Contextual word embedding models such as ELMo (, 2018) and BERT (, 2018) have dramatically improved performance for many natural language processing (NLP) tasks in recent months. However, these models have been minimally explored on specialty corpora, such as clinical text; moreover, in the clinical domain, no publicly-available pre-trained BERT models yet exist. In this work, we address this need by exploring and releasing BERT models for clinical text: one for generic clinical text and another for discharge summaries specifically. We demonstrate that using a domain-specific model yields performance improvements on three common clinical NLP tasks as compared to nonspecific embeddings. These domain-specific models are not as performant on two clinical de-identification tasks, and argue that this is a natural consequence of the differences between de-identified source text and synthetically non de-identified task text.
@cite_8 trains an ELMo model over a corpus of mixed clinical discharge summaries, clinical radiology notes and medically oriented wikipedia articles, then demonstrates improved performance on the i2b2 2010 task @cite_16 . They release a pre-trained ELMo model along with their work, enabling further clinical NLP research to work with these powerful contextual embeddings.
@cite_16 @cite_8
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Objective : Development of a general natural-language processor that identifies clinical information in narrative reports and maps that information into a structured representation containing clinical terms. @PARASPLIT Design : The natural-language processor provides three phases of processing, all of which are driven by different knowledge sources. The first phase performs the parsing. It identifies the structure of the text through use of a grammar that defines semantic patterns and a target form. The second phase, regularization, standardizes the terms in the initial target structure via a compositional mapping of multi-word phrases. The third phase, encoding, maps the terms to a controlled vocabulary. Radiology is the test domain for the processor and the target structure is a formal model for representing clinical information in that domain. @PARASPLIT Measurements : The impression sections of 230 radiology reports were encoded by the processor. Results of an automated query of the resultant database for the occurrences of four diseases were compared with the analysis of a panel of three physicians to determine recall and precision. @PARASPLIT Results : Without training specific to the four diseases, recall and precision of the system(combined effect of the processor and query generator) were 70 and 87 . Training of the query component increased recall to 85 without changing precision. Neural network-based representations ("embeddings") have dramatically advanced natural language processing (NLP) tasks, including clinical NLP tasks such as concept extraction. Recently, however, more advanced embedding methods and representations (e.g., ELMo, BERT) have further pushed the state-of-the-art in NLP, yet there are no common best practices for how to integrate these representations into clinical tasks. The purpose of this study, then, is to explore the space of possible options in utilizing these new models for clinical concept extraction, including comparing these to traditional word embedding methods (word2vec, GloVe, fastText). Both off-the-shelf, open-domain embeddings and pre-training clinical embeddings from MIMIC-III are evaluated. We explore a battery of embedding methods consisting of traditional word embeddings and contextual embeddings, and compare these on four concept extraction corpora: i2b2 2010, i2b2 2012, SemEval 2014, and SemEval 2015. We also analyze the impact of the pre-training time of a large language model like ELMo or BERT on the extraction performance. Finally, we present an intuitive way to understand the semantic information encoded by contextual embeddings. Contextual embeddings pre-trained on a large clinical corpus achieves new state-of-the-art performances across all concept extraction tasks. The best-performing model outperforms all state-of-the-art methods with respective F1-measures of 90.25, 93.18 (partial), 80.74, and 81.65. We demonstrate the potential of contextual embeddings through the state-of-the-art performance these methods achieve on clinical concept extraction. Additionally, we demonstrate contextual embeddings encode valuable semantic information not accounted for in traditional word representations. Communication of follow-up recommendations when abnormalities are identified on imaging studies is prone to error. The absence of an automated system to identify and track radiology recommendations is an important barrier to ensuring timely follow-up of patients especially with non-acute incidental findings on imaging examinations. In this paper, we present a text processing pipeline to automatically identify clinically important recommendation sentences in radiology reports. Our extraction pipeline is based on natural language processing (NLP) and supervised text classification methods. To develop and test the pipeline, we created a corpus of 800 radiology reports double annotated for recommendation sentences by a radiologist and an internist. We ran several experiments to measure the impact of different feature types and the data imbalance between positive and negative recommendation sentences. Our fully statistical approach achieved the best f-score 0.758 in identifying the critical recommendation sentences in radiology reports. Background The Sixth Informatics for Integrating Biology and the Bedside (i2b2) Natural Language Processing Challenge for Clinical Records focused on the temporal relations in clinical narratives. The organizers provided the research community with a corpus of discharge summaries annotated with temporal information, to be used for the development and evaluation of temporal reasoning systems. 