背景:医学文本,作为电子健康记录的一部分,是医疗保健中必不可少的信息来源。尽管用于医学文本的自然语言处理(NLP)技术发展迅速,成功转移到临床实践很少。特别是医院领域提供了巨大的潜力,同时面临着几个挑战,包括每个患者的许多文件,多个部门和复杂的相互关联的过程。
方法:在这项工作中,我们调查了相关文献,以确定和分类在临床背景下利用NLP的方法。我们的贡献涉及将相关研究系统地映射到医院中典型的患者旅程,沿着它创建医疗文件,由医院工作人员和患者自己处理和消费。具体来说,我们回顾了哪些数据集类型,数据集语言,在当前的临床NLP研究中研究了模型架构和任务。此外,我们提取和分析开发和实施过程中的主要障碍。我们讨论了解决这些问题的方案,并主张将重点放在缓解偏见和模型可解释性上。
结果:当患者的住院旅程产生大量结构化和非结构化文档时,某些步骤和文件比其他步骤和文件受到更多的研究关注。诊断,入院和出院是临床患者步骤,经常在接受调查的论文中进行研究。相比之下,我们的发现揭示了重大的研究不足的领域,如治疗,开单,护理后,智能家居。在这些阶段利用NLP可以大大提高临床决策和患者预后。此外,临床NLP模型主要基于放射学报告,出院信和录取通知书,尽管我们已经表明,许多其他文件是在整个病人的旅程中产生的。在分析整个患者旅程中产生的更广泛的医疗文档方面,有一个重要的机会,以提高NLP在医疗保健中的适用性和影响。
结论:我们的研究结果表明,利用NLP方法来推进临床决策系统是一个重要的机会,因为对患者旅程数据的分析仍有相当大的未研究的潜力。
BACKGROUND: Medical text, as part of an electronic health record, is an essential information source in healthcare. Although natural language processing (NLP) techniques for medical text are developing fast, successful transfer into clinical practice has been rare. Especially the hospital domain offers great potential while facing several challenges including many documents per patient, multiple departments and complex interrelated processes.
METHODS: In this work, we survey relevant literature to identify and classify approaches which exploit NLP in the clinical context. Our contribution involves a systematic mapping of related research onto a prototypical patient journey in the hospital, along which medical documents are created, processed and consumed by hospital staff and patients themselves. Specifically, we reviewed which dataset types, dataset languages, model architectures and tasks are researched in current clinical NLP research. Additionally, we extract and analyze major obstacles during development and implementation. We discuss options to address them and argue for a focus on bias mitigation and model explainability.
RESULTS: While a patient\'s hospital journey produces a significant amount of structured and unstructured documents, certain steps and documents receive more research attention than others. Diagnosis, Admission and Discharge are clinical patient steps that are researched often across the surveyed paper. In contrast, our findings reveal significant under-researched areas such as Treatment, Billing, After Care, and Smart Home. Leveraging NLP in these stages can greatly enhance clinical decision-making and patient outcomes. Additionally, clinical NLP models are mostly based on radiology reports, discharge letters and admission notes, even though we have shown that many other documents are produced throughout the patient journey. There is a significant opportunity in analyzing a wider range of medical documents produced throughout the patient journey to improve the applicability and impact of NLP in healthcare.
CONCLUSIONS: Our findings suggest that there is a significant opportunity to leverage NLP approaches to advance clinical decision-making systems, as there remains a considerable understudied potential for the analysis of patient journey data.