Adverse drug reaction extraction on electronic health records written in Spanish

148 p.This work focuses on the automatic extraction of Adverse Drug Reactions (ADRs) in Electronic HealthRecords (EHRs). That is, extracting a response to a medicine which is noxious and unintended and whichoccurs at doses normally used. From Natural Language Processing (NLP) perspective, this wasapproached as a relation extraction task in which the drug is the causative agent of a disease, sign orsymptom, that is, the adverse reaction.ADR extraction from EHRs involves major challenges. First, ADRs are rare events. That is, relationsbetween drugs and diseases found in an EHR are seldom ADRs (are often unrelated or, instead, related astreatment). This implies the inference from samples with skewed class distribution. Second, EHRs arewritten by experts often under time pressure, employing both rich medical jargon together with colloquialexpressions (not always grammatical) and it is not infrequent to find misspells and both standard andnon-standard abbreviations. All this leads to a high lexical variability.We explored several ADR detection algorithms and representations to characterize the ADR candidates.In addition, we have assessed the tolerance of the ADR detection model to external noise such as theincorrect detection of implied medical entities implied in the ADR extraction, i.e. drugs and diseases. Westtled the first steps on ADR extraction in Spanish using a corpus of real EHRs

Integrating speculation detection and deep learning to extract lung cancer diagnosis from clinical notes

Despite efforts to develop models for extracting medical concepts from clinical notes, there are still some challenges in particular to be able to relate concepts to dates. The high number of clinical notes written for each single patient, the use of negation, speculation, and different date formats cause ambiguity that has to be solved to reconstruct the patient’s natural history. In this paper, we concentrate on extracting from clinical narratives the cancer diagnosis and relating it to the diagnosis date. To address this challenge, a hybrid approach that combines deep learning-based and rule-based methods is proposed. The approach integrates three steps: (i) lung cancer named entity recognition, (ii) negation and speculation detection, and (iii) relating the cancer diagnosis to a valid date. In particular, we apply the proposed approach to extract the lung cancer diagnosis and its diagnosis date from clinical narratives written in Spanish. Results obtained show an F-score of 90% in the named entity recognition task, and a 89% F-score in the task of relating the cancer diagnosis to the diagnosis date. Our findings suggest that speculation detection is together with negation detection a key component to properly extract cancer diagnosis from clinical notesThis work is supported by the EU Horizon 2020 innovation program under grant agreement No. 780495, project BigMedilytics (Big Data for Medical Analytics). It has been also supported by Fundación AECC and Instituto de Salud Carlos III (grant AC19/00034), under the frame of ERA-NET PerMe

Contributions to information extraction for spanish written biomedical text

285 p.Healthcare practice and clinical research produce vast amounts of digitised, unstructured data in multiple languages that are currently underexploited, despite their potential applications in improving healthcare experiences, supporting trainee education, or enabling biomedical research, for example. To automatically transform those contents into relevant, structured information, advanced Natural Language Processing (NLP) mechanisms are required. In NLP, this task is known as Information Extraction. Our work takes place within this growing field of clinical NLP for the Spanish language, as we tackle three distinct problems. First, we compare several supervised machine learning approaches to the problem of sensitive data detection and classification. Specifically, we study the different approaches and their transferability in two corpora, one synthetic and the other authentic. Second, we present and evaluate UMLSmapper, a knowledge-intensive system for biomedical term identification based on the UMLS Metathesaurus. This system recognises and codifies terms without relying on annotated data nor external Named Entity Recognition tools. Although technically naive, it performs on par with more evolved systems, and does not exhibit a considerable deviation from other approaches that rely on oracle terms. Finally, we present and exploit a new corpus of real health records manually annotated with negation and uncertainty information: NUBes. This corpus is the basis for two sets of experiments, one on cue andscope detection, and the other on assertion classification. Throughout the thesis, we apply and compare techniques of varying levels of sophistication and novelty, which reflects the rapid advancement of the field

The impact of pretrained language models on negation and speculation detection in cross-lingual medical text: Comparative study

