COMPLEX QUESTION ANSWERING BASED ON A SEMANTIC DOMAIN MODEL OF CLINICAL MEDICINE

Much research in recent years has focused on question answering. Due to significant advances in answering simple fact-seeking questions, research is moving towards resolving complex questions. An approach adopted by many researchers is to decompose a complex question into a series of fact-seeking questions and reuse techniques developed for answering simple questions. This thesis presents an alternative novel approach to domain-specific complex question answering based on consistently applying a semantic domain model to question and document understanding as well as to answer extraction and generation. This study uses a semantic domain model of clinical medicine to encode (a) a clinician's information need expressed as a question on the one hand and (b) the meaning of scientific publications on the other to yield a common representation. It is hypothesized that this approach will work well for (1) finding documents that contain answers to clinical questions and (2) extracting these answers from the documents. The domain of clinical question answering was selected primarily because of its unparalleled resources that permit providing a proof by construction for this hypothesis. In addition, a working prototype of a clinical question answering system will support research in informed clinical decision making. The proposed methodology is based on the semantic domain model developed within the paradigm of Evidence Based Medicine. Three basic components of this model - the clinical task, a framework for capturing a synopsis of a clinical scenario that generated the question, and strength of evidence presented in an answer - are identified and discussed in detail. Algorithms and methods were developed that combine knowledge-based and statistical techniques to extract the basic components of the domain model from abstracts of biomedical articles. These algorithms serve as a foundation for the prototype end-to-end clinical question answering system that was built and evaluated to test the hypotheses. Evaluation of the system on test collections developed in the course of this work and based on real life clinical questions demonstrates feasibility of complex question answering and high accuracy information retrieval using a semantic domain model

Formative evaluation of a patient-specific clinical knowledge summarization tool

To iteratively design a prototype of a computerized clinical knowledge summarization (CKS) tool aimed at helping clinicians finding answers to their clinical questions; and to conduct a formative assessment of the usability, usefulness, efficiency, and impact of the CKS prototype on physicians’ perceived decision quality compared with standard search of UpToDate and PubMed

CiteFinder: a System to Find and Rank Medical Citations

This thesis presents CiteFinder, a system to find relevant citations for clinicians\u27 written content. Inclusion of citations for clinical information content makes the content more reliable through the provision of scientific articles as references, and enables clinicians to easily update their written content using new information. The proposed approach splits the content into sentences, identifies the sentences that need to be supported with citations by applying classification algorithms, and uses information retrieval and ranking techniques to extract and rank relevant citations from MEDLINE for any given sentence. Additionally, this system extracts snippets from the retrieved articles. We assessed our approach on 3,699 MEDLINE papers on the subject of Heart Failure . We implemented multi-level and weight ranking algorithms to rank the citations. This study shows that using Journal priority and Study Design type significantly improves results obtained with the traditional approach of only using the text of articles, by approximately 63%. We also show that using the full-text, rather than just the abstract text, leads to extraction of higher quality snippets

Suggested approach for establishing a rehabilitation engineering information service for the state of California

An ever expanding body of rehabilitation engineering technology is developing in this country, but it rarely reaches the people for whom it is intended. The increasing concern of state and federal departments of rehabilitation for this technology lag was the stimulus for a series of problem-solving workshops held in California during 1977. As a result of the workshops, the recommendation emerged that the California Department of Rehabilitation take the lead in the development of a coordinated delivery system that would eventually serve the entire state and be a model for similar systems across the nation

Clinical Context-Aware Biomedical Text Summarization Using Deep Neural Network: Model Development and Validation

