Automatische Diagnosekodierung mit XDIAG : Konzeption und Evaluation eines heuristischen Verfahrens zur leitbegrifforientierten automatischen Diagnosekodierung auf Basis der Daten des ICD10-Diagnosen-Thesaurus

In der medizinischen Praxis in Deutschland ist Klassifikation als essentieller Bestandteil der Dokumentation in vielen Bereichen durch gesetzliche Regelungen vorgeschrieben. Über diesen gesetzlich determinierten Rahmen hinaus können durch Klassifikation vergleichbar gemachte Informationen als Basis neuer wissenschaftlicher Erkenntnisse herangezogen werden und weiterhin helfen, bestehende Lehrmeinungen zu evaluieren. Ein Blick auf die im medizinischen Umfeld vorhandene organisatorische Realisierung der Klassifikation zeigt, daß diese in der Regel von medizinisch qualifiziertem Fachpersonal neben der eigentlichen Tätigkeit durchgeführt wird. Eine Klassifikation vorhandener Dokumentationen im Sinne einer Erschließung zusätzlicher wertvoller Informationsquellen über den gesetzlichen Mindestumfang hinaus scheitert somit häufig an der organisatorisch bedingten Überlastung der eingesetzten Mitarbeiter. Eine Unterstützung medizinischer Klassifikation in der Praxis durch den geeigneten Einsatz von Informationstechnologie (IT) erscheint somit sinnvoll und wünschenswert. Im Rahmen der vorliegenden Arbeit wird ein entsprechender Ansatz in Form eines entwickelten Prototypen (XDIAG) vorgestellt und evaluiert. Der entwickelte Prototyp realisiert ein IT-gestütztes leitbegrifforientiertes Verfahren zur automatischen Kodierung von Diagnosen auf Basis vorliegender medizinischer Freitexte. Die hierbei realisierten Ansätze und Verfahren folgen den Vorschlägen von Herrn D. Schalck und sind somit das Resultat langjähriger intensiver und praxisnaher Beschäftigung mit Fragen medizinischer Freitextverarbeitung und Klassifikation. Die besondere Vorgehensweise verleiht dem vorgestellten Prototypen den Charakter einer Heuristik. In Abgrenzung zu zahlreichen bestehenden Verfahren erfolgt eine konsequente Reduktion der Komplexität der eingesetzten Algorithmen und Stammdaten durch einen Verzicht auf eine tiefgreifende linguistische Analyse der zur Kodierung vorgelegten Texte. Durch diesen Verzicht kann auf die Verwendung einer Grammatik und somit auf die Verwendung komplexer Stammdaten verzichtet werden. Als Stammdatenbasis werden vielmehr Datenbestände verwendet, die entweder besonders leicht zu pflegen sind oder aber ohnehin permanent im Rahmen von Langzeitprojekten gepflegt werden. An dieser Stelle spielt insbesondere der ICD10-Diagnosen-Thesaurus mit seiner umfassenden und besonders praxisorientierten Begriffsmenge eine wichtige Rolle. In Erweiterung bestehender Verfahren bietet der vorgestellte Prototyp darüber hinaus die Möglichkeit, mehrere medizinische Diagnosen im Rahmen eines Satzes zu kodieren. Weiterhin können dem Benutzer interaktiv qualifizierte Fehlerhinweise mit dem Ziel einer verbesserten Kodierung bereitgestellt werden. Als Ergebnis der Evaluation des realisierten Prototypen läßt sich festhalten, daß die hierbei eingesetzten Verfahren helfen können, eine synergistische Brücke zwischen praktischer Medizin, medizinischer Verwaltung und medizinischer Forschung zu schlagen, wenn sie an der richtigen Stelle und mit der richtigen Motivation eingesetzt werden.In many areas of medical practice in Germany the classification, an essential part of documentation, is regulated by a legal framework. Beyond this regulatory framework, classification has the ability to make comparative information possible which may be used as a basis for research and also aids the evaluation of current doctrines. When assessing the current organisation of classification in the medical environment, it becomes apparent that this is generally performed by qualified professional staff in line with their actual job description. The classification of existing medical information using additional and useful sources of information beyond the legally required minimum, often fails due to the lack of time staff have because of heavy work load. Subsequently, the support of medical classification in practice through the employment of appropriate Information Technology seems practical and desirable. Due to this fact a prototype is presented to demonstrate and evaluate a system of procedures that can help to deliver the necessary kind of support. The prototype enables an IT-supported lead-term-orientated system of procedures to automatically code diagnoses based on available medical free-texts. Here, the resulting starting points and procedures follow the suggestions made by Mr. D. Schalck and therefore come from of years of intensive and practically orientated research into questions of the processing of medical free-texts. This special process provides the prototype with a heuristic character. As opposed to a vast number of existing processes the prototype enables a consequent reduction of complexity of the algorithms and master data used through the elimination of a syntactic analysis of the texts used for coding. This eliminates the need to use grammar and therefore also the need for employing complex master data. Hence, data banks are used as the basis of master data which are either easily maintained or maintained anyway within long term projects. The ICD10-Diagnoses-Thesaurus is of great importance at this point particularly due to its extensive and practically orientated number of expressions. As an extension of existing processes the prototype offers the opportunity of coding several medical diagnoses within one sentence. The system also offers the user a means of receiving interactive and qualitative error messages in order to enable coding in a second step when coding in the first step fails due to incomplete or non-consistent information. These error messages could also be used to improve the coding step by step. The evaluation of the resultant prototype concludes that the processes employed have the ability to aid the building of a synergetic bridge between practised medicine, medical administration and medical research if used at the right point and with the right motivation

