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.
On clinical text, @cite_22 uses a general-domain pretrained ELMo model towards the task of clinical text de-identification, reporting near state-of-the-art performance on the i2b2 2014 task @cite_3 @cite_6 and state of the art performance on several axes of the HIPAA PHI dataset.
@cite_22 @cite_3 @cite_6
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Display Omitted First de-identification shared task on clinical narratives.10 teams participated, submitting 22 system output.Top-performing system achieved micro-averaged F1 measure of .936 using strictest evaluation metric. The 2014 i2b2 UTHealth Natural Language Processing (NLP) shared task featured four tracks. The first of these was the de-identification track focused on identifying protected health information (PHI) in longitudinal clinical narratives. The longitudinal nature of clinical narratives calls particular attention to details of information that, while benign on their own in separate records, can lead to identification of patients in combination in longitudinal records. Accordingly, the 2014 de-identification track addressed a broader set of entities and PHI than covered by the Health Insurance Portability and Accountability Act - the focus of the de-identification shared task that was organized in 2006. Ten teams tackled the 2014 de-identification task and submitted 22 system outputs for evaluation. Each team was evaluated on their best performing system output. Three of the 10 systems achieved F1 scores over .90, and seven of the top 10 scored over .75. The most successful systems combined conditional random fields and hand-written rules. Our findings indicate that automated systems can be very effective for this task, but that de-identification is not yet a solved problem. Objective: Patient notes in electronic health records (EHRs) may contain critical information for medical investigations. However, the vast majority of medical investigators can only access de-identified notes, in order to protect the confidentiality of patients. In the United States, the Health Insurance Portability and Accountability Act (HIPAA) defines 18 types of protected health information (PHI) that needs to be removed to de-identify patient notes. Manual de-identification is impractical given the size of EHR databases, the limited number of researchers with access to the non-de-identified notes, and the frequent mistakes of human annotators. A reliable automated de-identification system would consequently be of high value. Materials and Methods: We introduce the first de-identification system based on artificial neural networks (ANNs), which requires no handcrafted features or rules, unlike existing systems. We compare the performance of the system with state-of-the-art systems on two datasets: the i2b2 2014 de-identification challenge dataset, which is the largest publicly available de-identification dataset, and the MIMIC de-identification dataset, which we assembled and is twice as large as the i2b2 2014 dataset. Results: Our ANN model outperforms the state-of-the-art systems. It yields an F1-score of 97.85 on the i2b2 2014 dataset, with a recall 97.38 and a precision of 97.32, and an F1-score of 99.23 on the MIMIC de-identification dataset, with a recall 99.25 and a precision of 99.06. Conclusion: Our findings support the use of ANNs for de-identification of patient notes, as they show better performance than previously published systems while requiring no feature engineering. 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. 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. Electronic clinical documentation can be useful for activities such as public health surveillance, quality improvement, and research, but existing methods of de-identification may not provide sufficient protection of patient data. The general-purpose natural language processor MedLEE retains medical concepts while excluding the remaining text so, in addition to processing text into structured data, it may be able provide a secondary benefit of de-identification. Without modifying the system, the authors tested the ability of MedLEE to remove protected health information (PHI) by comparing 100 outpatient clinical notes with the corresponding XML-tagged output. Of 809 instances of PHI, 26 (3.2 ) were detected in output as a result of processing and identification errors. However, PHI in the output was highly transformed, much appearing as normalized terms for medical concepts, potentially making re-identification more difficult. The MedLEE processor may be a good enhancement to other de-identification systems, both removing PHI and providing coded data from clinical text. De-identification is the process of removing 18 protected health information (PHI) from clinical notes in order for the text to be considered not individually identifiable. Recent advances in natural language processing (NLP) has allowed for the use of deep learning techniques for the task of de-identification. In this paper, we present a deep learning architecture that builds on the latest NLP advances by incorporating deep contextualized word embeddings and variational drop out Bi-LSTMs. We test this architecture on two gold standard datasets and show that the architecture achieves state-of-the-art performance on both data sets while also converging faster than other systems without the use of dictionaries or other knowledge sources. 