@phdthesis{Dietrich2019, author = {Dietrich, Georg}, title = {Ad Hoc Information Extraction in a Clinical Data Warehouse with Case Studies for Data Exploration and Consistency Checks}, doi = {10.25972/OPUS-18464}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-184642}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2019}, abstract = {The importance of Clinical Data Warehouses (CDW) has increased significantly in recent years as they support or enable many applications such as clinical trials, data mining, and decision making. CDWs integrate Electronic Health Records which still contain a large amount of text data, such as discharge letters or reports on diagnostic findings in addition to structured and coded data like ICD-codes of diagnoses. Existing CDWs hardly support features to gain information covered in texts. Information extraction methods offer a solution for this problem but they have a high and long development effort, which can only be carried out by computer scientists. Moreover, such systems only exist for a few medical domains. This paper presents a method empowering clinicians to extract information from texts on their own. Medical concepts can be extracted ad hoc from e.g. discharge letters, thus physicians can work promptly and autonomously. The proposed system achieves these improvements by efficient data storage, preprocessing, and with powerful query features. Negations in texts are recognized and automatically excluded, as well as the context of information is determined and undesired facts are filtered, such as historical events or references to other persons (family history). Context-sensitive queries ensure the semantic integrity of the concepts to be extracted. A new feature not available in other CDWs is to query numerical concepts in texts and even filter them (e.g. BMI > 25). The retrieved values can be extracted and exported for further analysis. This technique is implemented within the efficient architecture of the PaDaWaN CDW and evaluated with comprehensive and complex tests. The results outperform similar approaches reported in the literature. Ad hoc IE determines the results in a few (milli-) seconds and a user friendly GUI enables interactive working, allowing flexible adaptation of the extraction. In addition, the applicability of this system is demonstrated in three real-world applications at the W{\"u}rzburg University Hospital (UKW). Several drug trend studies are replicated: Findings of five studies on high blood pressure, atrial fibrillation and chronic renal failure can be partially or completely confirmed in the UKW. Another case study evaluates the prevalence of heart failure in inpatient hospitals using an algorithm that extracts information with ad hoc IE from discharge letters and echocardiogram report (e.g. LVEF < 45 ) and other sources of the hospital information system. This study reveals that the use of ICD codes leads to a significant underestimation (31\%) of the true prevalence of heart failure. The third case study evaluates the consistency of diagnoses by comparing structured ICD-10-coded diagnoses with the diagnoses described in the diagnostic section of the discharge letter. These diagnoses are extracted from texts with ad hoc IE, using synonyms generated with a novel method. The developed approach can extract diagnoses from the discharge letter with a high accuracy and furthermore it can prove the degree of consistency between the coded and reported diagnoses.}, subject = {Information Extraction}, language = {en} } @article{DietrichKrebsLimanetal.2019, author = {Dietrich, Georg and Krebs, Jonathan and Liman, Leon and Fette, Georg and Ertl, Maximilian and Kaspar, Mathias and St{\"o}rk, Stefan and Puppe, Frank}, title = {Replicating medication trend studies using ad hoc information extraction in a clinical data warehouse}, series = {BMC Medical Informatics and Decision Making}, volume = {19}, journal = {BMC Medical Informatics and Decision Making}, doi = {10.1186/s12911-018-0729-0}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-200409}, pages = {15}, year = {2019}, abstract = {Background Medication trend studies show the changes of medication over the years and may be replicated using a clinical Data Warehouse (CDW). Even nowadays, a lot of the patient information, like medication data, in the EHR is stored in the format of free text. As the conventional approach of information extraction (IE) demands a high developmental effort, we used ad hoc IE instead. This technique queries information and extracts it on the fly from texts contained in the CDW. Methods We present a generalizable approach of ad hoc IE for pharmacotherapy (medications and their daily dosage) presented in hospital discharge letters. We added import and query features to the CDW system, like error tolerant queries to deal with misspellings and proximity search for the extraction of the daily dosage. During the data integration process in the CDW, negated, historical and non-patient context data are filtered. For the replication studies, we used a drug list grouped by ATC (Anatomical Therapeutic Chemical Classification System) codes as input for queries to the CDW. Results We achieve an F1 score of 0.983 (precision 0.997, recall 0.970) for extracting medication from discharge letters and an F1 score of 0.974 (precision 0.977, recall 0.972) for extracting the dosage. We replicated three published medical trend studies for hypertension, atrial fibrillation and chronic kidney disease. Overall, 93\% of the main findings could be replicated, 68\% of sub-findings, and 75\% of all findings. One study could be completely replicated with all main and sub-findings. Conclusion A novel approach for ad hoc IE is presented. It is very suitable for basic medical texts like discharge letters and finding reports. Ad hoc IE is by definition more limited than conventional IE and does not claim to replace it, but it substantially exceeds the search capabilities of many CDWs and it is convenient to conduct replication studies fast and with high quality.}, language = {en} }