We present MedCATTrainer an interface for building, improving and customising a given Named Entity Recognition and Linking (NER+L) model for biomedical domain text. NER+L is often used as a first ...step in deriving value from clinical text. Collecting labelled data for training models is difficult due to the need for specialist domain knowledge. MedCATTrainer offers an interactive web-interface to inspect and improve recognised entities from an underlying NER+L model via active learning. Secondary use of data for clinical research often has task and context specific criteria. MedCATTrainer provides a further interface to define and collect supervised learning training data for researcher specific use cases. Initial results suggest our approach allows for efficient and accurate collection of research use case specific training data.
Background: Electronic Health Records hold detailed longitudinal information about each patient's health status and general clinical history, a large portion of which is stored within the ...unstructured text. Existing approaches focus mostly on structured data and a subset of single-domain outcomes. We explore how temporal modelling of patients from free text and structured data, using deep generative transformers can be used to forecast a wide range of future disorders, substances, procedures or findings. Methods: We present Foresight, a novel transformer-based pipeline that uses named entity recognition and linking tools to convert document text into structured, coded concepts, followed by providing probabilistic forecasts for future medical events such as disorders, substances, procedures and findings. We processed the entire free-text portion from three different hospital datasets totalling 811336 patients covering both physical and mental health. Findings: On tests in two UK hospitals (King's College Hospital, South London and Maudsley) and the US MIMIC-III dataset precision@10 0.68, 0.76 and 0.88 was achieved for forecasting the next disorder in a patient timeline, while precision@10 of 0.80, 0.81 and 0.91 was achieved for forecasting the next biomedical concept. Foresight was also validated on 34 synthetic patient timelines by five clinicians and achieved relevancy of 97% for the top forecasted candidate disorder. As a generative model, it can forecast follow-on biomedical concepts for as many steps as required. Interpretation: Foresight is a general-purpose model for biomedical concept modelling that can be used for real-world risk forecasting, virtual trials and clinical research to study the progression of disorders, simulate interventions and counterfactuals, and educational purposes.
Text classification tasks which aim at harvesting and/or organizing information from electronic health records are pivotal to support clinical and translational research. However these present ...specific challenges compared to other classification tasks, notably due to the particular nature of the medical lexicon and language used in clinical records. Recent advances in embedding methods have shown promising results for several clinical tasks, yet there is no exhaustive comparison of such approaches with other commonly used word representations and classification models. In this work, we analyse the impact of various word representations, text pre-processing and classification algorithms on the performance of four different text classification tasks. The results show that traditional approaches, when tailored to the specific language and structure of the text inherent to the classification task, can achieve or exceed the performance of more recent ones based on contextual embeddings such as BERT.
Biomedical documents such as Electronic Health Records (EHRs) contain a large amount of information in an unstructured format. The data in EHRs is a hugely valuable resource documenting clinical ...narratives and decisions, but whilst the text can be easily understood by human doctors it is challenging to use in research and clinical applications. To uncover the potential of biomedical documents we need to extract and structure the information they contain. The task at hand is Named Entity Recognition and Linking (NER+L). The number of entities, ambiguity of words, overlapping and nesting make the biomedical area significantly more difficult than many others. To overcome these difficulties, we have developed the Medical Concept Annotation Tool (MedCAT), an open-source unsupervised approach to NER+L. MedCAT uses unsupervised machine learning to disambiguate entities. It was validated on MIMIC-III (a freely accessible critical care database) and MedMentions (Biomedical papers annotated with mentions from the Unified Medical Language System). In case of NER+L, the comparison with existing tools shows that MedCAT improves the previous best with only unsupervised learning (F1=0.848 vs 0.691 for disease detection; F1=0.710 vs. 0.222 for general concept detection). A qualitative analysis of the vector embeddings learnt by MedCAT shows that it captures latent medical knowledge available in EHRs (MIMIC-III). Unsupervised learning can improve the performance of large scale entity extraction, but it has some limitations when working with only a couple of entities and a small dataset. In that case options are supervised learning or active learning, both of which are supported in MedCAT via the MedCATtrainer extension. Our approach can detect and link millions of different biomedical concepts with state-of-the-art performance, whilst being lightweight, fast and easy to use.
The ability to perform accurate prognosis of patients is crucial for proactive clinical decision making, informed resource management and personalised care. Existing outcome prediction models suffer ...from a low recall of infrequent positive outcomes. We present a highly-scalable and robust machine learning framework to automatically predict adversity represented by mortality and ICU admission from time-series vital signs and laboratory results obtained within the first 24 hours of hospital admission. The stacked platform comprises two components: a) an unsupervised LSTM Autoencoder that learns an optimal representation of the time-series, using it to differentiate the less frequent patterns which conclude with an adverse event from the majority patterns that do not, and b) a gradient boosting model, which relies on the constructed representation to refine prediction, incorporating static features of demographics, admission details and clinical summaries. The model is used to assess a patient's risk of adversity over time and provides visual justifications of its prediction based on the patient's static features and dynamic signals. Results of three case studies for predicting mortality and ICU admission show that the model outperforms all existing outcome prediction models, achieving PR-AUC of 0.891 (95\(%\) CI: 0.878 - 0.969) in predicting mortality in ICU and general ward settings and 0.908 (95\(%\) CI: 0.870-0.935) in predicting ICU admission.
Multimorbidity research in mental health services requires data from physical health conditions which is traditionally limited in mental health care electronic health records. In this study, we aimed ...to extract data from physical health conditions from clinical notes using SemEHR. Data was extracted from Clinical Record Interactive Search (CRIS) system at South London and Maudsley Biomedical Research Centre (SLaM BRC) and the cohort consisted of all individuals who had received a primary or secondary diagnosis of severe mental illness between 2007 and 2018. Three pairs of annotators annotated 2403 documents with an average Cohen's Kappa of 0.757. Results show that the NLP performance varies across different diseases areas (F1 0.601 - 0.954) suggesting that the language patterns or terminologies of different condition groups entail different technical challenges to the same NLP task.
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 customising 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.
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