Understanding Patient Safety Reports via Multi-label Text Classification and Semantic Representation

Medical errors are the results of problems in health care delivery. One of the key steps to eliminate errors and improve patient safety is through patient safety event reporting. A patient safety report may record a number of critical factors that are involved in the health care when incidents, near misses, and unsafe conditions occur. Therefore, clinicians and risk management can generate actionable knowledge by harnessing useful information from reports. To date, efforts have been made to establish a nationwide reporting and error analysis mechanism. The increasing volume of reports has been driving improvement in quantity measures of patient safety. For example, statistical distributions of errors across types of error and health care settings have been well documented. Nevertheless, a shift to quality measure is highly demanded. In a health care system, errors are likely to occur if one or more components (e.g., procedures, equipment, etc.) that are intrinsically associated go wrong. However, our understanding of what and how these components are connected is limited for at least two reasons. Firstly, the patient safety reports present difficulties in aggregate analysis since they are large in volume and complicated in semantic representation. Secondly, an efficient and clinically valuable mechanism to identify and categorize these components is absent. I strive to make my contribution by investigating the multi-labeled nature of patient safety reports. To facilitate clinical implementation, I propose that machine learning and semantic information of reports, e.g., semantic similarity between terms, can be used to jointly perform automated multi-label classification. My work is divided into three specific aims. In the first aim, I developed a patient safety ontology to enhance semantic representation of patient safety reports. The ontology supports a number of applications including automated text classification. In the second aim, I evaluated multilabel text classification algorithms on patient safety reports. The results demonstrated a list of productive algorithms with balanced predictive power and efficiency. In the third aim, to improve the performance of text classification, I developed a framework for incorporating semantic similarity and kernel-based multi-label text classification. Semantic similarity values produced by different semantic representation models are evaluated in the classification tasks. Both ontology-based and distributional semantic similarity exerted positive influence on classification performance but the latter one shown significant efficiency in terms of the measure of semantic similarity. Our work provides insights into the nature of patient safety reports, that is a report can be labeled by multiple components (e.g., different procedures, settings, error types, and contributing factors) it contains. Multi-labeled reports hold promise to disclose system vulnerabilities since they provide the insight of the intrinsically correlated components of health care systems. I demonstrated the effectiveness and efficiency of the use of automated multi-label text classification embedded with semantic similarity information on patient safety reports. The proposed solution holds potential to incorporate with existing reporting systems, significantly reducing the workload of aggregate report analysis

Determining the Characteristic Vocabulary for a Specialized Dictionary using Word2vec and a Directed Crawler

Specialized dictionaries are used to understand concepts in specific domains, especially where those concepts are not part of the general vocabulary, or having meanings that differ from ordinary languages. The first step in creating a specialized dictionary involves detecting the characteristic vocabulary of the domain in question. Classical methods for detecting this vocabulary involve gathering a domain corpus, calculating statistics on the terms found there, and then comparing these statistics to a background or general language corpus. Terms which are found significantly more often in the specialized corpus than in the background corpus are candidates for the characteristic vocabulary of the domain. Here we present two tools, a directed crawler, and a distributional semantics package, that can be used together, circumventing the need of a background corpus. Both tools are available on the web

Distributional Semantic Models for Clinical Text Applied to Health Record Summarization