Robust input representations for low-resource information extraction

Recent advances in the field of natural language processing were achieved with deep learning models. This led to a wide range of new research questions concerning the stability of such large-scale systems and their applicability beyond well-studied tasks and datasets, such as information extraction in non-standard domains and languages, in particular, in low-resource environments. In this work, we address these challenges and make important contributions across fields such as representation learning and transfer learning by proposing novel model architectures and training strategies to overcome existing limitations, including a lack of training resources, domain mismatches and language barriers. In particular, we propose solutions to close the domain gap between representation models by, e.g., domain-adaptive pre-training or our novel meta-embedding architecture for creating a joint representations of multiple embedding methods. Our broad set of experiments demonstrates state-of-the-art performance of our methods for various sequence tagging and classification tasks and highlight their robustness in challenging low-resource settings across languages and domains.Die jüngsten Fortschritte auf dem Gebiet der Verarbeitung natürlicher Sprache wurden mit Deep-Learning-Modellen erzielt. Dies führte zu einer Vielzahl neuer Forschungsfragen bezüglich der Stabilität solcher großen Systeme und ihrer Anwendbarkeit über gut untersuchte Aufgaben und Datensätze hinaus, wie z. B. die Informationsextraktion für Nicht-Standardsprachen, aber auch Textdomänen und Aufgaben, für die selbst im Englischen nur wenige Trainingsdaten zur Verfügung stehen. In dieser Arbeit gehen wir auf diese Herausforderungen ein und leisten wichtige Beiträge in Bereichen wie Repräsentationslernen und Transferlernen, indem wir neuartige Modellarchitekturen und Trainingsstrategien vorschlagen, um bestehende Beschränkungen zu überwinden, darunter fehlende Trainingsressourcen, ungesehene Domänen und Sprachbarrieren. Insbesondere schlagen wir Lösungen vor, um die Domänenlücke zwischen Repräsentationsmodellen zu schließen, z.B. durch domänenadaptives Vortrainieren oder unsere neuartige Meta-Embedding-Architektur zur Erstellung einer gemeinsamen Repräsentation mehrerer Embeddingmethoden. Unsere umfassende Evaluierung demonstriert die Leistungsfähigkeit unserer Methoden für verschiedene Klassifizierungsaufgaben auf Word und Satzebene und unterstreicht ihre Robustheit in anspruchsvollen, ressourcenarmen Umgebungen in verschiedenen Sprachen und Domänen

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe

The Role of General Practitioners in Disaster Health Management

Disasters are a time of excess demand for medical care overwhelming available medical services. General Practitioners (GPs) are local healthcare professionals already onsite managing the ongoing health of the majority of the community when disaster strikes. They are a medical resource, knowledgeable about the local community context, and remain to share the journey of adaptation and recovery with their local community in the days to years of aftermath. Early observations at commencement of this research demonstrated that whether GPs chose to or not, as local community health professionals they will be involved in some way in any disaster that strikes their community either during, and/or after the event. In most countries, including Australia, GPs are excluded from disaster response systems. The research aim was to identify the role of GPs in disaster health management, and to propose a system of involvement that aligns with: - the epidemiological evidence of disaster healthcare needs relevant to GPs, - the perceptions of GPs and Disaster Managers (DM) experts, and - the current All Hazards All Agencies Prevention-Preparedness-Response-Recovery (PPRR) international framework of disaster management The first study was a systematic literature review utilising PRISMA guidelines to categorise the epidemiology of physical health consequences of disasters relevant to GPs. Following this the thesis reports a series of three qualitative studies employing a constructivist grounded theory approach: two using semi-structured interviews, and one using a focus group, with disaster-experienced GPs and DMs. These studies explored barriers and facilitators to inclusion of GPs and investigated current and future roles. Research findings led to a conceptual representation for future integration of GPs, utilising the PPRR framework. Ultimately the thesis proposes a strategy for integration of GPs into existing disaster health management systems that addresses some of the barriers highlighted by the research, and elucidates the roles of GPs. The researchers sought to synthesise the emerging knowledge and facilitate implementation by key stakeholders with the intention of closing the gap between what is known and what is practiced. Findings were disseminated as per Graham's Knowledge to Action framework. Key outputs were enacted through peer-reviewed journal publications, textbook sections, guidelines for a broad range of practitioners, presentations internationally and nationally, policy revision through professional committee memberships, and advocacy for GP involvement at international, national, and local levels. To manage the challenges of disasters, countries require a resilient healthcare system that maximises capacity of all levels of local health resources, accommodates the surge in demand, and continues to sustain the local health services response in the aftermath. Comprehensive, people-focused coordination & continuity of care has the potential to improve the holistic health outcomes of disaster-affected people. Examination of the evidence from this doctorate suggests clear roles for GPs in disaster healthcare across all phases of disasters, with sustained contributions over the recovery. A knowledge of the temporal epidemiological patterns of health effects provides an opportunity for surveillance for emerging conditions over time, prevention of deterioration of existing conditions, and promotion of patient preparedness for future events, all roles within the usual realm of General Practice healthcare. An important element of GP integration is ongoing research on disaster healthcare needs presenting to GPs to continue to evaluate, justify and support ongoing GP involvement. The future challenge is to change the focus of disaster health management to person-centred healthcare integrated across all levels of usual healthcare, including evidence-based General Practice primary care contributions

