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首页> 外文期刊>BMC Medical Informatics and Decision Making >Supporting the classification of patients in public hospitals in Chile by designing, deploying and validating a system based on natural language processing
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Supporting the classification of patients in public hospitals in Chile by designing, deploying and validating a system based on natural language processing

机译：通过设计，部署和验证基于自然语言处理的系统，支持智利公立医院患者的分类

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In Chile, a patient needing a specialty consultation or surgery has to first be referred by a general practitioner, then placed on a waiting list. The Explicit Health Guarantees (GES in Spanish) ensures, by law, the maximum time to solve 85 health problems. Usually, a health professional manually verifies if each referral, written in natural language, corresponds or not to a GES-covered disease. An error in this classification is catastrophic for patients, as it puts them on a non-prioritized waiting list, characterized by prolonged waiting times. To support the manual process, we developed and deployed a system that automatically classifies referrals as GES-covered or not using historical data. Our system is based on word embeddings specially trained for clinical text produced in Chile. We used a vector representation of the reason for referral and patient's age as features for training machine learning models using human-labeled historical data. We constructed a ground truth dataset combining classifications made by three healthcare experts, which was used to validate our results. The best performing model over ground truth reached an AUC score of 0.94, with a weighted F1-score of 0.85 (0.87 in precision and 0.86 in recall). During seven months of continuous and voluntary use, the system has amended 87 patient misclassifications. This system is a result of a collaboration between technical and clinical experts, and the design of the classifier was custom-tailored for a hospital's clinical workflow, which encouraged the voluntary use of the platform. Our solution can be easily expanded across other hospitals since the registry is uniform in Chile.
机译：在智利中，需要专业咨询或手术的患者首先被一般从业者提到，然后放在等候名单上。明确的健康保障（西班牙语的GES）确保依法，通过法律来解决85个健康问题的最大时间。通常，如果以自然语言编写的每个转诊，则手动验证健康专业人士，对应于GES覆盖的疾病。该分类中的错误是针对患者的灾难性，因为它将它们放在非优先级等候名单上，其特征在于延长等待时间。为了支持手动进程，我们开发并部署了一个系统，它会自动将引用作为GES覆盖或不使用历史数据进行分类。我们的系统基于专门为智利生产的临床文本培训的单词嵌入式。我们使用了传记和患者年龄的原因作为使用人类标记的历史数据训练机器学习模型的特征的原因。我们构建了一个地面真理数据集，三个医疗专家的分类组合，用于验证我们的结果。地面真理的最佳表现模型达到了0.94的AUC评分，重量F1分数为0.85（精度为0.87，召回0.86）。在七个月的连续和自愿使用期间，该系统已修订87例患者错误分类。该系统是技术和临床专家之间合作的结果，分类器的设计是用于医院的临床工作流程的定制，这鼓励平台自愿使用。由于注册表在智利中是统一的，我们的解决方案可以在其他医院容易地扩展。

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