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 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. This paper describes the SemEval-2014, Task 7 on the Analysis of Clinical Text and presents the evaluation results. It focused on two subtasks: (i) identification (Task A) and (ii) normalization (Task B) of diseases and disorders in clinical reports as annotated in the Shared Annotated Resources (ShARe) 1 corpus. This task was a follow-up to the ShARe CLEF eHealth 2013 shared task, subtasks 1a and 1b, 2 but using a larger test set. A total of 21 teams competed in Task A, and 18 of those also participated in Task B. For Task A, the best system had a strict F1-score of 81.3, with a precision of 84.3 and recall of 78.6. For Task B, the same group had the best strict accuracy of 74.1. The organizers have made the text corpora, annotations, and evaluation tools available for future research and development at the shared task website. 3 We created a software tool that accurately removes all patient identifying information from various kinds of clinical data documents, including laboratory and narrative reports. We created the Medical De-identification System (MeDS), a software tool that de-identifies clinical documents, and performed 2 evaluations. Our first evaluation used 2,400 Health Level Seven (HL7) messages from 10 different HL7 message producers. After modifying the software based on the results of this first evaluation, we performed a second evaluation using 7,190 pathology report HL7 messages. We compared the results of MeDS de-identification process to a gold standard of human review to find identifying strings. For both evaluations, we calculated the number of successful scrubs, missed identifiers, and over-scrubs committed by MeDS and evaluated the readability and interpretability of the scrubbed messages. We categorized all missed identifiers into 3 groups: (1) complete HIPAA-specified identifiers, (2) HIPAA-specified identifier fragments, (3) non-HIPAA–specified identifiers (such as provider names and addresses). In the results of the first-pass evaluation, MeDS scrubbed 11,273 (99.06 ) of the 11,380 HIPAA-specified identifiers and 38,095 (98.26 ) of the 38,768 non-HIPAA–specified identifiers. In our second evaluation (status postmodification to the software), MeDS scrubbed 79,993 (99.47 ) of the 80,418 HIPAA-specified identifiers and 12,689 (96.93 ) of the 13,091 non-HIPAA–specified identifiers. Approximately 95 of scrubbed messages were both readable and interpretable. We conclude that MeDS successfully de-identified a wide range of medical documents from numerous sources and creates scrubbed reports that retain their interpretability, thereby maintaining their usefulness for research. Citation relationship between scientific publications has been successfully used for scholarly bibliometrics, information retrieval and data mining tasks, and citation-based recommendation algorithms are well documented. While previous studies investigated citation relations from various viewpoints, most of them share the same assumption that, if paper1 cites paper2 (or author1 cites author2), they are connected, regardless of citation importance, sentiment, reason, topic, or motivation. However, this assumption is oversimplified. In this study, we employ an innovative "context-rich heterogeneous network" approach, which paves a new way for citation recommendation task. In the network, we characterize 1) the importance of citation relationships between citing and cited papers, and 2) the topical citation motivation. Unlike earlier studies, the citation information, in this paper, is characterized by citation textual contexts extracted from the full-text citing paper. We also propose algorithm to cope with the situation when large portion of full-text missing information exists in the bibliographic repository. Evaluation results show that, context-rich heterogeneous network can significantly enhance the citation recommendation performance. In a document network such as a citation network of scientific documents, web-logs, etc., the content produced by authors exhibits their interest in certain topics. In addition some authors influence other authors' interests. In this work, we propose to model the influence of cited authors along with the interests of citing authors. Moreover, we hypothesize that apart from the citations present in documents, the context surrounding the citation mention provides extra topical information about the cited authors. However, associating terms in the context to the cited authors remains an open problem. We propose novel document generation schemes that incorporate the context while simultaneously modeling the interests of citing authors and influence of the cited authors. Our experiments show significant improvements over