Towards a system of concepts for Family Medicine. Multilingual indexing in General Practice/ Family Medicine in the era of Semantic Web

UNIVERSITY OF LIÈGE, BELGIUM Executive Summary Faculty of Medicine Département Universitaire de Médecine Générale. Unité de recherche Soins Primaires et Santé Doctor in biomedical sciences Towards a system of concepts for Family Medicine. Multilingual indexing in General Practice/ Family Medicine in the era of SemanticWeb by Dr. Marc JAMOULLE Introduction This thesis is about giving visibility to the often overlooked work of family physicians and consequently, is about grey literature in General Practice and Family Medicine (GP/FM). It often seems that conference organizers do not think of GP/FM as a knowledge-producing discipline that deserves active dissemination. A conference is organized, but not much is done with the knowledge shared at these meetings. In turn, the knowledge cannot be reused or reapplied. This these is also about indexing. To find knowledge back, indexing is mandatory. We must prepare tools that will automatically index the thousands of abstracts that family doctors produce each year in various languages. And finally this work is about semantics1. It is an introduction to health terminologies, ontologies, semantic data, and linked open data. All are expressions of the next step: Semantic Web for health care data. Concepts, units of thought expressed by terms, will be our target and must have the ability to be expressed in multiple languages. In turn, three areas of knowledge are at stake in this study: (i) Family Medicine as a pillar of primary health care, (ii) computational linguistics, and (iii) health information systems. Aim • To identify knowledge produced by General practitioners (GPs) by improving annotation of grey literature in Primary Health Care • To propose an experimental indexing system, acting as draft for a standardized table of content of GP/GM • To improve the searchability of repositories for grey literature in GP/GM. 1For specific terms, see the Glossary page 257 x Methods The first step aimed to design the taxonomy by identifying relevant concepts in a compiled corpus of GP/FM texts. We have studied the concepts identified in nearly two thousand communications of GPs during conferences. The relevant concepts belong to the fields that are focusing on GP/FM activities (e.g. teaching, ethics, management or environmental hazard issues). The second step was the development of an on-line, multilingual, terminological resource for each category of the resulting taxonomy, named Q-Codes. We have designed this terminology in the form of a lightweight ontology, accessible on-line for readers and ready for use by computers of the semantic web. It is also fit for the Linked Open Data universe. Results We propose 182 Q-Codes in an on-line multilingual database (10 languages) (www.hetop.eu/Q) acting each as a filter for Medline. Q-Codes are also available under the form of Unique Resource Identifiers (URIs) and are exportable in Web Ontology Language (OWL). The International Classification of Primary Care (ICPC) is linked to Q-Codes in order to form the Core Content Classification in General Practice/Family Medicine (3CGP). So far, 3CGP is in use by humans in pedagogy, in bibliographic studies, in indexing congresses, master theses and other forms of grey literature in GP/FM. Use by computers is experimented in automatic classifiers, annotators and natural language processing. Discussion To the best of our knowledge, this is the first attempt to expand the ICPC coding system with an extension for family physician contextual issues, thus covering non-clinical content of practice. It remains to be proven that our proposed terminology will help in dealing with more complex systems, such as MeSH, to support information storage and retrieval activities. However, this exercise is proposed as a first step in the creation of an ontology of GP/FM and as an opening to the complex world of Semantic Web technologies. Conclusion We expect that the creation of this terminological resource for indexing abstracts and for facilitating Medline searches for general practitioners, researchers and students in medicine will reduce loss of knowledge in the domain of GP/FM. In addition, through better indexing of the grey literature (congress abstracts, master’s and doctoral theses), we hope to enhance the accessibility of research results and give visibility to the invisible work of family physicians

Proceedings

Proceedings of the Workshop CHAT 2011: Creation, Harmonization and Application of Terminology Resources. Editors: Tatiana Gornostay and Andrejs Vasiļjevs. NEALT Proceedings Series, Vol. 12 (2011). © 2011 The editors and contributors. Published by Northern European Association for Language Technology (NEALT) http://omilia.uio.no/nealt . Electronically published at Tartu University Library (Estonia) http://hdl.handle.net/10062/16956

