Combining Free Text and Structured Electronic Medical Record Entries to Detect Acute Respiratory Infections

The electronic medical record (EMR) contains a rich source of information that could be harnessed for epidemic surveillance. We asked if structured EMR data could be coupled with computerized processing of free-text clinical entries to enhance detection of acute respiratory infections (ARI).A manual review of EMR records related to 15,377 outpatient visits uncovered 280 reference cases of ARI. We used logistic regression with backward elimination to determine which among candidate structured EMR parameters (diagnostic codes, vital signs and orders for tests, imaging and medications) contributed to the detection of those reference cases. We also developed a computerized free-text search to identify clinical notes documenting at least two non-negated ARI symptoms. We then used heuristics to build case-detection algorithms that best combined the retained structured EMR parameters with the results of the text analysis.An adjusted grouping of diagnostic codes identified reference ARI patients with a sensitivity of 79%, a specificity of 96% and a positive predictive value (PPV) of 32%. Of the 21 additional structured clinical parameters considered, two contributed significantly to ARI detection: new prescriptions for cough remedies and elevations in body temperature to at least 38°C. Together with the diagnostic codes, these parameters increased detection sensitivity to 87%, but specificity and PPV declined to 95% and 25%, respectively. Adding text analysis increased sensitivity to 99%, but PPV dropped further to 14%. Algorithms that required satisfying both a query of structured EMR parameters as well as text analysis disclosed PPVs of 52-68% and retained sensitivities of 69-73%.Structured EMR parameters and free-text analyses can be combined into algorithms that can detect ARI cases with new levels of sensitivity or precision. These results highlight potential paths by which repurposed EMR information could facilitate the discovery of epidemics before they cause mass casualties

PLoS One

BackgroundThe electronic medical record (EMR) contains a rich source of information that could be harnessed for epidemic surveillance. We asked if structured EMR data could be coupled with computerized processing of free-text clinical entries to enhance detection of acute respiratory infections (ARI).MethodologyA manual review of EMR records related to 15,377 outpatient visits uncovered 280 reference cases of ARI. We used logistic regression with backward elimination to determine which among candidate structured EMR parameters (diagnostic codes, vital signs and orders for tests, imaging and medications) contributed to the detection of those reference cases. We also developed a computerized free-text search to identify clinical notes documenting at least two non-negated ARI symptoms. We then used heuristics to build case-detection algorithms that best combined the retained structured EMR parameters with the results of the text analysis.Principal FindingsAn adjusted grouping of diagnostic codes identified reference ARI patients with a sensitivity of 79%, a specificity of 96% and a positive predictive value (PPV) of 32%. Of the 21 additional structured clinical parameters considered, two contributed significantly to ARI detection: new prescriptions for cough remedies and elevations in body temperature to at least 38\uc2\ub0C. Together with the diagnostic codes, these parameters increased detection sensitivity to 87%, but specificity and PPV declined to 95% and 25%, respectively. Adding text analysis increased sensitivity to 99%, but PPV dropped further to 14%. Algorithms that required satisfying both a query of structured EMR parameters as well as text analysis disclosed PPVs of 52\ue2\u20ac\u201c68% and retained sensitivities of 69\ue2\u20ac\u201c73%.ConclusionStructured EMR parameters and free-text analyses can be combined into algorithms that can detect ARI cases with new levels of sensitivity or precision. These results highlight potential paths by which repurposed EMR information could facilitate the discovery of epidemics before they cause mass casualties.1 P01HK000069-01/HK/PHITPO CDC HHS/United StatesR01 CI000098/CI/NCPDCID CDC HHS/United StatesRFA HK000013/HK/PHITPO CDC HHS/United States20976281PMC295479

An NLP Analysis of Health Advice Giving in the Medical Research Literature

Health advice – clinical and policy recommendations – plays a vital role in guiding medical practices and public health policies. Whether or not authors should give health advice in medical research publications is a controversial issue. The proponents of actionable research advocate for the more efficient and effective transmission of science evidence into practice. The opponents are concerned about the quality of health advice in individual research papers, especially that in observational studies. Arguments both for and against giving advice in individual studies indicate a strong need for identifying and accessing health advice, for either practical use or quality evaluation purposes. However, current information services do not support the direct retrieval of health advice. Compared to other natural language processing (NLP) applications, health advice has not been computationally modeled as a language construct either. A new information service for directly accessing health advice should be able to reduce information barriers and to provide external assessment in science communication. This dissertation work built an annotated corpus of scientific claims that distinguishes health advice according to its occurrence and strength. The study developed NLP-based prediction models to identify health advice in the PubMed literature. Using the annotated corpus and prediction models, the study answered research questions regarding the practice of advice giving in medical research literature. To test and demonstrate the potential use of the prediction model, it was used to retrieve health advice regarding the use of hydroxychloroquine (HCQ) as a treatment for COVID-19 from LitCovid, a large COVID-19 research literature database curated by the National Institutes of Health. An evaluation of sentences extracted from both abstracts and discussions showed that BERT-based pre-trained language models performed well at detecting health advice. The health advice prediction model may be combined with existing health information service systems to provide more convenient navigation of a large volume of health literature. Findings from the study also show researchers are careful not to give advice solely in abstracts. They also tend to give weaker and non-specific advice in abstracts than in discussions. In addition, the study found that health advice has appeared consistently in the abstracts of observational studies over the past 25 years. In the sample, 41.2% of the studies offered health advice in their conclusions, which is lower than earlier estimations based on analyses of much smaller samples processed manually. In the abstracts of observational studies, journals with a lower impact are more likely to give health advice than those with a higher impact, suggesting the significance of the role of journals as gatekeepers of science communication. For the communities of natural language processing, information science, and public health, this work advances knowledge of the automated recognition of health advice in scientific literature. The corpus and code developed for the study have been made publicly available to facilitate future efforts in health advice retrieval and analysis. Furthermore, this study discusses the ways in which researchers give health advice in medical research articles, knowledge of which could be an essential step towards curbing potential exaggeration in the current global science communication. It also contributes to ongoing discussions of the integrity of scientific output. This study calls for caution in advice-giving in medical research literature, especially in abstracts alone. It also calls for open access to medical research publications, so that health researchers and practitioners can fully review the advice in scientific outputs and its implications. More evaluative strategies that can increase the overall quality of health advice in research articles are needed by journal editors and reviewers, given their gatekeeping role in science communication