baseline models for various evaluation criteria such as link prediction between document and cited author, and quantitatively explaining unseen text. A citing sentence is one that appears in a scientific article and cites previous work. Citing sentences have been studied and used in many applications. For example, they have been used in scientific paper summarization, automatic survey generation, paraphrase identification, and citation function classification. Citing sentences that cite multiple papers are common in scientific writing. This observation should be taken into consideration when using citing sentences in applications. For instance, when a citing sentence is used in a summary of a scientific paper, only the fragments of the sentence that are relevant to the summarized paper should be included in the summary. In this paper, we present and compare three different approaches for identifying the fragments of a citing sentence that are related to a given target reference. Our methods are: word classification, sequence labeling, and segment classification. Our experiments show that segment classification achieves the best results. Abstract Documents in computer-readable form can be used to provide information about other documents, i.e. those they cite. To do this efficiently requires procedures for computer recognition of citing statements. This is not easy, especially for multi-sentence citing statements. Computer recognition procedures have been developed which are accurate to the following extent: 73 of the words in statements selected by computer procedures as being citing statements are words which are correctly attributable to the corresponding documents. The retrieval effectiveness of computer-recognized citing statements was tested in the following way. First, for eight retrieval requests in inorganiic chemistry, average recall by search of Chemical Abstracts Service indexing and Chemical Abstracts abstract text words was found to be 50 . Words from citing statements referring to the papers to be retrieved were then added to the index terms and abstract words as additional access points, and searching was repeated. Average recall increased to 70 . Only words from citing statements published within a year of the cited papers were used. The retrieval effect of citing statement words alone (published within a year) without index or abstract terms was the following: average recall was 40 . When just the words of the titles of the cited papers were added to those citing statement words, average recall increased to 50 . Scholars are increasingly citing electronic “web references” which are not preserved in libraries or full text archives. WebCite is a new standard for citing web references. To “webcite” a document involves archiving the cited Web page through www.webcitation.org and citing the WebCite permalink instead of (or in addition to) the unstable live Web page. This journal has amended its “instructions for authors” accordingly, asking authors to archive cited Web pages before submitting a manuscript. Almost 200 other journals are already using the system. We discuss the rationale for WebCite, its technology, and how scholars, editors, and publishers can benefit from the service. Citing scholars initiate an archiving process of all cited Web references, ideally before they submit a manuscript. Authors of online documents and websites which are expected to be cited by others can ensure that their work is permanently available by creating an archived copy using WebCite and providing the citation information including the WebCite link on their Web document(s). Editors should ask their authors to cache all cited Web addresses (Uniform Resource Locators, or URLs) “prospectively” before submitting their manuscripts to their journal. Editors and publishers should also instruct their copyeditors to cache cited Web material if the author has not done so already. Finally, WebCite can process publisher submitted “citing articles” (submitted for example as eXtensible Markup Language [XML] documents) to automatically archive all cited Web pages shortly before or on publication. Finally, WebCite can act as a focussed crawler, caching retrospectively references of already published articles. Copyright issues are addressed by honouring respective Internet standards (robot exclusion files, no-cache and no-archive tags). Long-term preservation is ensured by agreements with libraries and digital preservation organizations. The resulting WebCite Index may also have applications for research assessment exercises, being able to measure the impact of Web services and published Web documents through access and Web citation metrics. @PARASPLIT [J Med Internet Res 2005;7(5):e60] On the occasion of the 10th anniversary of the MSR conference, it is a worthwhile exercise to meditate on the past, present and future of our research discipline. Indeed, since the MSR community has experienced a big influx of researchers bringing in new ideas, state-of-the art technology and contemporary research methods it is unclear what the future might bring. In this paper, we report on a text mining