Scalable Approaches for Auditing the Completeness of Biomedical Ontologies

An ontology provides a formalized representation of knowledge within a domain. In biomedicine, ontologies have been widely used in modern biomedical applications to enable semantic interoperability and facilitate data exchange. Given the important roles that biomedical ontologies play, quality issues such as incompleteness, if not addressed, can affect the quality of downstream ontology-driven applications. However, biomedical ontologies often have large sizes and complex structures. Thus, it is infeasible to uncover potential quality issues through manual effort. In this dissertation, we introduce automated and scalable approaches for auditing the completeness of biomedical ontologies. We mainly focus on two incompleteness issues -- missing hierarchical relations and missing concepts. To identify missing hierarchical relations, we develop three approaches: a lexical-based approach, a hybrid approach utilizing both lexical features and logical definitions, and an approach based on concept name transformation. To identify missing concepts, a lexical-based Formal Concept Analysis (FCA) method is proposed for concept enrichment. We also predict proper concept names for the missing concepts using deep learning techniques. Manual review by domain experts is performed to evaluate these approaches. In addition, we leverage extrinsic knowledge (i.e., external ontologies) to help validate the detected incompleteness issues. The auditing approaches have been applied to a variety of biomedical ontologies, including the SNOMED CT, National Cancer Institute (NCI) Thesaurus and Gene Ontology. In the first lexical-based approach to identify missing hierarchical relations, each concept is modeled with an enriched set of lexical features, leveraging words and noun phrases in the name of the concept itself and the concept\u27s ancestors. Given a pair of concepts that are not linked by a hierarchical relation, if the enriched lexical attributes of one concept is a superset of the other\u27s, a potentially missing hierarchical relation will be suggested. Applying this approach to the September 2017 release of SNOMED CT (US edition) suggested 38,615 potentially missing hierarchical relations. A domain expert reviewed a random sample of 100 potentially missing ones, and confirmed 90 are valid (a precision of 90%). In the second work, a hybrid approach is proposed to detect missing hierarchical relations in non-lattice subgraphs. For each concept, its lexical features are harmonized with role definitions to provide a more comprehensive semantic model. Then a two-step subsumption testing is performed to automatically suggest potentially missing hierarchical relations. This approach identified 55 potentially missing hierarchical relations in the 19.08d version of the NCI Thesaurus. 29 out of 55 were confirmed as valid by the curators from the NCI Enterprise Vocabulary Service (EVS) and have been incorporated in the newer versions of the NCI Thesaurus. 7 out of 55 further revealed incorrect existing hierarchical relations in the NCI Thesaurus. In the third work, we introduce a transformation-based method that leverages the Unified Medical Language System (UMLS) knowledge to identify missing hierarchical relations in its source ontologies. Given a concept name, noun chunks within it are identified and replaced by their more general counterparts to generate new concept names that are supposed to be more general than the original one. Applying this method to the UMLS (2019AB release), a total of 39,359 potentially missing hierarchical relations were detected in 13 source ontologies. Domain experts evaluated a random sample of 200 potentially missing hierarchical relations identified in the SNOMED CT (US edition), and 100 in the Gene Ontology. 173 out of 200 and 63 out of 100 potentially missing hierarchical relations were confirmed by domain experts, indicating our method achieved a precision of 86.5% and 63% for the SNOMED CT and Gene Ontology, respectively. In the work of concept enrichment, we introduce a lexical method based on FCA to identify potentially missing concepts. Lexical features (i.e., words appearing in the concept names) are considered as FCA attributes while generating formal context. Applying multistage intersection on FCA attributes results in newly formalized concepts along with bags of words that can be utilized to name the concepts. This method was applied to the Disease or Disorder sub-hierarchy in the 19.08d version of the NCI Thesaurus and identified 8,983 potentially missing concepts. We performed a preliminary evaluation and validated that 592 out of 8,983 potentially missing concepts were included in external ontologies in the UMLS. After obtaining new concepts and their relevant bags of words, we further developed deep learning-based approaches to automatically predict concept names that comply with the naming convention of a specific ontology. We explored simple neural network, Long Short-Term Memory (LSTM), and Convolutional Neural Network (CNN) combined with LSTM. Our experiments showed that the LSTM-based approach achieved the best performance with an F1 score of 63.41% for predicting names for newly added concepts in the March 2018 release of SNOMED CT (US Edition) and an F1 score of 73.95% for naming missing concepts revealed by our previous work. In the last part of this dissertation, extrinsic knowledge is leveraged to collect supporting evidence for the detected incompleteness issues. We present a work in which cross-ontology evaluation based on extrinsic knowledge from the UMLS is utilized to help validate potentially missing hierarchical relations, aiming at relieving the heavy workload of manual review

