나의 인생 이야기: natural-language-processing-electronic-health-records

source :
http://www.kevinmd.com/blog/2011/09/natural-language-processing-electronic-health-records.html

David Voran a year ago
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A recent study http://bit.ly/psJFk7 showed the importance of a good history and physical exam in the accuracy of a diagnosis over diagnostic tests. We use a flexible structured documentation method throughout our clinics that has the potential to accurately trap and collect symptomatic data with each selected (or negatively selected item) explicitly linked to SNOMED-CT. The results of these selections are then converted into familiar narrative. Though stilted it does mimic the time-honored succinct story telling narrative of physicians.
Here's the irony: Despite using this system our organization has not developed nor exploited the tools the extrapolate this structured detail in order to improve our knowledge and decision making. The result is that downstream readers (including the patients) complain about the output of the structured narrative as it "doesn't really tell the story" about the patients encounter with the healthcare system nor does it adequately link the outcome of the encounter.
As a result of these complaints I'm spending more time honing the skill of taking the structured information and crafting a succinct, story-telling, summary sentence that collects structured data and presents the reader with a clearer picture of the history of the present illness than I ever did before. The image spawned by that sentence is what helps the downstream reader more than the structured image. Capitalizing on the "image" component I've started incorporating pictures of anything interesting (rashes, wounds, moles, lesions, physical features and findings) into our documentation system and now downstream users are commenting that the images ARE the essence of the note. This is starting to evolve pretty rapidly and, combined with on-line web-portal and e-mail communication tools in which patients are contributing information and pictures prior to the encounter I think NLP tools may wind up being a little too late unless applied to note only visit notes, but electronic exchanges between visits.
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- JoePetroNuanceHealthcare David Voran a year ago
  
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  Hi David, Thanks for the comment. I think you are spot on when it comes to working the balance between the story and the structure. We have been working on traditional NLP techniques to pull structure from narrative but we are also working on "natural interface dialogs." This is similar to what you describe above where a physician speaks to an EMR form and leverages the layout and labeling on the interface to guide him/her in applying a loosely constrained vocabulary to the experience. Think of this as “naturally” talking to the interface. We think the future is going to leverage several variations of these subtly different input modalities. As you point out, stitching together the story to look and sound natural and be of value is the real trick.
  
  As for integrating the patient into the story telling I can not agree more. With ACO's and the patient and doctor connection advancing I can easily imagine a world where the patient's story develops over time by contributions from multiple care settings as well as ongoing information from the patient themselves. It’s easy to imagine a disease management scenario that is very interactive and provides a lot of support and value to the patient and also provides very key and real time information back to the physician. This idea you have about leveraging pictures etc is the beginning of a high fidelity experience where that experience will eventually include pictures, video, audio, and quite probably patient specific decision support. With NLP and other technologies in the background there is high potential for a very rich and informed experience for both the patient and the physician.
  
  All the best, Joe Petro
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Gregory Park a year ago
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It seems as though one approach would be to allow physicians to continue their vocal narrative, but have that narrative interpreted real-time by one or multiple professionals. In this scenario the patient encounter would be completely recorded, both audio and video. This data would be transmitted either internally or externally to some level of clinical expertise. This may be someone from a coder to a physician in training to a seasoned professional with expertise in an area unfamiliar to the original practitioner.

During the visit the supporting expertise would record the data in a structured format, which would be subsequently reviewed and approved by the original practitioner.

This design serves all needs and also creates a new forum for education and collaboration. What stands in the way are reimbursements for these services and a method to make it financially viable. A study of this process may prove out better clinical outcomes, data collection processes, computer aided coding and could simplify litigation.

Just an idea, I would love to hear the detractions...
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