exercise applied on the complete corpus of MSR papers to reflect on where we come from; where we are now; and where we should be going. We address issues like the trendy (and outdated) research topics; the frequently (and less frequently) cited cases; the popular (and emerging) mining infrastructure; and finally the proclaimed actionable information which we are deemed to uncover. With the advent of electronic health records, more data are continuously collected for individual patients, and more data are available for review from past patients. Despite this, it has not yet been possible to successfully use this data to systematically build clinical decision support systems that can produce personalized clinical recommendations to assist clinicians in providing individualized healthcare. In this paper, we present a novel approach, discovery engine (DE), that discovers which patient characteristics are most relevant for predicting the correct diagnosis and or recommending the best treatment regimen for each patient. We demonstrate the performance of DE in two clinical settings: diagnosis of breast cancer as well as a personalized recommendation for a specific chemotherapy regimen for breast cancer patients. For each distinct clinical recommendation, different patient features are relevant; DE can discover these different relevant features and use them to recommend personalized clinical decisions. The DE approach achieves a 16.6 improvement over existing state-of-the-art recommendation algorithms regarding kappa coefficients for recommending the personalized chemotherapy regimens. For diagnostic predictions, the DE approach achieves a 2.18 and 4.20 improvement over existing state-of-the-art prediction algorithms regarding prediction error rate and false positive rate, respectively. We also demonstrate that the performance of our approach is robust against missing information and that the relevant features discovered by DE are confirmed by clinical references. State-of-the-art visual perception models for a wide range of tasks rely on supervised pretraining. ImageNet classification is the de facto pretraining task for these models. Yet, ImageNet is now nearly ten years old and is by modern standards “small”. Even so, relatively little is known about the behavior of pretraining with datasets that are multiple orders of magnitude larger. The reasons are obvious: such datasets are difficult to collect and annotate. In this paper, we present a unique study of transfer learning with large convolutional networks trained to predict hashtags on billions of social media images. Our experiments demonstrate that training for large-scale hashtag prediction leads to excellent results. We show improvements on several image classification and object detection tasks, and report the highest ImageNet-1k single-crop, top-1 accuracy to date: 85.4 (97.6 top-5). We also perform extensive experiments that provide novel empirical data on the relationship between large-scale pretraining and transfer learning performance. State-of-the-art visual perception models for a wide range of tasks rely on supervised pretraining. ImageNet classification is the de facto pretraining task for these models. Yet, ImageNet is now nearly ten years old and is by modern standards "small". Even so, relatively little is known about the behavior of pretraining with datasets that are multiple orders of magnitude larger. The reasons are obvious: such datasets are difficult to collect and annotate. In this paper, we present a unique study of transfer learning with large convolutional networks trained to predict hashtags on billions of social media images. Our experiments demonstrate that training for large-scale hashtag prediction leads to excellent results. We show improvements on several image classification and object detection tasks, and report the highest ImageNet-1k single-crop, top-1 accuracy to date: 85.4 (97.6 top-5). We also perform extensive experiments that provide novel empirical data on the relationship between large-scale pretraining and transfer learning performance. Meaningful Use guidelines have pushed the United States Healthcare System to adopt electronic health record systems (EHRs) at an unprecedented rate. Hospitals and medical centers are providing access to clinical data via clinical data warehouses such as i2b2, or Stanford’s STRIDE database. In order to realize the potential of using these data for translational research, clinical data warehouses must be interoperable with standardized health terminologies, biomedical ontologies, and growing networks of Linked Open Data such as Bio2RDF. Applying the principles of Linked Data, we transformed a de-identified version of the STRIDE into a semantic clinical data warehouse containing visits, labs, diagnoses, prescriptions, and annotated clinical notes. We demonstrate the utility of this system though basic cohort selection, phenotypic profiling, and identification of disease genes. This work is significant in that it demonstrates the feasibility of using semantic web technologies to directly exploit existing biomedical ontologies and Linked Open Data.