Cross-lingual Approaches for the Detection of Adverse Drug Reactions in German from a Patient's Perspective

In this work, we present the first corpus for German Adverse Drug Reaction (ADR) detection in patient-generated content. The data consists of 4,169 binary annotated documents from a German patient forum, where users talk about health issues and get advice from medical doctors. As is common in social media data in this domain, the class labels of the corpus are very imbalanced. This and a high topic imbalance make it a very challenging dataset, since often, the same symptom can have several causes and is not always related to a medication intake. We aim to encourage further multi-lingual efforts in the domain of ADR detection and provide preliminary experiments for binary classification using different methods of zero- and few-shot learning based on a multi-lingual model. When fine-tuning XLM-RoBERTa first on English patient forum data and then on the new German data, we achieve an F1-score of 37.52 for the positive class. We make the dataset and models publicly available for the community.Comment: Accepted at LREC 202

Identification and characterization of diseases on social web

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A PubMed-Wide Associational Study of Infectious Diseases

Background: Computational discovery is playing an ever-greater role in supporting the processes of knowledge synthesis. A significant proportion of the more than 18 million manuscripts indexed in the PubMed database describe infectious disease syndromes and various infectious agents. This study is the first attempt to integrate online repositories of text-based publications and microbial genome databases in order to explore the dynamics of relationships between pathogens and infectious diseases. Methodology/Principal Findings: Herein we demonstrate how the knowledge space of infectious diseases can be computationally represented and quantified, and tracked over time. The knowledge space is explored by mapping of the infectious disease literature, looking at dynamics of literature deposition, zooming in from pathogen to genome level and searching for new associations. Syndromic signatures for different pathogens can be created to enable a new and clinically focussed reclassification of the microbial world. Examples of syndrome and pathogen networks illustrate how multilevel network representations of the relationships between infectious syndromes, pathogens and pathogen genomes can illuminate unexpected biological similarities in disease pathogenesis and epidemiology. Conclusions/Significance: This new approach based on text and data mining can support the discovery of previously hidden associations between diseases and microbial pathogens, clinically relevant reclassification of pathogeni

Adverse Drug Event Detection, Causality Inference, Patient Communication and Translational Research

Adverse drug events (ADEs) are injuries resulting from a medical intervention related to a drug. ADEs are responsible for nearly 20% of all the adverse events that occur in hospitalized patients. ADEs have been shown to increase the cost of health care and the length of stays in hospital. Therefore, detecting and preventing ADEs for pharmacovigilance is an important task that can improve the quality of health care and reduce the cost in a hospital setting. In this dissertation, we focus on the development of ADEtector, a system that identifies ADEs and medication information from electronic medical records and the FDA Adverse Event Reporting System reports. The ADEtector system employs novel natural language processing approaches for ADE detection and provides a user interface to display ADE information. The ADEtector employs machine learning techniques to automatically processes the narrative text and identify the adverse event (AE) and medication entities that appear in that narrative text. The system will analyze the entities recognized to infer the causal relation that exists between AEs and medications by automating the elements of Naranjo score using knowledge and rule based approaches. The Naranjo Adverse Drug Reaction Probability Scale is a validated tool for finding the causality of a drug induced adverse event or ADE. The scale calculates the likelihood of an adverse event related to drugs based on a list of weighted questions. The ADEtector also presents the user with evidence for ADEs by extracting figures that contain ADE related information from biomedical literature. A brief summary is generated for each of the figures that are extracted to help users better comprehend the figure. This will further enhance the user experience in understanding the ADE information better. The ADEtector also helps patients better understand the narrative text by recognizing complex medical jargon and abbreviations that appear in the text and providing definitions and explanations for them from external knowledge resources. This system could help clinicians and researchers in discovering novel ADEs and drug relations and also hypothesize new research questions within the ADE domain