Three Essays on Enhancing Clinical Trial Subject Recruitment Using Natural Language Processing and Text Mining

Patient recruitment and enrollment are critical factors for a successful clinical trial; however, recruitment tends to be the most common problem in most clinical trials. The success of a clinical trial depends on efficiently recruiting suitable patients to conduct the trial. Every clinical trial research has a protocol, which describes what will be done in the study and how it will be conducted. Also, the protocol ensures the safety of the trial subjects and the integrity of the data collected. The eligibility criteria section of clinical trial protocols is important because it specifies the necessary conditions that participants have to satisfy. Since clinical trial eligibility criteria are usually written in free text form, they are not computer interpretable. To automate the analysis of the eligibility criteria, it is therefore necessary to transform those criteria into a computer-interpretable format. Unstructured format of eligibility criteria additionally create search efficiency issues. Thus, searching and selecting appropriate clinical trials for a patient from relatively large number of available trials is a complex task. A few attempts have been made to automate the matching process between patients and clinical trials. However, those attempts have not fully integrated the entire matching process and have not exploited the state-of-the-art Natural Language Processing (NLP) techniques that may improve the matching performance. Given the importance of patient recruitment in clinical trial research, the objective of this research is to automate the matching process using NLP and text mining techniques and, thereby, improve the efficiency and effectiveness of the recruitment process. This dissertation research, which comprises three essays, investigates the issues of clinical trial subject recruitment using state-of-the-art NLP and text mining techniques. Essay 1: Building a Domain-Specific Lexicon for Clinical Trial Subject Eligibility Analysis Essay 2: Clustering Clinical Trials Using Semantic-Based Feature Expansion Essay 3: An Automatic Matching Process of Clinical Trial Subject Recruitment In essay1, I develop a domain-specific lexicon for n-gram Named Entity Recognition (NER) in the breast cancer domain. The domain-specific dictionary is used for selection and reduction of n-gram features in clustering in eassy2. The domain-specific dictionary was evaluated by comparing it with Systematized Nomenclature of Medicine--Clinical Terms (SNOMED CT). The results showed that it add significant number of new terms which is very useful in effective natural language processing In essay 2, I explore the clustering of similar clinical trials using the domain-specific lexicon and term expansion using synonym from the Unified Medical Language System (UMLS). I generate word n-gram features and modify the features with the domain-specific dictionary matching process. In order to resolve semantic ambiguity, a semantic-based feature expansion technique using UMLS is applied. A hierarchical agglomerative clustering algorithm is used to generate clinical trial clusters. The focus is on summarization of clinical trial information in order to enhance trial search efficiency. Finally, in essay 3, I investigate an automatic matching process of clinical trial clusters and patient medical records. The patient records collected from a prior study were used to test our approach. The patient records were pre-processed by tokenization and lemmatization. The pre-processed patient information were then further enhanced by matching with breast cancer custom dictionary described in essay 1 and semantic feature expansion using UMLS Metathesaurus. Finally, I matched the patient record with clinical trial clusters to select the best matched cluster(s) and then with trials within the clusters. The matching results were evaluated by internal expert as well as external medical expert

Development and Evaluation of an Ontology-Based Quality Metrics Extraction System

