than commonly used NLI datasets.Comment: Findings of EMNLP 202

ICE-MILK: Intelligent Crowd Engineering using Machine-based Internet of Things Learning and Knowledge Building

Title from PDF of title page viewed June 1, 2022Dissertation advisor: Sejun SongVitaIncludes bibliographical references (pages 136-159)Thesis (Ph.D.)--School of Computing and Engineering. University of Missouri--Kansas City, 2022The lack of proper crowd safety control and management often leads to spreading human casualties and infectious diseases (e.g., COVID-19). Many Machine Learning (ML) technologies inspired by computer vision and video surveillance systems have been developed for crowd counting and density estimation to prevent potential personal injuries and deaths at densely crowded political, entertaining, and religious events. However, existing crowd safety management systems have significant challenges and limitations on their accuracy, scalability, and capacity to identify crowd characterization among people in crowds in real-time, such as a group characterization, impact of occlusions, mobility and contact tracing, and distancing. In this dissertation, we propose an Intelligent Crowd Engineering platform using Machine-based Internet of Things Learning, and Knowledge Building approaches (ICE-MILK) to enhance the accuracy, scalability, and crowd safety management capacity in real-time. Specifically, we design an ICE-MILK structure with three critical layers: IoT-based mobility characterization, ML-based video surveillance, and semantic information-based application layers. We built an IoT-based mobility characterization system by predicting and preventing potential disasters through real-time Radio Frequency (RF) data characterization and analytics. We tackle object group identification, speed, direction detection, and density for the mobile group among the many crowd mobility characteristics. Also, we tackled an ML-based video surveillance approach for effective dense crowd counting by characterizing scattered occlusions, named CSONet. CSONet recognizes the implications of event-induced, scene-embedded, and multitudinous obstacles such as umbrellas and picket signs to achieve an accurate crowd analysis result. Finally, we developed a couple of group semantics to track and prevent crowd-caused infectious diseases. We introduce a novel COVID-19 tracing application named Crowd-based Alert and Tracing Services (CATS) and a novel face masking and social distancing monitoring system for Modeling Safety Index in Crowd (MOSAIC). CATS and MOSAIC apply privacy-aware contact tracing, social distancing, and calculate spatiotemporal Safety Index (SI) values for the individual community to provide higher privacy protection, efficient penetration of technology, greater accuracy, and effective practical policy assistance.Introduction -- Literature review -- IoT-based mobility characterization -- ML-based video/image surveillance -- Semantic knowledge information-based tracing application -- Conclusions and future directions -- Appendi

Machine learning approaches to identifying social determinants of health in electronic health record clinical notes

Social determinants of health (SDH) represent the complex set of circumstances in which individuals are born, or with which they live, that impact health. Relatively little attention has been given to processes needed to extract SDH data from electronic health records. Despite their importance, SDH data in the EHR remains sparse, typically collected only in clinical notes and thus largely unavailable for clinical decision making. I focus on developing and validating more efficient information extraction approaches to identifying and classifying SDH in clinical notes. In this dissertation, I have three goals: First, I develop a word embedding model to expand SDH terminology in the context of identifying SDH clinical text. Second, I examine the effectiveness of different machine learning algorithms and a neural network model to classify the SDH characteristics financial resource strain and poor social support. Third, I compare the highest performing approaches to simpler text mining techniques and evaluate the models based on performance, cost, and generalizability in the task of classifying SDH in two distinct data sources.Doctor of Philosoph

An Evaluation of Computational Methods to Support the Clinical Management of Chronic Disease Populations

Innovative primary care models that deliver comprehensive primary care to address medical and social needs are an established means of improving health outcomes and reducing healthcare costs among persons living with chronic disease. Care management is one such approach that requires providers to monitor their respective patient panels and intervene on patients requiring care. Health information technology (IT) has been established as a critical component of care management and similar care models. While there exist a plethora of health IT systems for facilitating primary care, there is limited research on their ability to support care management and its emphasis on monitoring panels of patients with complex needs. In this dissertation, I advance the understanding of how computational methods can better support clinicians delivering care management, and use the management of human immunodeficiency virus (HIV) as an example scenario of use. The research described herein is segmented into 3 aims; the first was to understand the processes and barriers associated with care management and assess whether existing IT can support clinicians in this domain. The second and third aim focused on informing potential solutions to the technological shortcomings identified in the first aim. In the studies of the first aim, I conducted interviews and observations in two HIV primary care programs and analyzed the data generated to create a conceptual framework of population monitoring and identify challenges faced by clinicians in delivering care management. In the studies of the second aim, I used computational methods to advance the science of extracting from the patient record social and behavioral determinants of health (SBDH), which are not easily accessible to clinicians and represent an important barrier to care management. In the third aim, I conducted a controlled experimental evaluation to assess whether data visualization can improve clinician’s ability to maintain awareness of their patient panels

Opportunities and obstacles for deep learning in biology and medicine

Deep learning describes a class of machine learning algorithms that are capable of combining raw inputs into layers of intermediate features. These algorithms have recently shown impressive results across a variety of domains. Biology and medicine are data-rich disciplines, but the data are complex and often ill-understood. Hence, deep learning techniques may be particularly well suited to solve problems of these fields. We examine applications of deep learning to a variety of biomedical problems-patient classification, fundamental biological processes and treatment of patients-and discuss whether deep learning will be able to transform these tasks or if the biomedical sphere poses unique challenges. Following from an extensive literature review, we find that deep learning has yet to revolutionize biomedicine or definitively resolve any of the most pressing challenges in the field, but promising advances have been made on the prior state of the art. Even though improvements over previous baselines have been modest in general, the recent progress indicates that deep learning methods will provide valuable means for speeding up or aiding human investigation. Though progress has been made linking a specific neural network\u27s prediction to input features, understanding how users should interpret these models to make testable hypotheses about the system under study remains an open challenge. Furthermore, the limited amount of labelled data for training presents problems in some domains, as do legal and privacy constraints on work with sensitive health records. Nonetheless, we foresee deep learning enabling changes at both bench and bedside with the potential to transform several areas of biology and medicine