18 teams from around the world participated in the challenge. During the workshop, participating teams presented comprehensive reviews and analysis of their systems, and outlined future research directions suggested by the challenge contributions. @PARASPLIT Methods The challenge evaluated systems on the information extraction tasks that targeted: (1) clinically significant events, including both clinical concepts such as problems, tests, treatments, and clinical departments, and events relevant to the patient's clinical timeline, such as admissions, transfers between departments, etc; (2) temporal expressions, referring to the dates, times, durations, or frequencies phrases in the clinical text. The values of the extracted temporal expressions had to be normalized to an ISO specification standard; and (3) temporal relations, between the clinical events and temporal expressions. Participants determined pairs of events and temporal expressions that exhibited a temporal relation, and identified the temporal relation between them. @PARASPLIT Results For event detection, statistical machine learning (ML) methods consistently showed superior performance. While ML and rule based methods seemed to detect temporal expressions equally well, the best systems overwhelmingly adopted a rule based approach for value normalization. For temporal relation classification, the systems using hybrid approaches that combined ML and heuristics based methods produced the best results. Objective Build probabilistic topic model representations of hospital admissions processes and compare the ability of such models to predict clinical order patterns as compared to preconstructed order sets. @PARASPLIT Materials and Methods The authors evaluated the first 24 hours of structured electronic health record data for > 10 K inpatients. Drawing an analogy between structured items (e.g., clinical orders) to words in a text document, the authors performed latent Dirichlet allocation probabilistic topic modeling. These topic models use initial clinical information to predict clinical orders for a separate validation set of > 4 K patients. The authors evaluated these topic model-based predictions vs existing human-authored order sets by area under the receiver operating characteristic curve, precision, and recall for subsequent clinical orders. @PARASPLIT Results Existing order sets predict clinical orders used within 24 hours with area under the receiver operating characteristic curve 0.81, precision 16 , and recall 35 . This can be improved to 0.90, 24 , and 47 ( P < 10−20) by using probabilistic topic models to summarize clinical data into up to 32 topics. Many of these latent topics yield natural clinical interpretations (e.g., “critical care,” “pneumonia,” “neurologic evaluation”). @PARASPLIT Discussion Existing order sets tend to provide nonspecific, process-oriented aid, with usability limitations impairing more precise, patient-focused support. Algorithmic summarization has the potential to breach this usability barrier by automatically inferring patient context, but with potential tradeoffs in interpretability. @PARASPLIT Conclusion Probabilistic topic modeling provides an automated approach to detect thematic trends in patient care and generate decision support content. A potential use case finds related clinical orders for decision support. This issue of JAMIA focuses on natural language processing (NLP) techniques for clinical-text information extraction. Several articles are offshoots of the yearly ‘Informatics for Integrating Biology and the Bedside’ (i2b2) (http: www.i2b2.org) NLP shared-task challenge, introduced by ( see page 552 )1 and co-sponsored by the Veteran's Administration for the last 2 years. This shared task follows long-running challenge evaluations in other fields, such as the Message Understanding Conference (MUC) for information extraction,2 TREC3 for text information retrieval, and CASP4 for protein structure prediction. Shared tasks in the clinical domain are recent and include annual i2b2 Challenges that began in 2006, a challenge for multi-label classification of radiology reports sponsored by Cincinnati Children's Hospital in 2007,5 a 2011 Cincinnati Children's Hospital challenge on suicide notes,6 and the 2011 TREC information retrieval shared task involving retrieval of clinical cases from narrative records.7 @PARASPLIT Although NLP research in the clinical domain has been active since the 1960s, progress in the development of NLP applications for clinical text has been slow and lags behind progress in the general NLP domain. There are several barriers to NLP development in the clinical domain, and shared tasks like the i2b2 VA Challenge address some of these barriers. Nevertheless, many barriers remain and unless the community takes a more active role in developing novel approaches for addressing the barriers, advancement and innovation will continue to be slow. @PARASPLIT Historically, there have been substantial barriers to NLP development in the clinical domain. These barriers are not unique to the clinical domain: they also occur in the fields of software engineering and general NLP. @PARASPLIT ### Lack of access to shared data @PARASPLIT Because of concerns regarding patient