Multimodal Machine Learning for Automated ICD Coding

This study presents a multimodal machine learning model to predict ICD-10 diagnostic codes. We developed separate machine learning models that can handle data from different modalities, including unstructured text, semi-structured text and structured tabular data. We further employed an ensemble method to integrate all modality-specific models to generate ICD-10 codes. Key evidence was also extracted to make our prediction more convincing and explainable. We used the Medical Information Mart for Intensive Care III (MIMIC -III) dataset to validate our approach. For ICD code prediction, our best-performing model (micro-F1 = 0.7633, micro-AUC = 0.9541) significantly outperforms other baseline models including TF-IDF (micro-F1 = 0.6721, micro-AUC = 0.7879) and Text-CNN model (micro-F1 = 0.6569, micro-AUC = 0.9235). For interpretability, our approach achieves a Jaccard Similarity Coefficient (JSC) of 0.1806 on text data and 0.3105 on tabular data, where well-trained physicians achieve 0.2780 and 0.5002 respectively.Comment: Machine Learning for Healthcare 201

Distributed knowledge based clinical auto-coding system

Codification of free-text clinical narratives have long been recognised to be beneficial for secondary uses such as funding, insurance claim processing and research. In recent years, many researchers have studied the use of Natural Language Processing (NLP), related Machine Learning (ML) methods and techniques to resolve the problem of manual coding of clinical narratives. Most of the studies are focused on classification systems relevant to the U.S and there is a scarcity of studies relevant to Australian classification systems such as ICD- 10-AM and ACHI. Therefore, we aim to develop a knowledge-based clinical auto-coding system, that utilise appropriate NLP and ML techniques to assign ICD-10-AM and ACHI codes to clinical records, while adhering to both local coding standards (Australian Coding Standard) and international guidelines that get updated and validated continuously

Enhancing Timeliness of Drug Overdose Mortality Surveillance: A Machine Learning Approach

BACKGROUND: Timely data is key to effective public health responses to epidemics. Drug overdose deaths are identified in surveillance systems through ICD-10 codes present on death certificates. ICD-10 coding takes time, but free-text information is available on death certificates prior to ICD-10 coding. The objective of this study was to develop a machine learning method to classify free-text death certificates as drug overdoses to provide faster drug overdose mortality surveillance. METHODS: Using 2017–2018 Kentucky death certificate data, free-text fields were tokenized and features were created from these tokens using natural language processing (NLP). Word, bigram, and trigram features were created as well as features indicating the part-of-speech of each word. These features were then used to train machine learning classifiers on 2017 data. The resulting models were tested on 2018 Kentucky data and compared to a simple rule-based classification approach. Documented code for this method is available for reuse and extensions: https://github.com/pjward5656/dcnlp. RESULTS: The top scoring machine learning model achieved 0.96 positive predictive value (PPV) and 0.98 sensitivity for an F-score of 0.97 in identification of fatal drug overdoses on test data. This machine learning model achieved significantly higher performance for sensitivity (p \u3c 0.001) than the rule-based approach. Additional feature engineering may improve the model’s prediction. This model can be deployed on death certificates as soon as the free-text is available, eliminating the time needed to code the death certificates. CONCLUSION: Machine learning using natural language processing is a relatively new approach in the context of surveillance of health conditions. This method presents an accessible application of machine learning that improves the timeliness of drug overdose mortality surveillance. As such, it can be employed to inform public health responses to the drug overdose epidemic in near-real time as opposed to several weeks following events

Supporting the Billing Process in Outpatient Medical Care: Automated Medical Coding Through Machine Learning

Reimbursement in medical care implies significant administrative effort for medical staff. To bill the treatments or services provided, diagnosis and treatment codes must be assigned to patient records using standardized healthcare classification systems, which is a time-consuming and error-prone task. In contrast to ICD diagnosis codes used in most countries for inpatient care reimbursement, outpatient medical care often involves different reimbursement schemes. Following the Action Design Research methodology, we developed an NLP-based machine learning artifact in close collaboration with a general practitioner’s office in Germany, leveraging a dataset of over 5,600 patients with more than 63,000 billing codes. For the code prediction of most problematic treatments as well as a complete code prediction task, we achieved F1-scores of 93.60 % and 78.22 %, respectively. Throughout three iterations, we derived five meta requirements leading to three design principles for an automated coding system to support the reimbursement of outpatient medical care

Enhancing Drug Overdose Mortality Surveillance through Natural Language Processing and Machine Learning

Epidemiological surveillance is key to monitoring and assessing the health of populations. Drug overdose surveillance has become an increasingly important part of public health practice as overdose morbidity and mortality has increased due in large part to the opioid crisis. Monitoring drug overdose mortality relies on death certificate data, which has several limitations including timeliness and the coding structure used to identify specific substances that caused death. These limitations stem from the need to analyze the free-text cause-of-death sections of the death certificate that are completed by the medical certifier during death investigation. Other fields, including clinical sciences, have utilized natural language processing (NLP) methods to gain insight from free-text data, but thus far, adoption of NLP methods in epidemiological surveillance has been limited. Through a narrative review of NLP methods currently used in public health surveillance and the integration of two NLP tasks, classification and named entity recognition, this dissertation enhances the capabilities of public health practitioners and researchers to perform drug overdose mortality surveillance. This dissertation advances both surveillance science and public health practice by integrating methods from bioinformatics into the surveillance pipeline which provides more timely and increased quality overdose mortality surveillance, which is essential to guiding effective public health response to the continuing drug overdose epidemic

