Coherence-based modeling of clinical concepts inferred from heterogeneous clinical notes for ICU patient risk stratification

Abstract

In hospitals, critical care patients are often susceptible to various complications that adversely affect their morbidity and mortality. Digitized patient data from Electronic Health Records (EHRs) can be utilized to facilitate risk stratification accurately and provide prioritized care. Existing clinical decision support systems are heavily reliant on the structured nature of the EHRs. However, the valuable patient-specific data contained in unstructured clinical notes are often manually transcribed into EHRs. The prolific use of extensive medical jargon, heterogeneity, sparsity, rawness, inconsistent abbreviations, and complex structure of the clinical notes poses significant challenges, and also results in a loss of information during the manual conversion process. In this work, we employ two coherence-based topic modeling approaches to model the free-text in the unstructured clinical nursing notes and capture its semantic textual features with the emphasis on human interpretability. Furthermore, we present FarSight, a long-term aggregation mechanism intended to detect the onset of disease with the earliest recorded symptoms and infections. We utilize the predictive capabilities of deep neural models for the clinical task of risk stratification through ICD-9 code group prediction. Our experimental validation on MIMIC-III (v1.4) database underlined the efficacy of FarSight with coherence-based topic modeling, in extracting discriminative clinical features from the unstructured nursing notes. The proposed approach achieved a superior predictive performance when bench-marked against the structured EHR data based state-of-the-art model, with an improvement of 11.50% in AUPRC and 1.16% in AUROC. © 2019 Association for Computational Linguistics.