Distributional Semantic Models for Clinical Text Applied to Health Record Summarization

As information systems in the health sector are becoming increasingly computerized, large amounts of care-related information are being stored electronically. In hospitals clinicians continuously document treatment and care given to patients in electronic health record (EHR) systems. Much of the information being documented is in the form of clinical notes, or narratives, containing primarily unstructured free-text information. For each care episode, clinical notes are written on a regular basis, ending with a discharge summary that basically summarizes the care episode. Although EHR systems are helpful for storing and managing such information, there is an unrealized potential in utilizing this information for smarter care assistance, as well as for secondary purposes such as research and education. Advances in clinical language processing are enabling computers to assist clinicians in their interaction with the free-text information documented in EHR systems. This includes assisting in tasks like query-based search, terminology development, knowledge extraction, translation, and summarization. This thesis explores various computerized approaches and methods aimed at enabling automated semantic textual similarity assessment and information extraction based on the free-text information in EHR systems. The focus is placed on the task of (semi-)automated summarization of the clinical notes written during individual care episodes. The overall theme of the presented work is to utilize resource-light approaches and methods, circumventing the need to manually develop knowledge resources or training data. Thus, to enable computational semantic textual similarity assessment, word distribution statistics are derived from large training corpora of clinical free text and stored as vector-based representations referred to as distributional semantic models. Also resource-light methods are explored in the task of performing automatic summarization of clinical freetext information, relying on semantic textual similarity assessment. Novel and experimental methods are presented and evaluated that focus on: a) distributional semantic models trained in an unsupervised manner from statistical information derived from large unannotated clinical free-text corpora; b) representing and computing semantic similarities between linguistic items of different granularity, primarily words, sentences and clinical notes; and c) summarizing clinical free-text information from individual care episodes. Results are evaluated against gold standards that reflect human judgements. The results indicate that the use of distributional semantics is promising as a resource-light approach to automated capturing of semantic textual similarity relations from unannotated clinical text corpora. Here it is important that the semantics correlate with the clinical terminology, and with various semantic similarity assessment tasks. Improvements over classical approaches are achieved when the underlying vector-based representations allow for a broader range of semantic features to be captured and represented. These are either distributed over multiple semantic models trained with different features and training corpora, or use models that store multiple sense-vectors per word. Further, the use of structured meta-level information accompanying care episodes is explored as training features for distributional semantic models, with the aim of capturing semantic relations suitable for care episode-level information retrieval. Results indicate that such models performs well in clinical information retrieval. It is shown that a method called Random Indexing can be modified to construct distributional semantic models that capture multiple sense-vectors for each word in the training corpus. This is done in a way that retains the original training properties of the Random Indexing method, by being incremental, scalable and distributional. Distributional semantic models trained with a framework called Word2vec, which relies on the use of neural networks, outperform those trained using the classic Random Indexing method in several semantic similarity assessment tasks, when training is done using comparable parameters and the same training corpora. Finally, several statistical features in clinical text are explored in terms of their ability to indicate sentence significance in a text summary generated from the clinical notes. This includes the use of distributional semantics to enable case-based similarity assessment, where cases are other care episodes and their “solutions”, i.e., discharge summaries. A type of manual evaluation is performed, where human experts rates the different aspects of the summaries using a evaluation scheme/tool. In addition, the original clinician-written discharge summaries are explored as gold standard for the purpose of automated evaluation. Evaluation shows a high correlation between manual and automated evaluation, suggesting that such a gold standard can function as a proxy for human evaluations. --- This thesis has been published jointly with Norwegian University of Science and Technology, Norway and University of Turku, Finland.This thesis has beenpublished jointly with Norwegian University of Science and Technology, Norway.Siirretty Doriast

The MeSH-gram Neural Network Model: Extending Word Embedding Vectors with MeSH Concepts for UMLS Semantic Similarity and Relatedness in the Biomedical Domain

