journal article·2024-07-24Open access

Using Enhanced Representations to Predict Medical Procedures from Clinician Notes

Roberto Móstoles, Oscar Araque, Carlos Á. Iglesias

Applied Sciences· Volume 14· Issue 15

Abstract

Nowadays, most health professionals use electronic health records to keep track of patients. To properly use and share these data, the community has relied on medical classification standards to represent patient information. However, the coding process is tedious and time-consuming, often limiting its application. This paper proposes a novel feature representation method that considers the distinction between diagnoses and procedure codes, and applies this to the task of medical procedure code prediction. Diagnosis codes are combined with text annotations, and the result is then used as input to a downstream procedure code prediction task. Various diagnosis code representations are considered by exploiting a code hierarchy. Furthermore, different text representation strategies are also used, including embeddings from language models. Finally, the method was evaluated using the MIMIC-III database. Our experiments showed improved performance in procedure code prediction when exploiting the diagnosis codes, outperforming state-of-the-art models.
Source: crossref · Quality: baseline

Research context

OpenAlex topics: Machine Learning in Healthcare · Biomedical Text Mining and Ontologies · Topic Modeling

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

Affiliations

Intelligent Systems Group, ETSI Telecomunicación, Universidad Politécnica de Madrid, Avda. Complutense 30, 28040 Madrid, Spain

Funding

Spanish Ministry of Science and Innovation · European Union

References (62)

