Extraction of Temporal Information from Clinical Narratives

AI-Assisted Summarization of Radiologic Reports: Evaluating GPT3davinci, BARTcnn, LongT5booksum, LEDbooksum, LEDlegal, and LEDclinical

BACKGROUND AND PURPOSE

The review of clinical reports is an essential part of monitoring disease progression. Synthesizing multiple imaging reports is also important for clinical decisions. It is critical to aggregate information quickly and accurately. Machine learning natural language processing (NLP) models hold promise to address an unmet need for report summarization.

MATERIALS AND METHODS

We evaluated NLP methods to summarize longitudinal aneurysm reports. A total of 137 clinical reports and 100 PubMed case reports were used in this study. Models were 1) compared against expert-generated summary using longitudinal imaging notes collected in our institute and 2) compared using publicly accessible PubMed case reports. Five AI models were used to summarize the clinical reports, and a sixth model, the online GPT3davinci NLP large language model (LLM), was added for the summarization of PubMed case reports. We assessed the summary quality through comparison with expert summaries using quantitative metrics and quality reviews by experts.

RESULTS

In clinical summarization, BARTcnn had the best performance (BERTscore = 0.8371), followed by LongT5Booksum and LEDlegal. In the analysis using PubMed case reports, GPT3davinci demonstrated the best performance, followed by models BARTcnn and then LEDbooksum (BERTscore = 0.894, 0.872, and 0.867, respectively).

CONCLUSIONS

AI NLP summarization models demonstrated great potential in summarizing longitudinal aneurysm reports, though none yet reached the level of quality for clinical usage. We found the online GPT LLM outperformed the others; however, the BARTcnn model is potentially more useful because it can be implemented on-site. Future work to improve summarization, address other types of neuroimaging reports, and develop structured reports may allow NLP models to ease clinical workflow.

A Systematic Temporal Extraction Pipeline for Medical Concepts in Clinical Notes

With increased application of natural language processing (NLP) in medicine, many NLP models are being developed for uncovering relevant clinical features from electronic health records. Temporal information plays a key role in understanding the context, significance, and interpretation of medical concepts extracted from clinical notes. This is particularly true in situations where the behavior, value, or status of a medical concept changes over time. In this paper, we introduce a systematic framework, NLP annotation-Relaxation-Generation (NRG). NRG compiles incidents of medical concept changes from status annotations and timestamps of multiple clinical notes. We demonstrate the effectiveness of the NRG pipeline by applying it to two medical concepts related to patients with inflammatory bowel disease: extra-intestinal manifestations and medications. We show that the NRG pipeline offers not only insights into medical concept changes over time, but can help convey longitudinal changes in clinical features at both individual and population level.

Temporal fact extraction of fruit cultivation technologies based on deep learning

There are great differences in fruit planting techniques due to different regional environments. Farmers can't use the same standard in growing fruit. Most of the information about fruit planting comes from the Internet, which is characterized by complexity and heterogeneous multi-source. How to deal with such information to form the convenient facts becomes an urgent problem. Information extraction could automatically extract fruit cultivation facts from unstructured text. Temporal information is especially crucial for fruit cultivation. Extracting temporal facts from the corpus of cultivation technologies for fruit is also vital to several downstream applications in fruit cultivation. However, the framework of ordinary triplets focuses on handling static facts and ignores the temporal information. Therefore, we propose Basic Fact Extraction and Multi-layer CRFs (BFE-MCRFs), an end-to-end neural network model for the joint extraction of temporal facts. BFE-MCRFs describes temporal knowledge using an improved schema that adds the time dimension. Firstly, the basic facts are extracted from the primary model. Then, multiple temporal relations are added between basic facts and time expressions. Finally, the multi-layer Conditional Random Field are used to detect the objects corresponding to the basic facts under the predefined temporal relationships. Experiments conducted on public and self-constructed datasets show that BFE-MCRFs achieves the best current performance and outperforms the baseline models by a significant margin.

Knowledge Representation and Reasoning for Complex Time Expression in Clinical Text

Temporal information is pervasive and crucial in medical records and other clinical text, as it formulates the development process of medical conditions and is vital for clinical decision making. However, providing a holistic knowledge representation and reasoning framework for various time expressions in the clinical text is challenging. In order to capture complex temporal semantics in clinical text, we propose a novel Clinical Time Ontology (CTO) as an extension from OWL framework. More specifically, we identified eight time-related problems in clinical text and created 11 core temporal classes to conceptualize the fuzzy time, cyclic time, irregular time, negations and other complex aspects of clinical time. Then, we extended Allen's and TEO's temporal relations and defined the relation concept description between complex and simple time. Simultaneously, we provided a formulaic and graphical presentation of complex time and complex time relationships. We carried out empirical study on the expressiveness and usability of CTO using real-world healthcare datasets. Finally, experiment results demonstrate that CTO could faithfully represent and reason over 93% of the temporal expressions, and it can cover a wider range of time-related classes in clinical domain.

Viewpoint: An Information Extraction Framework for Disability Determination Using a Mental Functioning Use-Case (Preprint)

Natural language processing (NLP) in health care enables transformation of complex narrative information into high value products such as clinical decision support and adverse event monitoring in real time via the electronic health record (EHR). However, information technologies for mental health have consistently lagged because of the complexity of measuring and modeling mental health and illness. The use of NLP to support management of mental health conditions is a viable topic that has not been explored in depth. This paper provides a framework for the advanced application of NLP methods to identify, extract, and organize information on mental health and functioning to inform the decision-making process applied to assessing mental health. We present a use-case related to work disability, guided by the disability determination process of the US Social Security Administration (SSA). From this perspective, the following questions must be addressed about each problem that leads to a disability benefits claim: When did the problem occur and how long has it existed? How severe is it? Does it affect the person’s ability to work? and What is the source of the evidence about the problem? Our framework includes 4 dimensions of medical information that are central to assessing disability—temporal sequence and duration, severity, context, and information source. We describe key aspects of each dimension and promising approaches for application in mental functioning. For example, to address temporality, a complete functional timeline must be created with all relevant aspects of functioning such as intermittence, persistence, and recurrence. Severity of mental health symptoms can be successfully identified and extracted on a 4-level ordinal scale from absent to severe. Some NLP work has been reported on the extraction of context for specific cases of wheelchair use in clinical settings. We discuss the links between the task of information source assessment and work on source attribution, coreference resolution, event extraction, and rule-based methods. Gaps were identified in NLP applications that directly applied to the framework and in existing relevant annotated data sets. We highlighted NLP methods with the potential for advanced application in the field of mental functioning. Findings of this work will inform the development of instruments for supporting SSA adjudicators in their disability determination process. The 4 dimensions of medical information may have relevance for a broad array of individuals and organizations responsible for assessing mental health function and ability. Further, our framework with 4 specific dimensions presents significant opportunity for the application of NLP in the realm of mental health and functioning beyond the SSA setting, and it may support the development of robust tools and methods for decision-making related to clinical care, program implementation, and other outcomes.