The Impact of Automatic Pre-annotation in Clinical Note Data Element Extraction - the CLEAN Tool

Objective. Annotation is expensive but essential for clinical note review and clinical natural language processing (cNLP). However, the extent to which computer-generated pre-annotation is beneficial to human annotation is still an open question. Our study introduces CLEAN (CLinical note rEview and ANnotation), a pre-annotation-based cNLP annotation system to improve clinical note annotation of data elements, and comprehensively compares CLEAN with the widely-used annotation system Brat Rapid Annotation Tool (BRAT). Materials and Methods. CLEAN includes an ensemble pipeline (CLEAN-EP) with a newly developed annotation tool (CLEAN-AT). A domain expert and a novice user/annotator participated in a comparative usability test by tagging 87 data elements related to Congestive Heart Failure (CHF) and Kawasaki Disease (KD) cohorts in 84 public notes. Results. CLEAN achieved higher note-level F1-score (0.896) over BRAT (0.820), with significant difference in correctness (P-value < 0.001), and the mostly related factor being system/software (P-value < 0.001). No significant difference (P-value 0.188) in annotation time was observed between CLEAN (7.262 minutes/note) and BRAT (8.286 minutes/note). The difference was mostly associated with note length (P-value < 0.001) and system/software (P-value 0.013). The expert reported CLEAN to be useful/satisfactory, while the novice reported slight improvements. Discussion. CLEAN improves the correctness of annotation and increases usefulness/satisfaction with the same level of efficiency. Limitations include untested impact of pre-annotation correctness rate, small sample size, small user size, and restrictedly validated gold standard. Conclusion. CLEAN with pre-annotation can be beneficial for an expert to deal with complex annotation tasks involving numerous and diverse target data elements

Ontology-Based Clinical Information Extraction Using SNOMED CT

Extracting and encoding clinical information captured in unstructured clinical documents with standard medical terminologies is vital to enable secondary use of clinical data from practice. SNOMED CT is the most comprehensive medical ontology with broad types of concepts and detailed relationships and it has been widely used for many clinical applications. However, few studies have investigated the use of SNOMED CT in clinical information extraction. In this dissertation research, we developed a fine-grained information model based on the SNOMED CT and built novel information extraction systems to recognize clinical entities and identify their relations, as well as to encode them to SNOMED CT concepts. Our evaluation shows that such ontology-based information extraction systems using SNOMED CT could achieve state-of-the-art performance, indicating its potential in clinical natural language processing