Background: Negation and speculation are critical elements in natural language processing (NLP)-related tasks, such as information extraction, as these phenomena change the truth value of a proposition. In the clinical narrative that is informal, these linguistic facts are used extensively with the objective of indicating hypotheses, impressions, or negative findings. Previous state-of-the-art approaches addressed negation and speculation detection tasks using rule-based methods, but in the last few years, models based on machine learning and deep learning exploiting morphological, syntactic, and semantic features represented as spare and dense vectors have emerged. However, although such methods of named entity recognition (NER) employ a broad set of features, they are limited to existing pretrained models for a specific domain or language. Objective: As a fundamental subsystem of any information extraction pipeline, a system for cross-lingual and domain-independent negation and speculation detection was introduced with special focus on the biomedical scientific literature and clinical narrative. In this work, detection of negation and speculation was considered as a sequence-labeling task where cues and the scopes of both phenomena are recognized as a sequence of nested labels recognized in a single step. Methods: We proposed the following two approaches for negation and speculation detection: (1) bidirectional long short-term memory (Bi-LSTM) and conditional random field using character, word, and sense embeddings to deal with the extraction of semantic, syntactic, and contextual patterns and (2) bidirectional encoder representations for transformers (BERT) with fine tuning for NER. Results: The approach was evaluated for English and Spanish languages on biomedical and review text, particularly with the BioScope corpus, IULA corpus, and SFU Spanish Review corpus, with F-measures of 86.6%, 85.0%, and 88.1%, respectively, for NeuroNER and 86.4%, 80.8%, and 91.7%, respectively, for BERT. Conclusions: These results show that these architectures perform considerably better than the previous rule-based and conventional machine learning-based systems. Moreover, our analysis results show that pretrained word embedding and particularly contextualized embedding for biomedical corpora help to understand complexities inherent to biomedical text.This work was supported by the Research Program of the Ministry of Economy and Competitiveness, Government of Spain (DeepEMR Project TIN2017-87548-C2-1-R)

Assessing mortality prediction through different representation models based on concepts extracted from clinical notes

Recent years have seen particular interest in using electronic medical records (EMRs) for secondary purposes to enhance the quality and safety of healthcare delivery. EMRs tend to contain large amounts of valuable clinical notes. Learning of embedding is a method for converting notes into a format that makes them comparable. Transformer-based representation models have recently made a great leap forward. These models are pre-trained on large online datasets to understand natural language texts effectively. The quality of a learning embedding is influenced by how clinical notes are used as input to representation models. A clinical note has several sections with different levels of information value. It is also common for healthcare providers to use different expressions for the same concept. Existing methods use clinical notes directly or with an initial preprocessing as input to representation models. However, to learn a good embedding, we identified the most essential clinical notes section. We then mapped the extracted concepts from selected sections to the standard names in the Unified Medical Language System (UMLS). We used the standard phrases corresponding to the unique concepts as input for clinical models. We performed experiments to measure the usefulness of the learned embedding vectors in the task of hospital mortality prediction on a subset of the publicly available Medical Information Mart for Intensive Care (MIMIC-III) dataset. According to the experiments, clinical transformer-based representation models produced better results with getting input generated by standard names of extracted unique concepts compared to other input formats. The best-performing models were BioBERT, PubMedBERT, and UmlsBERT, respectively

Multi-domain clinical natural language processing with MedCAT: The Medical Concept Annotation Toolkit

Electronic health records (EHR) contain large volumes of unstructured text, requiring the application of information extraction (IE) technologies to enable clinical analysis. We present the open source Medical Concept Annotation Toolkit (MedCAT) that provides: (a) a novel self-supervised machine learning algorithm for extracting concepts using any concept vocabulary including UMLS/SNOMED-CT; (b) a feature-rich annotation interface for customizing and training IE models; and (c) integrations to the broader CogStack ecosystem for vendor-agnostic health system deployment. We show improved performance in extracting UMLS concepts from open datasets (F1:0.448-0.738 vs 0.429-0.650). Further real-world validation demonstrates SNOMED-CT extraction at 3 large London hospitals with self-supervised training over ∼8.8B words from ∼17M clinical records and further fine-tuning with ∼6K clinician annotated examples. We show strong transferability (F1 > 0.94) between hospitals, datasets and concept types indicating cross-domain EHR-agnostic utility for accelerated clinical and research use cases