Show source-provided references
1. Clinical Benefits of Electronic Health Record Use: National Findings10.1111/1475-6773.12135 ↗
2. A Qualitative Analysis of the Impact of Electronic Health Records (EHR) on Healthcare Quality and Safety: Clinicians’ Lived Experiences10.1177/11786329211070722 ↗
3. An empirical evaluation of deep learning for ICD-9 code assignment using MIMIC-III clinical notes10.1016/j.cmpb.2019.05.024 ↗
4. Baumel, T., Nassour-Kassis, J., Cohen, R., Elhadad, M., and Elhadad, N. (2018, January 2–7). Multi-label classification of patient notes: Case study on ICD code assignment. Proceedings of the Workshops at the Thirty-Second AAAI Conference on Artificial Intelligence, New Orleans, LA, USA.
5. HCPCS Coding: An Integral Part of Your Reimbursement Strategy10.1089/wound.2013.0484 ↗
6. CPT® Codes: What Are They, Why Are They Necessary, and How Are They Developed?10.1089/wound.2013.0483 ↗
7. (2024, July 21). Australian Coding Standards for ICD-10-AM and ACHI (ICD-10-AM/ACHI/ACS Twelfth Edition). National Centre for Classification in Health: Sydney, Australia, Available online: https://www.ihacpa.gov.au/resources/icd-10-amachiacs-twelfth-edition.
8. Harrison, J.E., Weber, S., Jakob, R., and Chute, C.G. (2021). ICD-11: An international classification of diseases for the twenty-first century. BMC Med. Inform. Decis. Mak., 21.10.1186/s12911-021-01534-6 ↗
9. Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders10.1002/wps.20611 ↗
10. Mullenbach, J., Wiegreffe, S., Duke, J., Sun, J., and Eisenstein, J. (2018, January 1–6). Explainable Prediction of Medical Codes from Clinical Text. Proceedings of the 2018 Conference of the North American Chapter of the Association for Computational Linguistics: Human Language Technologies, Volume 1 (Long Papers), New Orleans, LA, USA.10.18653/v1/N18-1100 ↗
11. Nuthakki, S., Neela, S., Gichoya, J.W., and Purkayastha, S. (2019). Natural language processing of MIMIC-III clinical notes for identifying diagnosis and procedures with neural networks. arXiv.
12. MIMIC-III, a freely accessible critical care database10.1038/sdata.2016.35 ↗
13. Hindsight bias critically impacts on clinicians’ assessment of care quality in retrospective case note review10.7861/clinmedicine.19-1-16 ↗
14. The road to ICD-10-CM/PCS implementation: Forecasting the transition for providers, payers, and other healthcare organizations
15. Diagnosis code assignment: Models and evaluation metrics10.1136/amiajnl-2013-002159 ↗
16. Automatic ICD-10 classification of cancers from free-text death certificates10.1016/j.ijmedinf.2015.08.004 ↗
17. An empirical evaluation of supervised learning approaches in assigning diagnosis codes to electronic medical records10.1016/j.artmed.2015.04.007 ↗
18. Cerri, R., and Prati, R.C. (2020). Predicting Multiple ICD-10 Codes from Brazilian-Portuguese Clinical Notes. Intelligent Systems: 9th Brazilian Conference, BRACIS 2020, Rio Grande, Brazil, 20–23 October 2020, Springer International Publishing. Proceedings, Part I 9.
19. Automatic ICD-10 Coding and Training System: Deep Neural Network Based on Supervised Learning10.2196/23230 ↗
20. Pascual, D., Luck, S., and Wattenhofer, R. (2021). Towards BERT-based Automatic ICD Coding: Limitations and Opportunities. arXiv.10.18653/v1/2021.bionlp-1.6 ↗
21. Kaur, R., Ginige, J.A., and Obst, O. (2021). A Systematic Literature Review of Automated ICD Coding and Classification Systems using Discharge Summaries. arXiv.
22. Diagnosis and Treatment in Physical Therapy: An Investigation of Their Relationship10.1093/ptj/73.9.568 ↗
23. Diagnosis-Treatment Relationships in Psychiatry: A Statistical Analysis10.1192/bjp.110.468.726 ↗
24. Relations between mental health diagnoses, mental health treatment, and substance use in homeless youth10.1016/j.drugalcdep.2017.01.028 ↗
25. Antibiotic use in Dutch primary care: Relation between diagnosis, consultation and treatment10.1093/jac/dku005 ↗
26. Subotin, M., and Davis, A. (2014, January 27–28). A System for Predicting ICD-10-PCS Codes from Electronic Health Records. Proceedings of the BioNLP 2014, Baltimore, Maryland.10.3115/v1/W14-3409 ↗
27. Chen, Y. (2024, July 21). Predicting ICD-9 Codes from Medical Notes—Does the Magic of BERT Applies Here?. Available online: https://web.stanford.edu/class/archive/cs/cs224n/cs224n.1204/reports/custom/report25.pdf.
28. Tsai, S.C., Huang, C.W., and Chen, Y.N. (2021, January 6–11). Modeling Diagnostic Label Correlation for Automatic ICD Coding. Proceedings of the 2021 Conference of the North American Chapter of the Association for Computational Linguistics: Human Language Technologies, Online.10.18653/v1/2021.naacl-main.318 ↗
29. Yan, Y., Fung, G., Dy, J.G., and Rosales, R. (2010, January 25–28). Medical coding classification by leveraging inter-code relationships. Proceedings of the 16th ACM SIGKDD International Conference on Knowledge Discovery and Data Mining, Washington, DC, USA.10.1145/1835804.1835831 ↗
30. Mahdi, S.S., Papagiannopoulou, E., Deligiannis, N., and Sahli, H. (2024, January 14–19). Co-Occurrence Graph-Enhanced Hierarchical Prediction of ICD Codes. Proceedings of the ICASSP 2024—2024 IEEE International Conference on Acoustics, Speech and Signal Processing (ICASSP), Seoul, Republic of Korea.10.1109/ICASSP48485.2024.10447721 ↗
31. Haq, H.U., Ahmad, R., and Hussain, S.U. (2017). Intelligent EHRs: Predicting Procedure Codes from Diagnosis Codes. arXiv.
