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      COVID-19 SignSym: a fast adaptation of a general clinical NLP tool to identify and normalize COVID-19 signs and symptoms to OMOP common data model

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          Abstract

          The COVID-19 pandemic swept across the world rapidly, infecting millions of people. An efficient tool that can accurately recognize important clinical concepts of COVID-19 from free text in electronic health records (EHRs) will be valuable to accelerate COVID-19 clinical research. To this end, this study aims at adapting the existing CLAMP natural language processing tool to quickly build COVID-19 SignSym, which can extract COVID-19 signs/symptoms and their 8 attributes (body location, severity, temporal expression, subject, condition, uncertainty, negation, and course) from clinical text. The extracted information is also mapped to standard concepts in the Observational Medical Outcomes Partnership common data model. A hybrid approach of combining deep learning-based models, curated lexicons, and pattern-based rules was applied to quickly build the COVID-19 SignSym from CLAMP, with optimized performance. Our extensive evaluation using 3 external sites with clinical notes of COVID-19 patients, as well as the online medical dialogues of COVID-19, shows COVID-19 SignSym can achieve high performance across data sources. The workflow used for this study can be generalized to other use cases, where existing clinical natural language processing tools need to be customized for specific information needs within a short time. COVID-19 SignSym is freely accessible to the research community as a downloadable package ( https://clamp.uth.edu/covid/nlp.php) and has been used by 16 healthcare organizations to support clinical research of COVID-19.

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          Most cited references7

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          Mayo clinical Text Analysis and Knowledge Extraction System (cTAKES): architecture, component evaluation and applications.

          We aim to build and evaluate an open-source natural language processing system for information extraction from electronic medical record clinical free-text. We describe and evaluate our system, the clinical Text Analysis and Knowledge Extraction System (cTAKES), released open-source at http://www.ohnlp.org. The cTAKES builds on existing open-source technologies-the Unstructured Information Management Architecture framework and OpenNLP natural language processing toolkit. Its components, specifically trained for the clinical domain, create rich linguistic and semantic annotations. Performance of individual components: sentence boundary detector accuracy=0.949; tokenizer accuracy=0.949; part-of-speech tagger accuracy=0.936; shallow parser F-score=0.924; named entity recognizer and system-level evaluation F-score=0.715 for exact and 0.824 for overlapping spans, and accuracy for concept mapping, negation, and status attributes for exact and overlapping spans of 0.957, 0.943, 0.859, and 0.580, 0.939, and 0.839, respectively. Overall performance is discussed against five applications. The cTAKES annotations are the foundation for methods and modules for higher-level semantic processing of clinical free-text.
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            Is Open Access

            CLAMP – a toolkit for efficiently building customized clinical natural language processing pipelines

            Abstract Existing general clinical natural language processing (NLP) systems such as MetaMap and Clinical Text Analysis and Knowledge Extraction System have been successfully applied to information extraction from clinical text. However, end users often have to customize existing systems for their individual tasks, which can require substantial NLP skills. Here we present CLAMP (Clinical Language Annotation, Modeling, and Processing), a newly developed clinical NLP toolkit that provides not only state-of-the-art NLP components, but also a user-friendly graphic user interface that can help users quickly build customized NLP pipelines for their individual applications. Our evaluation shows that the CLAMP default pipeline achieved good performance on named entity recognition and concept encoding. We also demonstrate the efficiency of the CLAMP graphic user interface in building customized, high-performance NLP pipelines with 2 use cases, extracting smoking status and lab test values. CLAMP is publicly available for research use, and we believe it is a unique asset for the clinical NLP community.
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              2010 i2b2/VA challenge on concepts, assertions, and relations in clinical text.

              The 2010 i2b2/VA Workshop on Natural Language Processing Challenges for Clinical Records presented three tasks: a concept extraction task focused on the extraction of medical concepts from patient reports; an assertion classification task focused on assigning assertion types for medical problem concepts; and a relation classification task focused on assigning relation types that hold between medical problems, tests, and treatments. i2b2 and the VA provided an annotated reference standard corpus for the three tasks. Using this reference standard, 22 systems were developed for concept extraction, 21 for assertion classification, and 16 for relation classification. These systems showed that machine learning approaches could be augmented with rule-based systems to determine concepts, assertions, and relations. Depending on the task, the rule-based systems can either provide input for machine learning or post-process the output of machine learning. Ensembles of classifiers, information from unlabeled data, and external knowledge sources can help when the training data are inadequate.
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                Author and article information

                Contributors
                Journal
                J Am Med Inform Assoc
                J Am Med Inform Assoc
                jamia
                Journal of the American Medical Informatics Association : JAMIA
                Oxford University Press
                1067-5027
                1527-974X
                01 March 2021
                : ocab015
                Affiliations
                Melax Technologies, Inc , Houston, Texas, USA
                School of Biomedical Informatics, The University of Texas Health Science Center at Houston , Houston, Texas, USA
                Division of Medical Informatics, University of Kansas Medical Center , Kansas City, Kansas, USA
                Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
                Melax Technologies, Inc , Houston, Texas, USA
                School of Biomedical Informatics, The University of Texas Health Science Center at Houston , Houston, Texas, USA
                Melax Technologies, Inc , Houston, Texas, USA
                Division of Medical Informatics, University of Kansas Medical Center , Kansas City, Kansas, USA
                University of Missouri School of Medicine , Columbia, Missouri, USA
                School of Biomedical Informatics, The University of Texas Health Science Center at Houston , Houston, Texas, USA
                Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
                Melax Technologies, Inc , Houston, Texas, USA
                Author notes

                Jingqi Wang and Noor Abu-el-Rub Contributed equally as first authors.

                Masoud Rouhizadeh and Yaoyun Zhang Contributed equally as corresponding authors
                Author information
                https://orcid.org/0000-0002-3388-5867
                https://orcid.org/0000-0003-0889-2261
                https://orcid.org/0000-0002-8036-2110
                https://orcid.org/0000-0002-5274-4672
                https://orcid.org/0000-0001-9220-3101
                Article
                ocab015
                10.1093/jamia/ocab015
                7989301
                33674830
                3fc95886-5c5d-45e4-994d-ce3aff19e2ac
                © The Author(s) 2021. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

                History
                : 20 November 2020
                : 19 January 2021
                : 29 January 2021
                Page count
                Pages: 9
                Funding
                Funded by: National Center for Advancing Translational Sciences, DOI 10.13039/100006108;
                Award ID: grant number R44TR003254 and CTSA grant number UL1TR002366
                Categories
                Brief Communications
                AcademicSubjects/MED00580
                AcademicSubjects/SCI01060
                AcademicSubjects/SCI01530
                Custom metadata
                PAP

                Bioinformatics & Computational biology
                Bioinformatics & Computational biology

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