Evaluation of Natural Language Processing for the Identification of Crohn Disease-Related Variables in Spanish Electronic Health Records:A Validation Study for the PREMONITION-CD Project

Background: The exploration of clinically relevant information in the free text of electronic health records (EHRs) holds the potential to positively impact clinical practice as well as knowledge regarding Crohn disease (CD), an inflammatory bowel disease that may affect any segment of the gastrointestinal tract. The EHRead technology, a clinical natural language processing (cNLP) system, was designed to detect and extract clinical information from narratives in the clinical notes contained in EHRs. Objective: The aim of this study is to validate the performance of the EHRead technology in identifying information of patients with CD. Methods: We used the EHRead technology to explore and extract CD-related clinical information from EHRs. To validate this tool, we compared the output of the EHRead technology with a manually curated gold standard to assess the quality of our cNLP system in detecting records containing any reference to CD and its related variables. Results: The validation metrics for the main variable (CD) were a precision of 0.88, a recall of 0.98, and an F1 score of 0.93. Regarding the secondary variables, we obtained a precision of 0.91, a recall of 0.71, and an F1 score of 0.80 for CD flare, while for the variable vedolizumab (treatment), a precision, recall, and F1 score of 0.86, 0.94, and 0.90 were obtained, respectively. Conclusions: This evaluation demonstrates the ability of the EHRead technology to identify patients with CD and their related variables from the free text of EHRs. To the best of our knowledge, this study is the first to use a cNLP system for the identification of CD in EHRs written in Spanish. © 2022 JMIR Medical Informatics. All rights reserved

Experimentación basada en deep learning para el reconocimiento del alcance y disparadores de la negación

The automatic detection of negation elements is an active area of study due to its high impact on several natural language processing tasks. This article presents a system based on deep learning and a non-language dependent architecture for the automatic detection of both, triggers and scopes of negation for English and Spanish. The presented system obtains for English comparable results with those obtained in recent works by more complex systems. For Spanish, the results obtained in the detection of negation triggers are remarkable. The results for the scope recognition are similar to those obtained for English.La detección automática de los distintos elementos de la negación es un frecuente tema de estudio debido a su alto impacto en diversas tareas de procesamiento de lenguaje natural. Este artículo presenta un sistema basado en deep learning y de arquitectura no dependiente del idioma para la detección automática tanto de disparadores como del alcance de la negación para inglés y español. El sistema presentado obtiene para ingles resultados comparables a los obtenidos en recientes trabajos por sistemas más complejos. Para español destacan los resultados obtenidos en la detección de claves de negación. Por último, los resultados para el reconocimiento del alcance de la negación, son similares a los obtenidos en inglés.This work has been partially supported by the Spanish Ministry of Science and Innovation within the projects PROSAMED (TIN2016-77820-C3-2-R) and EXTRAE (IMIENS 2017)

Negation and Speculation in NLP: A Survey, Corpora, Methods, and Applications

Negation and speculation are universal linguistic phenomena that affect the performance of Natural Language Processing (NLP) applications, such as those for opinion mining and information retrieval, especially in biomedical data. In this article, we review the corpora annotated with negation and speculation in various natural languages and domains. Furthermore, we discuss the ongoing research into recent rule-based, supervised, and transfer learning techniques for the detection of negating and speculative content. Many English corpora for various domains are now annotated with negation and speculation; moreover, the availability of annotated corpora in other languages has started to increase. However, this growth is insufficient to address these important phenomena in languages with limited resources. The use of cross-lingual models and translation of the well-known languages are acceptable alternatives. We also highlight the lack of consistent annotation guidelines and the shortcomings of the existing techniques, and suggest alternatives that may speed up progress in this research direction. Adding more syntactic features may alleviate the limitations of the existing techniques, such as cue ambiguity and detecting the discontinuous scopes. In some NLP applications, inclusion of a system that is negation- and speculation-aware improves performance, yet this aspect is still not addressed or considered an essential step