privacy and worry about revealing unfavorable institutional practices, hospitals and clinics have been extremely reluctant to allow access to clinical data for researchers from outside … @PARASPLIT Correspondence to Dr Wendy W Chapman, Department of Biomedical Informatics, University of California San Diego, 9500 Gilman Dr, Bldg 2 #0728, La Jolla, California, USA; wwchapman at ucsd.edu The volume of biomedical literature has experienced explosive growth in recent years. This is reflected in the corresponding increase in the size of MEDLINE^(R), the largest bibliographic database of biomedical citations. Indexers at the US National Library of Medicine (NLM) need efficient tools to help them accommodate the ensuing workload. After reviewing issues in the automatic assignment of Medical Subject Headings (MeSH^(R) terms) to biomedical text, we focus more specifically on the new subheading attachment feature for NLM's Medical Text Indexer (MTI). Natural Language Processing, statistical, and machine learning methods of producing automatic MeSH main heading subheading pair recommendations were assessed independently and combined. The best combination achieves 48 precision and 30 recall. After validation by NLM indexers, a suitable combination of the methods presented in this paper was integrated into MTI as a subheading attachment feature producing MeSH indexing recommendations compliant with current state-of-the-art indexing practice. Radiological reporting has generated large quantities of digital content within the electronic health record, which is potentially a valuable source of information for improving clinical care and supporting research. Although radiology reports are stored for communication and documentation of diagnostic imaging, harnessing their potential requires efficient and automated information extraction: they exist mainly as free-text clinical narrative, from which it is a major challenge to obtain structured data. Natural language processing (NLP) provides techniques that aid the conversion of text into a structured representation, and thus enables computers to derive meaning from human (ie, natural language) input. Used on radiology reports, NLP techniques enable automatic identification and extraction of information. By exploring the various purposes for their use, this review examines how radiology benefits from NLP. A systematic literature search identified 67 relevant publications describing NLP methods that support practical applications in radiology. This review takes a close look at the individual studies in terms of tasks (ie, the extracted information), the NLP methodology and tools used, and their application purpose and performance results. Additionally, limitations, future challenges, and requirements for advancing NLP in radiology will be discussed. The 2010 i2b2 VA Workshop on Natural Language Processing Challenges for Clinical Records presented three tasks: a concept extraction task focused on the extraction of medical concepts from patient reports; an assertion classification task focused on assigning assertion types for medical problem concepts; and a relation classification task focused on assigning relation types that hold between medical problems, tests, and treatments. i2b2 and the VA provided an annotated reference standard corpus for the three tasks. Using this reference standard, 22 systems were developed for concept extraction, 21 for assertion classification, and 16 for relation classification. @PARASPLIT These systems showed that machine learning approaches could be augmented with rule-based systems to determine concepts, assertions, and relations. Depending on the task, the rule-based systems can either provide input for machine learning or post-process the output of machine learning. Ensembles of classifiers, information from unlabeled data, and external knowledge sources can help when the training data are inadequate. Motivation: In recent years, several biomedical event extraction (EE) systems have been developed. However, the nature of the annotated training corpora, as well as the training process itself, can limit the performance levels of the trained EE systems. In particular, most event-annotated corpora do not deal adequately with coreference. This impacts on the trained systems' ability to recognize biomedical entities, thus affecting their performance in extracting events accurately. Additionally, the fact that most EE systems are trained on a single annotated corpus further restricts their coverage. Results: We have enhanced our existing EE system, EventMine, in two ways. First, we developed a new coreference resolution (CR) system and integrated it with EventMine. The standalone performance of our CR system in resolving anaphoric references to proteins is considerably higher than the best ranked system in the COREF subtask of the BioNLP'11 Shared Task. Secondly, the improved EventMine incorporates domain adaptation (DA) methods, which extend EE coverage by allowing several different annotated corpora to be used during training. Combined with a novel set of methods to increase the generality and efficiency of EventMine, the integration of both CR and DA have resulted in significant improvements in EE, ranging between 0.5 and 3.4 F-Score. The enhanced EventMine outperforms the highest ranked systems from the BioNLP'09 shared task, and from the GENIA and Infectious Diseases subtasks of the BioNLP'11 shared task. Availability: The improved version of EventMine, incorporating the CR system and DA methods, is available at: http: www.nactem.ac.uk EventMine . Contact: makoto.miwa@manchester.ac.uk This