BACKGROUND: Automatic text summarization (ATS) enables users to retrieve meaningful evidence from big data of biomedical repositories to make complex clinical decisions. Deep neural and recurrent networks outperform traditional machine-learning techniques in areas of natural language processing and computer vision; however, they are yet to be explored in the ATS domain, particularly for medical text summarization. OBJECTIVE: Traditional approaches in ATS for biomedical text suffer from fundamental issues such as an inability to capture clinical context, quality of evidence, and purpose-driven selection of passages for the summary. We aimed to circumvent these limitations through achieving precise, succinct, and coherent information extraction from credible published biomedical resources, and to construct a simplified summary containing the most informative content that can offer a review particular to clinical needs. METHODS: In our proposed approach, we introduce a novel framework, termed Biomed-Summarizer, that provides quality-aware Patient/Problem, Intervention, Comparison, and Outcome (PICO)-based intelligent and context-enabled summarization of biomedical text. Biomed-Summarizer integrates the prognosis quality recognition model with a clinical context-aware model to locate text sequences in the body of a biomedical article for use in the final summary. First, we developed a deep neural network binary classifier for quality recognition to acquire scientifically sound studies and filter out others. Second, we developed a bidirectional long-short term memory recurrent neural network as a clinical context-aware classifier, which was trained on semantically enriched features generated using a word-embedding tokenizer for identification of meaningful sentences representing PICO text sequences. Third, we calculated the similarity between query and PICO text sequences using Jaccard similarity with semantic enrichments, where the semantic enrichments are obtained using medical ontologies. Last, we generated a representative summary from the high-scoring PICO sequences aggregated by study type, publication credibility, and freshness score. RESULTS: Evaluation of the prognosis quality recognition model using a large dataset of biomedical literature related to intracranial aneurysm showed an accuracy of 95.41% (2562/2686) in terms of recognizing quality articles. The clinical context-aware multiclass classifier outperformed the traditional machine-learning algorithms, including support vector machine, gradient boosted tree, linear regression, K-nearest neighbor, and naïve Bayes, by achieving 93% (16127/17341) accuracy for classifying five categories: aim, population, intervention, results, and outcome. The semantic similarity algorithm achieved a significant Pearson correlation coefficient of 0.61 (0-1 scale) on a well-known BIOSSES dataset (with 100 pair sentences) after semantic enrichment, representing an improvement of 8.9% over baseline Jaccard similarity. Finally, we found a highly positive correlation among the evaluations performed by three domain experts concerning different metrics, suggesting that the automated summarization is satisfactory. CONCLUSIONS: By employing the proposed method Biomed-Summarizer, high accuracy in ATS was achieved, enabling seamless curation of research evidence from the biomedical literature to use for clinical decision-making

Question answering systems for health professionals at the point of care -- a systematic review

Objective: Question answering (QA) systems have the potential to improve the quality of clinical care by providing health professionals with the latest and most relevant evidence. However, QA systems have not been widely adopted. This systematic review aims to characterize current medical QA systems, assess their suitability for healthcare, and identify areas of improvement. Materials and methods: We searched PubMed, IEEE Xplore, ACM Digital Library, ACL Anthology and forward and backward citations on 7th February 2023. We included peer-reviewed journal and conference papers describing the design and evaluation of biomedical QA systems. Two reviewers screened titles, abstracts, and full-text articles. We conducted a narrative synthesis and risk of bias assessment for each study. We assessed the utility of biomedical QA systems. Results: We included 79 studies and identified themes, including question realism, answer reliability, answer utility, clinical specialism, systems, usability, and evaluation methods. Clinicians' questions used to train and evaluate QA systems were restricted to certain sources, types and complexity levels. No system communicated confidence levels in the answers or sources. Many studies suffered from high risks of bias and applicability concerns. Only 8 studies completely satisfied any criterion for clinical utility, and only 7 reported user evaluations. Most systems were built with limited input from clinicians. Discussion: While machine learning methods have led to increased accuracy, most studies imperfectly reflected real-world healthcare information needs. Key research priorities include developing more realistic healthcare QA datasets and considering the reliability of answer sources, rather than merely focusing on accuracy.Comment: Accepted to the Journal of the American Medical Informatics Association (JAMIA

Information Systems and Healthcare XXXIV: Clinical Knowledge Management Systems—Literature Review and Research Issues for Information Systems

Knowledge Management (KM) has emerged as a possible solution to many of the challenges facing U.S. and international healthcare systems. These challenges include concerns regarding the safety and quality of patient care, critical inefficiency, disparate technologies and information standards, rapidly rising costs and clinical information overload. In this paper, we focus on clinical knowledge management systems (CKMS) research. The objectives of the paper are to evaluate the current state of knowledge management systems diffusion in the clinical setting, assess the present status and focus of CKMS research efforts, and identify research gaps and opportunities for future work across the medical informatics and information systems disciplines. The study analyzes the literature along two dimensions: (1) the knowledge management processes of creation, capture, transfer, and application, and (2) the clinical processes of diagnosis, treatment, monitoring and prognosis. The study reveals that the vast majority of CKMS research has been conducted by the medical and health informatics communities. Information systems (IS) researchers have played a limited role in past CKMS research. Overall, the results indicate that there is considerable potential for IS researchers to contribute their expertise to the improvement of clinical process through technology-based KM approaches