Predicting Multiple ICD-10 Codes from Brazilian-Portuguese Clinical Notes

ICD coding from electronic clinical records is a manual, time-consuming and expensive process. Code assignment is, however, an important task for billing purposes and database organization. While many works have studied the problem of automated ICD coding from free text using machine learning techniques, most use records in the English language, especially from the MIMIC-III public dataset. This work presents results for a dataset with Brazilian Portuguese clinical notes. We develop and optimize a Logistic Regression model, a Convolutional Neural Network (CNN), a Gated Recurrent Unit Neural Network and a CNN with Attention (CNN-Att) for prediction of diagnosis ICD codes. We also report our results for the MIMIC-III dataset, which outperform previous work among models of the same families, as well as the state of the art. Compared to MIMIC-III, the Brazilian Portuguese dataset contains far fewer words per document, when only discharge summaries are used. We experiment concatenating additional documents available in this dataset, achieving a great boost in performance. The CNN-Att model achieves the best results on both datasets, with micro-averaged F1 score of 0.537 on MIMIC-III and 0.485 on our dataset with additional documents.Comment: Accepted at BRACIS 202

Automatic multilabel detection of ICD10 codes in Dutch cardiology discharge letters using neural networks

Standard reference terminology of diagnoses and risk factors is crucial for billing, epidemiological studies, and inter/intranational comparisons of diseases. The International Classification of Disease (ICD) is a standardized and widely used method, but the manual classification is an enormously time-consuming endeavor. Natural language processing together with machine learning allows automated structuring of diagnoses using ICD-10 codes, but the limited performance of machine learning models, the necessity of gigantic datasets, and poor reliability of terminal parts of these codes restricted clinical usability. We aimed to create a high performing pipeline for automated classification of reliable ICD-10 codes in the free medical text in cardiology. We focussed on frequently used and well-defined three- and four-digit ICD-10 codes that still have enough granularity to be clinically relevant such as atrial fibrillation (I48), acute myocardial infarction (I21), or dilated cardiomyopathy (I42.0). Our pipeline uses a deep neural network known as a Bidirectional Gated Recurrent Unit Neural Network and was trained and tested with 5548 discharge letters and validated in 5089 discharge and procedural letters. As in clinical practice discharge letters may be labeled with more than one code, we assessed the single- and multilabel performance of main diagnoses and cardiovascular risk factors. We investigated using both the entire body of text and only the summary paragraph, supplemented by age and sex. Given the privacy-sensitive information included in discharge letters, we added a de-identification step. The performance was high, with F1 scores of 0.76–0.99 for three-character and 0.87–0.98 for four-character ICD-10 codes, and was best when using complete discharge letters. Adding variables age/sex did not affect results. For model interpretability, word coefficients were provided and qualitative assessment of classification was manually performed. Because of its high performance, this pipeline can be useful to decrease the administrative burden of classifying discharge diagnoses and may serve as a scaffold for reimbursement and research applications

Deep learning for ICD coding: Looking for medical concepts in clinical documents in english and in French

© Springer Nature Switzerland AG 2018. Medical Concept Coding (MCD) is a crucial task in biomedical information extraction. Recent advances in neural network modeling have demonstrated its usefulness in the task of natural language processing. Modern framework of sequence-to-sequence learning that was initially used for recurrent neural networks has been shown to provide powerful solution to tasks such as Named Entity Recognition or Medical Concept Coding. We have addressed the identification of clinical concepts within the International Classification of Diseases version 10 (ICD-10) in two benchmark data sets of death certificates provided for the task 1 in the CLEF eHealth shared task 2017. A proposed architecture combines ideas from recurrent neural networks and traditional text retrieval term weighting schemes. We found that our models reach accuracy of 75% and 86% as evaluated by the F-measure on the CépiDc corpus of French texts and on the CDC corpus of English texts, respectfully. The proposed models can be employed for coding electronic medical records with ICD codes including diagnosis and procedure codes

Extreme multi-label deep neural classification of Spanish health records according to the International Classification of Diseases

111 p.Este trabajo trata sobre la minería de textos clínicos, un campo del Procesamiento del Lenguaje Natural aplicado al dominio biomédico. El objetivo es automatizar la tarea de codificación médica. Los registros electrónicos de salud (EHR) son documentos que contienen información clínica sobre la salud de unpaciente. Los diagnósticos y procedimientos médicos plasmados en la Historia Clínica Electrónica están codificados con respecto a la Clasificación Internacional de Enfermedades (CIE). De hecho, la CIE es la base para identificar estadísticas de salud internacionales y el estándar para informar enfermedades y condiciones de salud. Desde la perspectiva del aprendizaje automático, el objetivo es resolver un problema extremo de clasificación de texto de múltiples etiquetas, ya que a cada registro de salud se le asignan múltiples códigos ICD de un conjunto de más de 70 000 términos de diagnóstico. Una cantidad importante de recursos se dedican a la codificación médica, una laboriosa tarea que actualmente se realiza de forma manual. Los EHR son narraciones extensas, y los codificadores médicos revisan los registros escritos por los médicos y asignan los códigos ICD correspondientes. Los textos son técnicos ya que los médicos emplean una jerga médica especializada, aunque rica en abreviaturas, acrónimos y errores ortográficos, ya que los médicos documentan los registros mientras realizan la práctica clínica real. Paraabordar la clasificación automática de registros de salud, investigamos y desarrollamos un conjunto de técnicas de clasificación de texto de aprendizaje profundo