paper addresses an information-extraction problem that aims to identify semantic relations among medical concepts (problems, tests, and treatments) in clinical text. The objectives of the paper are twofold. First, we extend an earlier one-page description (appearing as a part of [5]) of a top-ranked model in the 2010 I2B2 NLP Challenge to a necessary level of details, with the belief that feature design is the most crucial factor to the success of our system and hence deserves a more detailed discussion. We present a precise quantification of the contributions of a wide variety of knowledge sources. In addition, we show the end-to-end results obtained on the noisy output of a top-ranked concept detector, which could help construct a more complete view of the state of the art in the real-world scenario. As the second major objective, we reformulate our models into a composite-kernel framework and present the best result, according to our knowledge, on the same dataset. Attentional, RNN-based encoder-decoder models for abstractive summarization have achieved good performance on short input and output sequences. For longer documents and summaries however these models often include repetitive and incoherent phrases. We introduce a neural network model with a novel intra-attention that attends over the input and continuously generated output separately, and a new training method that combines standard supervised word prediction and reinforcement learning (RL). Models trained only with supervised learning often exhibit "exposure bias" - they assume ground truth is provided at each step during training. However, when standard word prediction is combined with the global sequence prediction training of RL the resulting summaries become more readable. We evaluate this model on the CNN Daily Mail and New York Times datasets. Our model obtains a 41.16 ROUGE-1 score on the CNN Daily Mail dataset, an improvement over previous state-of-the-art models. Human evaluation also shows that our model produces higher quality summaries. Temporal information in clinical narratives plays an important role in patients' diagnosis, treatment and prognosis. In order to represent narrative information accurately, medical natural language processing (MLP) systems need to correctly identify and interpret temporal information. To promote research in this area, the Informatics for Integrating Biology and the Bedside (i2b2) project developed a temporally annotated corpus of clinical narratives. This corpus contains 310 de-identified discharge summaries, with annotations of clinical events, temporal expressions and temporal relations. This paper describes the process followed for the development of this corpus and discusses annotation guideline development, annotation methodology, and corpus quality. Display Omitted De-identification shared task for longitudinal clinical records.Protected Health Information in records replaced with realistic surrogates.First corpus of its kind available for distribution.Used for Track 1 of the 2014 i2b2 UTHealth NLP shared task. The 2014 i2b2 UTHealth natural language processing shared task featured a track focused on the de-identification of longitudinal medical records. For this track, we de-identified a set of 1304 longitudinal medical records describing 296 patients. This corpus was de-identified under a broad interpretation of the HIPAA guidelines using double-annotation followed by arbitration, rounds of sanity checking, and proof reading. The average token-based F1 measure for the annotators compared to the gold standard was 0.927. The resulting annotations were used both to de-identify the data and to set the gold standard for the de-identification track of the 2014 i2b2 UTHealth shared task. All annotated private health information were replaced with realistic surrogates automatically and then read over and corrected manually. The resulting corpus is the first of its kind made available for de-identification research. This corpus was first used for the 2014 i2b2 UTHealth shared task, during which the systems achieved a mean F-measure of 0.872 and a maximum F-measure of 0.964 using entity-based micro-averaged evaluations. Large amount of electronic clinical data encompass important information in free text format. To be able to help guide medical decision-making, text needs to be efficiently processed and coded. In this research, we investigate techniques to improve classification of Emergency Department computed topography (CT) reports. The proposed system uses Natural Language Processing (NLP) to generate structured output from patient reports and then applies machine learning techniques to code for the presence of clinically important injuries for traumatic orbital fracture victims. Topic modeling of the corpora is also utilized as an alternative representation of the patient reports. Our results show that both NLP and topic modeling improve raw text classification results. Within NLP features, filtering the codes using modifiers produces the best performance. Topic modeling, on the other hand, shows mixed results. Topic vectors provide good dimensionality reduction and get comparable classification results as with NLP features. However, binary topic classification fails to improve upon raw text classification. In this work, we exploit the task of joint classification and weakly supervised localization of thoracic diseases from chest radiographs, with only image-level disease labels coupled with disease severity-level (DSL) information of a subset. A convolutional neural network (CNN) based attention-guided curriculum learning (AGCL) framework