Enriching information extraction pipelines in clinical decision support systems

Programa Oficial de Doutoramento en Tecnoloxías da Información e as Comunicacións. 5032V01[Resumo] Os estudos sanitarios de múltiples centros son importantes para aumentar a repercusión dos resultados da investigación médica debido ao número de suxeitos que poden participar neles. Para simplificar a execución destes estudos, o proceso de intercambio de datos debería ser sinxelo, por exemplo, mediante o uso de bases de datos interoperables. Con todo, a consecución desta interoperabilidade segue sendo un tema de investigación en curso, sobre todo debido aos problemas de gobernanza e privacidade dos datos. Na primeira fase deste traballo, propoñemos varias metodoloxías para optimizar os procesos de estandarización das bases de datos sanitarias. Este traballo centrouse na estandarización de fontes de datos heteroxéneas nun esquema de datos estándar, concretamente o OMOP CDM, que foi desenvolvido e promovido pola comunidade OHDSI. Validamos a nosa proposta utilizando conxuntos de datos de pacientes con enfermidade de Alzheimer procedentes de distintas institucións. Na seguinte etapa, co obxectivo de enriquecer a información almacenada nas bases de datos de OMOP CDM, investigamos solucións para extraer conceptos clínicos de narrativas non estruturadas, utilizando técnicas de recuperación de información e de procesamento da linguaxe natural. A validación realizouse a través de conxuntos de datos proporcionados en desafíos científicos, concretamente no National NLP Clinical Challenges(n2c2). Na etapa final, propuxémonos simplificar a execución de protocolos de estudos provenientes de múltiples centros, propoñendo solucións novas para perfilar, publicar e facilitar o descubrimento de bases de datos. Algunhas das solucións desenvolvidas están a utilizarse actualmente en tres proxectos europeos destinados a crear redes federadas de bases de datos de saúde en toda Europa.[Resumen] Los estudios sanitarios de múltiples centros son importantes para aumentar la repercusión de los resultados de la investigación médica debido al número de sujetos que pueden participar en ellos. Para simplificar la ejecución de estos estudios, el proceso de intercambio de datos debería ser sencillo, por ejemplo, mediante el uso de bases de datos interoperables. Sin embargo, la consecución de esta interoperabilidad sigue siendo un tema de investigación en curso, sobre todo debido a los problemas de gobernanza y privacidad de los datos. En la primera fase de este trabajo, proponemos varias metodologías para optimizar los procesos de estandarización de las bases de datos sanitarias. Este trabajo se centró en la estandarización de fuentes de datos heterogéneas en un esquema de datos estándar, concretamente el OMOP CDM, que ha sido desarrollado y promovido por la comunidad OHDSI. Validamos nuestra propuesta utilizando conjuntos de datos de pacientes con enfermedad de Alzheimer procedentes de distintas instituciones. En la siguiente etapa, con el objetivo de enriquecer la información almacenada en las bases de datos de OMOP CDM, hemos investigado soluciones para extraer conceptos clínicos de narrativas no estructuradas, utilizando técnicas de recuperación de información y de procesamiento del lenguaje natural. La validación se realizó a través de conjuntos de datos proporcionados en desafíos científicos, concretamente en el National NLP Clinical Challenges (n2c2). En la etapa final, nos propusimos simplificar la ejecución de protocolos de estudios provenientes de múltiples centros, proponiendo soluciones novedosas para perfilar, publicar y facilitar el descubrimiento de bases de datos. Algunas de las soluciones desarrolladas se están utilizando actualmente en tres proyectos europeos destinados a crear redes federadas de bases de datos de salud en toda Europa.[Abstract] Multicentre health studies are important to increase the impact of medical research findings due to the number of subjects that they are able to engage. To simplify the execution of these studies, the data-sharing process should be effortless, for instance, through the use of interoperable databases. However, achieving this interoperability is still an ongoing research topic, namely due to data governance and privacy issues. In the first stage of this work, we propose several methodologies to optimise the harmonisation pipelines of health databases. This work was focused on harmonising heterogeneous data sources into a standard data schema, namely the OMOP CDM which has been developed and promoted by the OHDSI community. We validated our proposal using data sets of Alzheimer’s disease patients from distinct institutions. In the following stage, aiming to enrich the information stored in OMOP CDM databases, we have investigated solutions to extract clinical concepts from unstructured narratives, using information retrieval and natural language processing techniques. The validation was performed through datasets provided in scientific challenges, namely in the National NLP Clinical Challenges (n2c2). In the final stage, we aimed to simplify the protocol execution of multicentre studies, by proposing novel solutions for profiling, publishing and facilitating the discovery of databases. Some of the developed solutions are currently being used in three European projects aiming to create federated networks of health databases across Europe

Processamento automático de texto de narrativas clínicas

The informatization of medical systems and the subsequent move towards the usage of Electronic Health Records (EHR) over the paper format by medical professionals allowed for safer and more e cient healthcare. Additionally, EHR can also be used as a data source for observational studies around the world. However, it is estimated that 70-80% of all clinical data is in the form of unstructured free text and regarding the data that is structured, not all of it follows the same standards, making it di cult to use on the mentioned observational studies. This dissertation aims to tackle those two adversities using natural language processing for the task of extracting concepts from free text and, afterwards, use a common data model to harmonize the data. The developed system employs an annotator, namely cTAKES, to extract the concepts from free text. The extracted concepts are then normalized using text preprocessing, word embeddings, MetaMap and UMLS Metathesaurus lookup. Finally, the normalized concepts are converted to the OMOP Common Data Model and stored in a database. In order to test the developed system, the i2b2 2010 data set was used. The di erent components of the system were tested and evaluated separately, with the concept extraction component achieving a precision, recall and F-score of 77.12%, 70.29% and 73.55%, respectively. The normalization component was evaluated by completing the N2C2 2019 challenge track 3, where it achieved a 77.5% accuracy. Finally, during the OMOP CDM conversion component, it was observed that 7.92% of the concepts were lost during the process. In conclusion, even though the developed system still has margin for improvements, it proves to be a viable method of automatically processing clinical narratives.A informatização dos sistemas médicos e a subsequente tendência por parte de profissionais de saúde a substituir registos em formato de papel por registos eletrónicos de saúde, permitiu que os serviços de saúde se tornassem mais seguros e eficientes. Além disso, estes registos eletrónicos apresentam também o benefício de poderem ser utilizados como fonte de dados para estudos observacionais. No entanto, estima-se que 70-80% de todos os dados clínicos se encontrem na forma de texto livre não-estruturado e os dados que estão estruturados não seguem todos os mesmos padrões, dificultando o seu potencial uso nos estudos observacionais. Esta dissertação pretende solucionar essas duas adversidades através do uso de processamento de linguagem natural para a tarefa de extrair conceitos de texto livre e, de seguida, usar um modelo comum de dados para os harmonizar. O sistema desenvolvido utiliza um anotador, especificamente o cTAKES, para extrair conceitos de texto livre. Os conceitos extraídos são, então, normalizados através de técnicas de pré-processamento de texto, Word Embeddings, MetaMap e um sistema de procura no Metathesaurus do UMLS. Por fim, os conceitos normalizados são convertidos para o modelo comum de dados da OMOP e guardados numa base de dados. Para testar o sistema desenvolvido usou-se o conjunto de dados i2b2 de 2010. As diferentes partes do sistema foram testadas e avaliadas individualmente sendo que na extração dos conceitos obteve-se uma precisão, recall e F-score de 77.12%, 70.29% e 73.55%, respetivamente. A normalização foi avaliada através do desafio N2C2 2019-track 3 onde se obteve uma exatidão de 77.5%. Na conversão para o modelo comum de dados OMOP observou-se que durante a conversão perderam-se 7.92% dos conceitos. Concluiu-se que, embora o sistema desenvolvido ainda tenha margem para melhorias, este demonstrou-se como um método viável de processamento automático do texto de narrativas clínicas.Mestrado em Engenharia de Computadores e Telemátic

