Automatic de-identification of textual documents in the electronic health record: a review of recent research

<p>Abstract</p> <p>Background</p> <p>In the United States, the Health Insurance Portability and Accountability Act (HIPAA) protects the confidentiality of patient data and requires the informed consent of the patient and approval of the Internal Review Board to use data for research purposes, but these requirements can be waived if data is de-identified. For clinical data to be considered de-identified, the HIPAA "Safe Harbor" technique requires 18 data elements (called PHI: Protected Health Information) to be removed. The de-identification of narrative text documents is often realized manually, and requires significant resources. Well aware of these issues, several authors have investigated automated de-identification of narrative text documents from the electronic health record, and a review of recent research in this domain is presented here.</p> <p>Methods</p> <p>This review focuses on recently published research (after 1995), and includes relevant publications from bibliographic queries in PubMed, conference proceedings, the ACM Digital Library, and interesting publications referenced in already included papers.</p> <p>Results</p> <p>The literature search returned more than 200 publications. The majority focused only on structured data de-identification instead of narrative text, on image de-identification, or described manual de-identification, and were therefore excluded. Finally, 18 publications describing automated text de-identification were selected for detailed analysis of the architecture and methods used, the types of PHI detected and removed, the external resources used, and the types of clinical documents targeted. All text de-identification systems aimed to identify and remove person names, and many included other types of PHI. Most systems used only one or two specific clinical document types, and were mostly based on two different groups of methodologies: pattern matching and machine learning. Many systems combined both approaches for different types of PHI, but the majority relied only on pattern matching, rules, and dictionaries.</p> <p>Conclusions</p> <p>In general, methods based on dictionaries performed better with PHI that is rarely mentioned in clinical text, but are more difficult to generalize. Methods based on machine learning tend to perform better, especially with PHI that is not mentioned in the dictionaries used. Finally, the issues of anonymization, sufficient performance, and "over-scrubbing" are discussed in this publication.</p

Identification of Entity References in Hospital Discharge Letters

Proceedings of the 16th Nordic Conference of Computational Linguistics NODALIDA-2007. Editors: Joakim Nivre, Heiki-Jaan Kaalep, Kadri Muischnek and Mare Koit. University of Tartu, Tartu, 2007. ISBN 978-9985-4-0513-0 (online) ISBN 978-9985-4-0514-7 (CD-ROM) pp. 329-332

Doctor of Philosophy

dissertationDomain adaptation of natural language processing systems is challenging because it requires human expertise. While manual e ort is e ective in creating a high quality knowledge base, it is expensive and time consuming. Clinical text adds another layer of complexity to the task due to privacy and con dentiality restrictions that hinder the ability to share training corpora among di erent research groups. Semantic ambiguity is a major barrier for e ective and accurate concept recognition by natural language processing systems. In my research I propose an automated domain adaptation method that utilizes sublanguage semantic schema for all-word word sense disambiguation of clinical narrative. According to the sublanguage theory developed by Zellig Harris, domain-speci c language is characterized by a relatively small set of semantic classes that combine into a small number of sentence types. Previous research relied on manual analysis to create language models that could be used for more e ective natural language processing. Building on previous semantic type disambiguation research, I propose a method of resolving semantic ambiguity utilizing automatically acquired semantic type disambiguation rules applied on clinical text ambiguously mapped to a standard set of concepts. This research aims to provide an automatic method to acquire Sublanguage Semantic Schema (S3) and apply this model to disambiguate terms that map to more than one concept with di erent semantic types. The research is conducted using unmodi ed MetaMap version 2009, a concept recognition system provided by the National Library of Medicine, applied on a large set of clinical text. The project includes creating and comparing models, which are based on unambiguous concept mappings found in seventeen clinical note types. The e ectiveness of the nal application was validated through a manual review of a subset of processed clinical notes using recall, precision and F-score metrics

Automated Transformation of Semi-Structured Text Elements

Interconnected systems, such as electronic health records (EHR), considerably improved the handling and processing of health information while keeping the costs at a controlled level. Since the EHR virtually stores all data in digitized form, personal medical documents are easily and swiftly available when needed. However, multiple formats and differences in the health documents managed by various health care providers severely reduce the efficiency of the data sharing process. This paper presents a rule-based transformation system that converts semi-structured (annotated) text into standardized formats, such as HL7 CDA. It identifies relevant information in the input document by analyzing its structure as well as its content and inserts the required elements into corresponding reusable CDA templates, where the templates are selected according to the CDA document type-specific requirements

A cascade of classifiers for extracting medication information from discharge summaries

<p>Abstract</p> <p>Background</p> <p>Extracting medication information from clinical records has many potential applications, and recently published research, systems, and competitions reflect an interest therein. Much of the early extraction work involved rules and lexicons, but more recently machine learning has been applied to the task.</p> <p>Methods</p> <p>We present a hybrid system consisting of two parts. The first part, field detection, uses a cascade of statistical classifiers to identify medication-related named entities. The second part uses simple heuristics to link those entities into medication events.</p> <p>Results</p> <p>The system achieved performance that is comparable to other approaches to the same task. This performance is further improved by adding features that reference external medication name lists.</p> <p>Conclusions</p> <p>This study demonstrates that our hybrid approach outperforms purely statistical or rule-based systems. The study also shows that a cascade of classifiers works better than a single classifier in extracting medication information. The system is available as is upon request from the first author.</p

