比较用于电子健康记录预测的编码疾病序列的自然语言处理表示法。

IF 4.7 2区 医学 Q1 COMPUTER SCIENCE, INFORMATION SYSTEMS
Thomas Beaney, Sneha Jha, Asem Alaa, Alexander Smith, Jonathan Clarke, Thomas Woodcock, Azeem Majeed, Paul Aylin, Mauricio Barahona
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引用次数: 0

摘要

目的:自然语言处理(NLP)算法越来越多地被用于获取电子健康记录(EHR)数据的无监督表示,但它们在预测临床终点方面的比较性能仍不清楚。我们的目的是比较由词袋生成的疾病代码序列的无监督表示与基于序列的 NLP 算法在预测临床相关结果方面的性能:这项队列研究使用了英格兰 6 286 233 名患有多种长期疾病患者的初级保健电子病历。对于每位患者,我们使用两种输入策略(212 种疾病类别和 9462 个诊断代码)和不同的 NLP 算法(潜在 Dirichlet 分配、doc2vec 和 2 个专为电子病历设计的转换器模型)生成了其疾病时间排序序列的无监督向量表示。我们还开发了一种转换器架构,名为 EHR-BERT,其中包含社会人口信息。我们比较了这些表征(未经微调)作为逻辑分类器输入的性能,以预测 1 年死亡率、医疗保健使用情况和新疾病诊断:在预测临床终点方面,基于序列算法生成的患者表征始终优于字袋法,其中 EHR-BERT 在所有任务中的表现最佳,但绝对改进幅度较小。使用疾病类别生成的表征与使用诊断代码作为输入的表征表现类似,这表明模型同样可以管理较小或较大的词汇表来预测这些结果:基于序列的 NLP 算法根据疾病代码序列生成的患者表征与基于共现的算法生成的表征相比,对患者结果的预测内容有所改善。这表明,即使不进行微调,转换器模型也可用于生成多用途表征。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparing natural language processing representations of coded disease sequences for prediction in electronic health records.

Objective: Natural language processing (NLP) algorithms are increasingly being applied to obtain unsupervised representations of electronic health record (EHR) data, but their comparative performance at predicting clinical endpoints remains unclear. Our objective was to compare the performance of unsupervised representations of sequences of disease codes generated by bag-of-words versus sequence-based NLP algorithms at predicting clinically relevant outcomes.

Materials and methods: This cohort study used primary care EHRs from 6 286 233 people with Multiple Long-Term Conditions in England. For each patient, an unsupervised vector representation of their time-ordered sequences of diseases was generated using 2 input strategies (212 disease categories versus 9462 diagnostic codes) and different NLP algorithms (Latent Dirichlet Allocation, doc2vec, and 2 transformer models designed for EHRs). We also developed a transformer architecture, named EHR-BERT, incorporating sociodemographic information. We compared the performance of each of these representations (without fine-tuning) as inputs into a logistic classifier to predict 1-year mortality, healthcare use, and new disease diagnosis.

Results: Patient representations generated by sequence-based algorithms performed consistently better than bag-of-words methods in predicting clinical endpoints, with the highest performance for EHR-BERT across all tasks, although the absolute improvement was small. Representations generated using disease categories perform similarly to those using diagnostic codes as inputs, suggesting models can equally manage smaller or larger vocabularies for prediction of these outcomes.

Discussion and conclusion: Patient representations produced by sequence-based NLP algorithms from sequences of disease codes demonstrate improved predictive content for patient outcomes compared with representations generated by co-occurrence-based algorithms. This suggests transformer models may be useful for generating multi-purpose representations, even without fine-tuning.

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来源期刊
Journal of the American Medical Informatics Association
Journal of the American Medical Informatics Association 医学-计算机:跨学科应用
CiteScore
14.50
自引率
7.80%
发文量
230
审稿时长
3-8 weeks
期刊介绍: JAMIA is AMIA''s premier peer-reviewed journal for biomedical and health informatics. Covering the full spectrum of activities in the field, JAMIA includes informatics articles in the areas of clinical care, clinical research, translational science, implementation science, imaging, education, consumer health, public health, and policy. JAMIA''s articles describe innovative informatics research and systems that help to advance biomedical science and to promote health. Case reports, perspectives and reviews also help readers stay connected with the most important informatics developments in implementation, policy and education.
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