Birth defects surveillance : a manual for programme managers

Second edition.Congenital anomalies, also known as birth defects, are structural or functional abnormalities, including metabolic disorders, which are present at birth. Congenital anomalies are a diverse group of disorders of prenatal origin, which can be caused by single-gene defects, chromosomal disorders, multifactorial inheritance, environmental teratogens or micronutrient malnutrition.This manual is intended to serve as a tool for the development, implementation and ongoing improvement of a congenital anomalies surveillance programme, particularly for countries with limited resources. The focus of the manual is on population-based and hospital-based surveillance programmes. Some countries might not find it feasible to begin with the development of a population-based programme. Therefore, the manual covers the methodology needed for the development of both population-based and hospital-based surveillance programmes. Further, although many births in predominantly low- and middle-income countries (LMICs) occur outside of hospitals, some countries with limited resources might choose to start with a hospital-based surveillance programme and expand it later into one that is population-based. Any country wishing to expand its current hospital-based programme into a population-based programme, or to begin the initial development of a population-based system, should find this manual helpful in reaching its goal.This manual provides selected examples of congenital anomalies (see Appendix A). These anomalies are severe enough that many would probably be captured during the first few days following birth. While a number of the anomalies listed are external and easily identified by physical exam, others are internal and typically require more advanced diagnostic evaluations such as imaging. However, because of their severity and frequency, all these selected conditions have significant public health impact, and for some there is a potential for primary prevention. Nevertheless, these are just suggestions; countries might choose to monitor a subset of these conditions or add other congenital anomalies to meet their needs.WHO thanks the United States Centers for Disease Control and Prevention, especially the National Center on Birth Defects and Developmental Disabilities, for providing financial support for the publication of this manual as part of the cooperative agreement 5 E11 DP002196, Global prevention of noncommunicable diseases and promotion of health. Supported in part by contract from Task Force for Global Health to the International Center on Birth Defects (ICBD) of the ICBDSR. We gratefully acknowledge and thank the United States Agency for International Development for providing financial support for this work.Suggested citation. Birth defects surveillance: a manual for programme managers, second edition. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.9789240015395 (\u200eelectronic version)\u200e9789240015401 (\u200eprint version)\u200eBirth-Defects-Surveillance-A-Manual-for-Programme-Managers-2020Manual-P.pdfAcknowledgements -- Financial support -- Abbreviations -- Objectives of the manual -- 1. Surveillance of congenital anomalies -- 2. Planning activities and tools -- 3. Approaches to surveillance -- 4. Dianosing congenital anomalies -- 5. Congenital infectious syndromes -- 6. Coding and diagnosis -- 7. Primer on data quality in birth defects surveillance.2020cooperative agreement 5 E11 DP002196891

Proceedings of the Seventh Italian Conference on Computational Linguistics CLiC-it 2020

On behalf of the Program Committee, a very warm welcome to the Seventh Italian Conference on Computational Linguistics (CLiC-it 2020). This edition of the conference is held in Bologna and organised by the University of Bologna. The CLiC-it conference series is an initiative of the Italian Association for Computational Linguistics (AILC) which, after six years of activity, has clearly established itself as the premier national forum for research and development in the fields of Computational Linguistics and Natural Language Processing, where leading researchers and practitioners from academia and industry meet to share their research results, experiences, and challenges

Journal of Telecommunications and Information Technology, 2006, nr 2

kwartalni