SelfClean: A Self-Supervised Data Cleaning Strategy

Most benchmark datasets for computer vision contain irrelevant images, near duplicates, and label errors. Consequently, model performance on these benchmarks may not be an accurate estimate of generalization capabilities. This is a particularly acute concern in computer vision for medicine where datasets are typically small, stakes are high, and annotation processes are expensive and error-prone. In this paper we propose SelfClean, a general procedure to clean up image datasets exploiting a latent space learned with self-supervision. By relying on self-supervised learning, our approach focuses on intrinsic properties of the data and avoids annotation biases. We formulate dataset cleaning as either a set of ranking problems, which significantly reduce human annotation effort, or a set of scoring problems, which enable fully automated decisions based on score distributions. We demonstrate that SelfClean achieves state-of-the-art performance in detecting irrelevant images, near duplicates, and label errors within popular computer vision benchmarks, retrieving both injected synthetic noise and natural contamination. In addition, we apply our method to multiple image datasets and confirm an improvement in evaluation reliability

Weak supervision and label noise handling for Natural language processing in low-resource scenarios

The lack of large amounts of labeled data is a significant factor blocking many low-resource languages and domains from catching up with recent advancements in natural language processing. To reduce this dependency on labeled instances, weak supervision (semi-)automatically annotates unlabeled data. These labels can be obtained more quickly and cheaply than manual, gold-standard annotations. They also, however, contain more errors. Handling these noisy labels is often required to leverage the weakly supervised data successfully. In this dissertation, we study the whole weak supervision pipeline with a focus on the task of named entity recognition. We develop a tool for automatic annotation, and we propose an approach to model label noise when a small amount of clean data is available. We study the factors that influence the noise model's quality from a theoretic perspective, and we validate this approach empirically on several different tasks and languages. An important aspect is the aim for a realistic evaluation. We perform our analysis, among others, on several African low-resource languages. We show the performance benefits that can be achieved using weak supervision and label noise modeling. But we also highlight open issues that the field still has to overcome. For the low-resource settings, we expand the analysis to few-shot learning. For classification errors, we present a novel approach to obtain interpretable insights of where classifiers fail.Der Mangel an annotierten Daten ist ein wesentlicher Faktor, der viele Sprachen und Domänen mit geringen Ressourcen daran hindert, mit den jüngsten Fortschritten in der digitalen Textverarbeitung Schritt zu halten. Um diese Abhängigkeit von gelabelten Trainingsdaten zu verringern, werden bei Weak Supervision nicht gelabelte Daten (halb-)automatisch annotiert. Diese Annotationen sind schneller und günstiger zu erhalten. Sie enthalten jedoch auch mehr Fehler. Oft ist eine besondere Behandlung dieser Noisy Labels notwendig, um die Daten erfolgreich nutzen zu können. In dieser Dissertation untersuchen wir die gesamte Weak Supervision Pipeline mit einem Schwerpunkt auf den Einsatz für die Erkennung von Entitäten. Wir entwickeln ein Tool zur automatischen Annotation und präsentieren einen neuen Ansatz zur Modellierung von Noisy Labels. Wir untersuchen die Faktoren, die die Qualität dieses Modells aus theoretischer Sicht beeinflussen, und wir validieren den Ansatz empirisch für verschiedene Aufgaben und Sprachen. Ein wichtiger Aspekt dieser Arbeit ist das Ziel einer realistischen Analyse. Die Untersuchung führen wir unter anderem an mehreren afrikanischen Sprachen durch und zeigen die Leistungsvorteile, die durch Weak Supervision und die Modellierung von Label Noise erreicht werden können. Auch erweitern wir die Analyse auf das Lernen mit wenigen Beispielen. In Bezug auf Klassifizierungsfehler, stellen wir zudem einen neuen Ansatz vor, um interpretierbare Erkenntnisse zu gewinnen