As information systems in the health sector are becoming increasingly computerized, large amounts of care-related information are being stored electronically. In hospitals clinicians continuously document treatment and care given to patients in electronic health record (EHR) systems. Much of the information being documented is in the form of clinical notes, or narratives, containing primarily unstructured free-text information. For each care episode, clinical notes are written on a regular basis, ending with a discharge summary that basically summarizes the care episode. Although EHR systems are helpful for storing and managing such information, there is an unrealized potential in utilizing this information for smarter care assistance, as well as for secondary purposes such as research and education. Advances in clinical language processing are enabling computers to assist clinicians in their interaction with the free-text information documented in EHR systems. This includes assisting in tasks like query-based search, terminology development, knowledge extraction, translation, and summarization. This thesis explores various computerized approaches and methods aimed at enabling automated semantic textual similarity assessment and information extraction based on the free-text information in EHR systems. The focus is placed on the task of (semi-)automated summarization of the clinical notes written during individual care episodes. The overall theme of the presented work is to utilize resource-light approaches and methods, circumventing the need to manually develop knowledge resources or training data. Thus, to enable computational semantic textual similarity assessment, word distribution statistics are derived from large training corpora of clinical free text and stored as vector-based representations referred to as distributional semantic models. Also resource-light methods are explored in the task of performing automatic summarization of clinical freetext information, relying on semantic textual similarity assessment. Novel and experimental methods are presented and evaluated that focus on: a) distributional semantic models trained in an unsupervised manner from statistical information derived from large unannotated clinical free-text corpora; b) representing and computing semantic similarities between linguistic items of different granularity, primarily words, sentences and clinical notes; and c) summarizing clinical free-text information from individual care episodes. Results are evaluated against gold standards that reflect human judgements. The results indicate that the use of distributional semantics is promising as a resource-light approach to automated capturing of semantic textual similarity relations from unannotated clinical text corpora. Here it is important that the semantics correlate with the clinical terminology, and with various semantic similarity assessment tasks. Improvements over classical approaches are achieved when the underlying vector-based representations allow for a broader range of semantic features to be captured and represented. These are either distributed over multiple semantic models trained with different features and training corpora, or use models that store multiple sense-vectors per word. Further, the use of structured meta-level information accompanying care episodes is explored as training features for distributional semantic models, with the aim of capturing semantic relations suitable for care episode-level information retrieval. Results indicate that such models performs well in clinical information retrieval. It is shown that a method called Random Indexing can be modified to construct distributional semantic models that capture multiple sense-vectors for each word in the training corpus. This is done in a way that retains the original training properties of the Random Indexing method, by being incremental, scalable and distributional. Distributional semantic models trained with a framework called Word2vec, which relies on the use of neural networks, outperform those trained using the classic Random Indexing method in several semantic similarity assessment tasks, when training is done using comparable parameters and the same training corpora. Finally, several statistical features in clinical text are explored in terms of their ability to indicate sentence significance in a text summary generated from the clinical notes. This includes the use of distributional semantics to enable case-based similarity assessment, where cases are other care episodes and their “solutions”, i.e., discharge summaries. A type of manual evaluation is performed, where human experts rates the different aspects of the summaries using a evaluation scheme/tool. In addition, the original clinician-written discharge summaries are explored as gold standard for the purpose of automated evaluation. Evaluation shows a high correlation between manual and automated evaluation, suggesting that such a gold standard can function as a proxy for human evaluations. --- This thesis has been published jointly with Norwegian University of Science and Technology, Norway and University of Turku, Finland.This thesis has beenpublished jointly with Norwegian University of Science and Technology, Norway.Siirretty Doriast

Topic-Specific Sentiment Analysis Can Help Identify Political Ideology

Ideological leanings of an individual can often be gauged by the sentiment one expresses about different issues. We propose a simple framework that represents a political ideology as a distribution of sentiment polarities towards a set of topics. This representation can then be used to detect ideological leanings of documents (speeches, news articles, etc.) based on the sentiments expressed towards different topics. Experiments performed using a widely used dataset show the promise of our proposed approach that achieves comparable performance to other methods despite being much simpler and more interpretable.Comment: Presented at EMNLP Workshop on Computational Approaches to Subjectivity, Sentiment & Social Media Analysis, 201

Care episode retrieval: distributional semantic models for information retrieval in the clinical domain

Patients' health related information is stored in electronic health records (EHRs) by health service providers. These records include sequential documentation of care episodes in the form of clinical notes. EHRs are used throughout the health care sector by professionals, administrators and patients, primarily for clinical purposes, but also for secondary purposes such as decision support and research. The vast amounts of information in EHR systems complicate information management and increase the risk of information overload. Therefore, clinicians and researchers need new tools to manage the information stored in the EHRs. A common use case is, given a - possibly unfinished - care episode, to retrieve the most similar care episodes among the records. This paper presents several methods for information retrieval, focusing on care episode retrieval, based on textual similarity, where similarity is measured through domain-specific modelling of the distributional semantics of words. Models include variants of random indexing and the semantic neural network model word2vec. Two novel methods are introduced that utilize the ICD-10 codes attached to care episodes to better induce domain-specificity in the semantic model. We report on experimental evaluation of care episode retrieval that circumvents the lack of human judgements regarding episode relevance. Results suggest that several of the methods proposed outperform a state-of-the art search engine (Lucene) on the retrieval task

Hybrid e-rehabilitation services: SMART-system for remote support of rehabilitation activities and services

One of the most effective solutions in medical rehabilitation assistance is remote patient / person-centered rehabilitation. Rehabilitation also needs effective methods for the “Physical therapist – Patient – Multidisciplinary team” system, including the statistical processing of large volumes of data. Therefore, along with the traditional means of rehabilitation, as part of the “Transdisciplinary intelligent information and analytical system for the rehabilitation processes support in a pandemic (TISP)” in this paper, we introduce and define: the basic concepts of the new hybrid e-rehabilitation notion and its fundamental foundations; the formalization concept of the new Smart-system for remote support of rehabilitation activities and services; and the methodological foundations for the use of services (UkrVectores and vHealth) of the remote Patient / Person-centered Smart-system. The software implementation of the services of the Smart-system has been developed