De-identification of primary care electronic medical records free-text data in Ontario, Canada

<p>Abstract</p> <p>Background</p> <p>Electronic medical records (EMRs) represent a potentially rich source of health information for research but the free-text in EMRs often contains identifying information. While de-identification tools have been developed for free-text, none have been developed or tested for the full range of primary care EMR data</p> <p>Methods</p> <p>We used <it>deid </it>open source de-identification software and modified it for an Ontario context for use on primary care EMR data. We developed the modified program on a training set of 1000 free-text records from one group practice and then tested it on two validation sets from a random sample of 700 free-text EMR records from 17 different physicians from 7 different practices in 5 different cities and 500 free-text records from a group practice that was in a different city than the group practice that was used for the training set. We measured the sensitivity/recall, precision, specificity, accuracy and F-measure of the modified tool against manually tagged free-text records to remove patient and physician names, locations, addresses, medical record, health card and telephone numbers.</p> <p>Results</p> <p>We found that the modified training program performed with a sensitivity of 88.3%, specificity of 91.4%, precision of 91.3%, accuracy of 89.9% and F-measure of 0.90. The validations sets had sensitivities of 86.7% and 80.2%, specificities of 91.4% and 87.7%, precisions of 91.1% and 87.4%, accuracies of 89.0% and 83.8% and F-measures of 0.89 and 0.84 for the first and second validation sets respectively.</p> <p>Conclusion</p> <p>The <it>deid </it>program can be modified to reasonably accurately de-identify free-text primary care EMR records while preserving clinical content.</p

Large-scale evaluation of automated clinical note de-identification and its impact on information extraction

Objective: (1) To evaluate a state-of-the-art natural language processing (NLP)-based approach to automatically de-identify a large set of diverse clinical notes. (2) To measure the impact of de-identification on the performance of information extraction algorithms on the de-identified documents. Material and methods A cross-sectional study that included 3503 stratified, randomly selected clinical notes (over 22 note types) from five million documents produced at one of the largest US pediatric hospitals. Sensitivity, precision, F value of two automated de-identification systems for removing all 18 HIPAA-defined protected health information elements were computed. Performance was assessed against a manually generated ‘gold standard’. Statistical significance was tested. The automated de-identification performance was also compared with that of two humans on a 10% subsample of the gold standard. The effect of de-identification on the performance of subsequent medication extraction was measured. Results: The gold standard included 30 815 protected health information elements and more than one million tokens. The most accurate NLP method had 91.92% sensitivity (R) and 95.08% precision (P) overall. The performance of the system was indistinguishable from that of human annotators (annotators' performance was 92.15%(R)/93.95%(P) and 94.55%(R)/88.45%(P) overall while the best system obtained 92.91%(R)/95.73%(P) on same text). The impact of automated de-identification was minimal on the utility of the narrative notes for subsequent information extraction as measured by the sensitivity and precision of medication name extraction. Discussion and conclusion NLP-based de-identification shows excellent performance that rivals the performance of human annotators. Furthermore, unlike manual de-identification, the automated approach scales up to millions of documents quickly and inexpensively

Research in the Language, Information and Computation Laboratory of the University of Pennsylvania

This report takes its name from the Computational Linguistics Feedback Forum (CLiFF), an informal discussion group for students and faculty. However the scope of the research covered in this report is broader than the title might suggest; this is the yearly report of the LINC Lab, the Language, Information and Computation Laboratory of the University of Pennsylvania. It may at first be hard to see the threads that bind together the work presented here, work by faculty, graduate students and postdocs in the Computer Science and Linguistics Departments, and the Institute for Research in Cognitive Science. It includes prototypical Natural Language fields such as: Combinatorial Categorial Grammars, Tree Adjoining Grammars, syntactic parsing and the syntax-semantics interface; but it extends to statistical methods, plan inference, instruction understanding, intonation, causal reasoning, free word order languages, geometric reasoning, medical informatics, connectionism, and language acquisition. Naturally, this introduction cannot spell out all the connections between these abstracts; we invite you to explore them on your own. In fact, with this issue it’s easier than ever to do so: this document is accessible on the “information superhighway”. Just call up http://www.cis.upenn.edu/~cliff-group/94/cliffnotes.html In addition, you can find many of the papers referenced in the CLiFF Notes on the net. Most can be obtained by following links from the authors’ abstracts in the web version of this report. The abstracts describe the researchers’ many areas of investigation, explain their shared concerns, and present some interesting work in Cognitive Science. We hope its new online format makes the CLiFF Notes a more useful and interesting guide to Computational Linguistics activity at Penn