is presented, which leverages the severity-level attributes mined from radiology reports. Images in order of difficulty (grouped by different severity-levels) are fed to CNN to boost the learning gradually. In addition, highly confident samples (measured by classification probabilities) and their corresponding class-conditional heatmaps (generated by the CNN) are extracted and further fed into the AGCL framework to guide the learning of more distinctive convolutional features in the next iteration. A two-path network architecture is designed to regress the heatmaps from selected seed samples in addition to the original classification task. The joint learning scheme can improve the classification and localization performance along with more seed samples for the next iteration. We demonstrate the effectiveness of this iterative refinement framework via extensive experimental evaluations on the publicly available ChestXray14 dataset. AGCL achieves over 5.7 (averaged over 14 diseases) increase in classification AUC and 7 11 increases in Recall Precision for the localization task compared to the state of the art. Automatic extraction of clinical concepts is an essential step for turning the unstructured data within a clinical note into structured and actionable information. In this work, we propose a clinical concept extraction model for automatic annotation of clinical problems, treatments, and tests in clinical notes utilizing domain-specific contextual word embedding. A contextual word embedding model is first trained on a corpus with a mixture of clinical reports and relevant Wikipedia pages in the clinical domain. Next, a bidirectional LSTM-CRF model is trained for clinical concept extraction using the contextual word embedding model. We tested our proposed model on the I2B2 2010 challenge dataset. Our proposed model achieved the best performance among reported baseline models and outperformed the state-of-the-art models by 3.4 in terms of F1-score. Unsupervised representation learning algorithms such as word2vec and ELMo improve the accuracy of many supervised NLP models, mainly because they can take advantage of large amounts of unlabeled text. However, the supervised models only learn from task-specific labeled data during the main training phase. We therefore propose Cross-View Training (CVT), a semi-supervised learning algorithm that improves the representations of a Bi-LSTM sentence encoder using a mix of labeled and unlabeled data. On labeled examples, standard supervised learning is used. On unlabeled examples, CVT teaches auxiliary prediction modules that see restricted views of the input (e.g., only part of a sentence) to match the predictions of the full model seeing the whole input. Since the auxiliary modules and the full model share intermediate representations, this in turn improves the full model. Moreover, we show that CVT is particularly effective when combined with multi-task learning. We evaluate CVT on five sequence tagging tasks, machine translation, and dependency parsing, achieving state-of-the-art results. Recently, neural models pretrained on a language modeling task, such as ELMo (, 2017), OpenAI GPT (, 2018), and BERT (, 2018), have achieved impressive results on various natural language processing tasks such as question-answering and natural language inference. In this paper, we describe a simple re-implementation of BERT for query-based passage re-ranking. Our system is the state of the art on the TREC-CAR dataset and the top entry in the leaderboard of the MS MARCO passage retrieval task, outperforming the previous state of the art by 27 (relative) in MRR@10. The code to reproduce our results is available at this https URL Background Existing risk adjustment models for intensive care unit (ICU) outcomes rely on manual abstraction of patient-level predictors from medical charts. Developing an automated method for abstracting these data from free text might reduce cost and data collection times. @PARASPLIT Objective To develop a support vector machine (SVM) classifier capable of identifying a range of procedures and diagnoses in ICU clinical notes for use in risk adjustment. @PARASPLIT Materials and methods We selected notes from 2001–2008 for 4191 neonatal ICU (NICU) and 2198 adult ICU patients from the MIMIC-II database from the Beth Israel Deaconess Medical Center. Using these notes, we developed an implementation of the SVM classifier to identify procedures (mechanical ventilation and phototherapy in NICU notes) and diagnoses (jaundice in NICU and intracranial hemorrhage (ICH) in adult ICU). On the jaundice classification task, we also compared classifier performance using n-gram features to unigrams with application of a negation algorithm (NegEx). @PARASPLIT Results Our classifier accurately identified mechanical ventilation (accuracy=0.982, F1=0.954) and phototherapy use (accuracy=0.940, F1=0.912), as well as jaundice (accuracy=0.898, F1=0.884) and ICH diagnoses (accuracy=0.938, F1=0.943). Including bigram features improved performance on the jaundice (accuracy=0.898 vs 0.865) and ICH (0.938 vs 0.927) tasks, and outperformed NegEx-derived unigram features (accuracy=0.898 vs 0.863) on the jaundice task. @PARASPLIT Discussion Overall, a classifier using n-gram support vectors displayed excellent performance characteristics. The classifier generalizes to diverse patient populations, diagnoses, and procedures. @PARASPLIT Conclusions SVM-based classifiers can accurately identify procedure status and diagnoses among ICU patients, and including n-gram features improves performance, compared to existing methods.