The Institute of Medicine reports a growing demand in recent years for quality improvement within the healthcare industry. In response, numerous organizations have been involved in the development and reporting of quality measurement metrics. However, disparate data models from such organizations shift the burden of accurate and reliable metrics extraction and reporting to healthcare providers. Furthermore, manual abstraction of quality metrics and diverse implementation of Electronic Health Record (EHR) systems deepens the complexity of consistent, valid, explicit, and comparable quality measurement reporting within healthcare provider organizations. The main objective of this research is to evaluate an ontology-based information extraction framework to utilize unstructured clinical text for defining and reporting quality of care metrics that are interpretable and comparable across different healthcare institutions. All clinical transcribed notes (48,835) from 2,085 patients who had undergone surgery in 2011 at MD Anderson Cancer Center were extracted from their EMR system and pre- processed for identification of section headers. Subsequently, all notes were analyzed by MetaMap v2012 and one XML file was generated per each note. XML outputs were converted into Resource Description Framework (RDF) format. We also developed three ontologies: section header ontology from extracted section headers using RDF standard, concept ontology comprising entities representing five quality metrics from SNOMED (Diabetes, Hypertension, Cardiac Surgery, Transient Ischemic Attack, CNS tumor), and a clinical note ontology that represented clinical note elements and their relationships. All ontologies (Web Ontology Language format) and patient notes (RDFs) were imported into a triple store (AllegroGraph?) as classes and instances respectively. SPARQL information retrieval protocol was used for reporting extracted concepts under four settings: base Natural Language Processing (NLP) output, inclusion of concept ontology, exclusion of negated concepts, and inclusion of section header ontology. Existing manual abstraction data from surgical clinical reviewers, on the same set of patients and documents, was considered as the gold standard. Micro-average results of statistical agreement tests on the base NLP output showed an increase from 59%, 81%, and 68% to 74%, 91%, and 82% (Precision, Recall, F-Measure) respectively after incremental addition of ontology layers. Our study introduced a framework that may contribute to advances in “complementary” components for the existing information extraction systems. The application of an ontology-based approach for natural language processing in our study has provided mechanisms for increasing the performance of such tools. The pivot point for extracting more meaningful quality metrics from clinical narratives is the abstraction of contextual semantics hidden in the notes. We have defined some of these semantics and quantified them in multiple complementary layers in order to demonstrate the importance and applicability of an ontology-based approach in quality metric extraction. The application of such ontology layers introduces powerful new ways of querying context dependent entities from clinical texts. Rigorous evaluation is still necessary to ensure the quality of these “complementary” NLP systems. Moreover, research is needed for creating and updating evaluation guidelines and criteria for assessment of performance and efficiency of ontology-based information extraction in healthcare and to provide a consistent baseline for the purpose of comparing alternative approaches

Clinical foundations and information architecture for the implementation of a federated health record service

Clinical care increasingly requires healthcare professionals to access patient record information that may be distributed across multiple sites, held in a variety of paper and electronic formats, and represented as mixtures of narrative, structured, coded and multi-media entries. A longitudinal person-centred electronic health record (EHR) is a much-anticipated solution to this problem, but its realisation is proving to be a long and complex journey. This Thesis explores the history and evolution of clinical information systems, and establishes a set of clinical and ethico-legal requirements for a generic EHR server. A federation approach (FHR) to harmonising distributed heterogeneous electronic clinical databases is advocated as the basis for meeting these requirements. A set of information models and middleware services, needed to implement a Federated Health Record server, are then described, thereby supporting access by clinical applications to a distributed set of feeder systems holding patient record information. The overall information architecture thus defined provides a generic means of combining such feeder system data to create a virtual electronic health record. Active collaboration in a wide range of clinical contexts, across the whole of Europe, has been central to the evolution of the approach taken. A federated health record server based on this architecture has been implemented by the author and colleagues and deployed in a live clinical environment in the Department of Cardiovascular Medicine at the Whittington Hospital in North London. This implementation experience has fed back into the conceptual development of the approach and has provided "proof-of-concept" verification of its completeness and practical utility. This research has benefited from collaboration with a wide range of healthcare sites, informatics organisations and industry across Europe though several EU Health Telematics projects: GEHR, Synapses, EHCR-SupA, SynEx, Medicate and 6WINIT. The information models published here have been placed in the public domain and have substantially contributed to two generations of CEN health informatics standards, including CEN TC/251 ENV 13606