Eliciting semantic similarity between concepts in the biomedical domain remains a challenging task. Recent approaches founded on embedding vectors have gained in popularity as they risen to efficiently capture semantic relationships The underlying idea is that two words that have close meaning gather similar contexts. In this study, we propose a new neural network model named MeSH-gram which relies on a straighforward approach that extends the skip-gram neural network model by considering MeSH (Medical Subject Headings) descriptors instead words. Trained on publicly available corpus PubMed MEDLINE, MeSH-gram is evaluated on reference standards manually annotated for semantic similarity. MeSH-gram is first compared to skip-gram with vectors of size 300 and at several windows contexts. A deeper comparison is performed with tewenty existing models. All the obtained results of Spearman's rank correlations between human scores and computed similarities show that MeSH-gram outperforms the skip-gram model, and is comparable to the best methods but that need more computation and external resources.Comment: 6 pages, 2 table

Building Continents of Knowledge in Oceans of Data: The Future of Co-Created eHealth

We report on the development and evaluation of a prototype tool aimed to assist laymen/patients in understanding the content of clinical narratives. The tool relies largely on unsupervised machine learning applied to two large corpora of unlabeled text – a clinical corpus and a general domain corpus. A joint semantic word-space model is created for the purpose of extracting easier to understand alternatives for words considered difficult to understand by laymen. Two domain experts evaluate the tool and inter-rater agreement is calculated. When having the tool suggest ten alternatives to each difficult word, it suggests acceptable lay words for 55.51% of them. This and future manual evaluation will serve to further improve performance, where also supervised machine learning will be used.</p

Acronyms as an integral part of multi–word term recognition - A token of appreciation

Term conflation is the process of linking together different variants of the same term. In automatic term recognition approaches, all term variants should be aggregated into a single normalized term representative, which is associated with a single domain–specific concept as a latent variable. In a previous study, we described FlexiTerm, an unsupervised method for recognition of multi–word terms from a domain–specific corpus. It uses a range of methods to normalize three types of term variation – orthographic, morphological and syntactic variation. Acronyms, which represent a highly productive type of term variation, were not supported. In this study, we describe how the functionality of FlexiTerm has been extended to recognize acronyms and incorporate them into the term conflation process. The main contribution of this study is not acronym recognition per se, but rather its integration with other types of term variation into the term conflation process. We evaluated the effects of term conflation in the context of information retrieval as one of its most prominent applications. On average, relative recall increased by 32 percent points, whereas index compression factor increased by 7 percent points. Therefore, evidence suggests that integration of acronyms provides non–trivial improvement of term conflation

From Distributional to Semantic Similarity

Institute for Communicating and Collaborative SystemsLexical-semantic resources, including thesauri and WORDNET, have been successfully incorporated into a wide range of applications in Natural Language Processing. However they are very difficult and expensive to create and maintain, and their usefulness has been severely hampered by their limited coverage, bias and inconsistency. Automated and semi-automated methods for developing such resources are therefore crucial for further resource development and improved application performance. Systems that extract thesauri often identify similar words using the distributional hypothesis that similar words appear in similar contexts. This approach involves using corpora to examine the contexts each word appears in and then calculating the similarity between context distributions. Different definitions of context can be used, and I begin by examining how different types of extracted context influence similarity. To be of most benefit these systems must be capable of finding synonyms for rare words. Reliable context counts for rare events can only be extracted from vast collections of text. In this dissertation I describe how to extract contexts from a corpus of over 2 billion words. I describe techniques for processing text on this scale and examine the trade-off between context accuracy, information content and quantity of text analysed. Distributional similarity is at best an approximation to semantic similarity. I develop improved approximations motivated by the intuition that some events in the context distribution are more indicative of meaning than others. For instance, the object-of-verb context wear is far more indicative of a clothing noun than get. However, existing distributional techniques do not effectively utilise this information. The new context-weighted similarity metric I propose in this dissertation significantly outperforms every distributional similarity metric described in the literature. Nearest-neighbour similarity algorithms scale poorly with vocabulary and context vector size. To overcome this problem I introduce a new context-weighted approximation algorithm with bounded complexity in context vector size that significantly reduces the system runtime with only a minor performance penalty. I also describe a parallelized version of the system that runs on a Beowulf cluster for the 2 billion word experiments. To evaluate the context-weighted similarity measure I compare ranked similarity lists against gold-standard resources using precision and recall-based measures from Information Retrieval, since the alternative, application-based evaluation, can often be influenced by distributional as well as semantic similarity. I also perform a detailed analysis of the final results using WORDNET. Finally, I apply my similarity metric to the task of assigning words to WORDNET semantic categories. I demonstrate that this new approach outperforms existing methods and overcomes some of their weaknesses