32. Jia, Z., Lu, X., Duan, H., and Li, H. (2019). Using the distance between sets of hierarchical taxonomic clinical concepts to measure patient similarity. BMC Med. Inform. Decis. Mak., 19.10.1186/s12911-019-0807-y ↗
33. Physicians’ outlook on ICD-10-CM/PCS and its effect on their practice
34. PhysioBank, PhysioToolkit, and PhysioNet: Components of a New Research Resource for Complex Physiologic Signals10.1161/01.CIR.101.23.e215 ↗
35. Using TF-IDF to Determine Word Relevance in Document Queries
36. Bird, S., Klein, E., and Loper, E. (2009). Natural Language Processing with Python, O’Reilly.
37. Calzolari, N., Béchet, F., Blache, P., Choukri, K., Cieri, C., Declerck, T., Goggi, S., Isahara, H., Maegaard, B., and Mariani, J. (2020, January 11–16). Contextualized Embeddings based Transformer Encoder for Sentence Similarity Modeling in Answer Selection Task. Proceedings of the Twelfth Language Resources and Evaluation Conference, Marseille, France.
38. Malik, P., Aggrawal, A., and Vishwakarma, D.K. (2021, January 8–10). Toxic Speech Detection using Traditional Machine Learning Models and BERT and fastText Embedding with Deep Neural Networks. Proceedings of the 2021 5th International Conference on Computing Methodologies and Communication (ICCMC), Erode, India.10.1109/ICCMC51019.2021.9418395 ↗
39. Tanaka, H., Shinnou, H., Cao, R., Bai, J., and Ma, W. (2020). Document Classification by Word Embeddings of BERT. Computational Linguistics, Springer.10.1007/978-981-15-6168-9_13 ↗
40. Huang, H., Jing, X.Y., Wu, F., Yao, Y.F., Zhang, X.Y., and Dong, X.W. (2019, January 21–23). DCNN-BiGRU Text Classification Model Based on BERT Embedding. Proceedings of the 2019 IEEE International Conferences on Ubiquitous Computing & Communications (IUCC) and Data Science and Computational Intelligence (DSCI) and Smart Computing, Networking and Services (SmartCNS), Shenyang, China.10.1109/IUCC/DSCI/SmartCNS.2019.00132 ↗
41. Chanda, A.K. (2021). Efficacy of BERT embeddings on predicting disaster from Twitter data. arXiv.
42. Sanh, V., Debut, L., Chaumond, J., and Wolf, T. (2019). DistilBERT, a distilled version of BERT: Smaller, faster, cheaper and lighter. arXiv.
43. Optimized glycemic control of type 2 diabetes with reinforcement learning: A proof-of-concept trial10.1038/s41591-023-02552-9 ↗
44. Choi, H., Kim, J., Joe, S., and Gwon, Y. (2021). Evaluation of BERT and ALBERT Sentence Embedding Performance on Downstream NLP Tasks. arXiv.10.1109/ICPR48806.2021.9412102 ↗
45. Multi-Label Few-Shot ICD Coding as Autoregressive Generation with Prompt
46. Scikit-learn: Machine Learning in Python
47. Kingma, D.P., and Ba, J. (2014). Adam: A Method for Stochastic Optimization. arXiv.
48. Clark, K., Khandelwal, U., Levy, O., and Manning, C.D. (2019). What Does BERT Look At? An Analysis of BERT’s Attention. arXiv.10.18653/v1/W19-4828 ↗
49. Biswas, B., Pham, T.H., and Zhang, P. (2021). TransICD: Transformer Based Code-Wise Attention Model for Explainable ICD Coding. Lecture Notes in Computer Science, Springer International Publishing.10.1007/978-3-030-77211-6_56 ↗
50. IMP-ICDX: An injury mortality prediction based on ICD-10-CM codes10.1186/s13017-019-0265-y ↗
51. Marcou, Q., Berti-Equille, L., and Novelli, N. (2024). Creating a computer assisted ICD coding system: Performance metric choice and use of the ICD hierarchy. J. Biomed. Inform., 152.10.1016/j.jbi.2024.104617 ↗
52. Popescu, M., and Khalilia, M. (2011, January 27–30). Improving disease prediction using ICD-9 ontological features. Proceedings of the 2011 IEEE International Conference on Fuzzy Systems (FUZZ-IEEE 2011), Taipei, Taiwan.10.1109/FUZZY.2011.6007410 ↗
53. When the machine is wrong. Characteristics of true and false predictions of Out-of-Hospital Cardiac arrests in emergency calls using a machine-learning model10.1016/j.resuscitation.2023.109689 ↗
54. When AI Is Wrong: Addressing Liability Challenges in Women’s Healthcare
55. Stojkovic, J., Choukse, E., Zhang, C., Goiri, I., and Torrellas, J. (2024). Towards Greener LLMs: Bringing Energy-Efficiency to the Forefront of LLM Inference. arXiv.
56. How to reduce the number of rating scale items without predictability loss?10.1007/s11192-017-2283-4 ↗
57. Scales for assessing patient satisfaction with mental health care: A systematic review10.1016/j.jpsychires.2018.02.014 ↗
58. Ji, Q., Zhang, L., Xu, J., Ji, P., Song, M., Chen, Y., and Guo, L. (2024). The relationship between stigma and quality of life in hospitalized middle-aged and elderly patients with chronic diseases: The mediating role of depression and the moderating role of psychological resilience. Front. Psychiatry, 15.10.3389/fpsyt.2024.1346881 ↗
59. Mental health in the post-COVID-19 era: Challenges and the way forward10.1136/gpsych-2020-100424 ↗
60. Saqib, K., Qureshi, A.S., and Butt, Z.A. (2023). COVID-19, Mental Health, and Chronic Illnesses: A Syndemic Perspective. Int. J. Environ. Res. Public Health, 20.10.3390/ijerph20043262 ↗
61. Paschke, K., Napp, A.K., and Thomasius, R. (2023). Parents Rate Problematic Video Streaming in Adolescents: Conceptualization and External Assessment of a New Clinical Phenomenon Based on the ICD-11 Criteria of Gaming Disorder. J. Clin. Med., 12.10.3390/jcm12031010 ↗
62. Describing the features of catatonia: A comparative phenotypic analysis10.1016/j.schres.2022.08.002 ↗