Using NLP workflows to identify key social determinants of health

A year has gone by since I last blogged about the importance of social determinants of health (SDoH). Since then so much has happened in our lives. The COVID-19 pandemic has affected us all, in ways we could never imagine and it will continue to do so into the future.  When you review the SDoH risk factors, you realize that, due to the pandemic, responsible citizens are now enforcing one of these risk factors for safety reasons: social isolation.  It wasn’t too long ago that social isolation was branded a warning sign for mental health issues - not a recommendation for maintaining physical health.  

How research at Kaiser Permanente found that NLP can assist in identifying hospitalizations for worsening heart failure

Heart health is nothing to be taken lightly.  A healthy functioning heart is a key factor in providing every part of your body the blood it needs to provide nutrients and oxygen and remove the waste necessary for life. If there is presence of disease there are times when the heart decompensates, meaning that the heart is no longer able to maintain an efficient circulation allowing for this imperative exchange amongst tissues. According to the Center for Disease Control, in 2017 approximately 6.5 million adults in the United States had heart failure, and it was a major factor of mortality in 1 of 8 deaths. In 2017 it was reported that average wait times for a replacement heart in the U.S. is 191 days, and the cost can approach 1.4 million dollars. So, it is of no surprise that it is better to take care of the heart you have and imperative to capture decompensation as early as possible. Unfortunately, sometimes decompensation can be missed.

NLP workflows in contrast to manual abstraction

Imperative information is often hidden within free text and reports that are attachments within the Electronic Health Record (EHR). A myriad of key cardiology measures can be abstracted from EHRs, be it text based notes to test reports that are PDF attachments, for example: ejection fraction measurement; symptoms such as shortness of breath, fatigue and palpitations; New York Heart Association classifications, and B-type natriuretic peptide (BNP).

In the rapidly evolving fight against COVID-19, IQVIA is committed to deploying our resources and capabilities to help everyone in healthcare do what needs to be done, and to keep things moving forward. Pharmaceutical and healthcare organizations, governments, and the broader scientific communities around the world are working to assess the impact of the virus, and how this can be tackled.

As part of this effort, it’s critical to have access to the best evidence from a broad range of data, including scientific literature, clinical trials and other textual sources. For intelligence from unstructured text, Linguamatics can help. Our Natural Language Processing (NLP) technology enables fast, systematic, and comprehensive insight generation from unstructured text. These sources can include scientific literature, clinical trial records, preprints, internal sources, social media, and news. Capturing key information from these many sources and synthesizing into one place – an Evidence Hub – gives users a deeper understanding of everything that’s going on. This approach can speed answers to key questions to confront the COVID-19 pandemic, such as:

Better diagnosis needs more than diagnosis codes

It’s well known that cardiovascular diseases are one of the major causes of death both in the US and globally. This level of disease puts great pressures on health systems to manage the patient load, both at the population level and at the individual level. As with all diseases, treatment is more effective and less costly if patients can be diagnosed earlier on their care journey. One barrier here is that diagnosis codes for conditions such as valvular heart disease can be inaccurate and vary across health systems. More information resides in the unstructured text of medical records but this is slow and tedious to extract manually.

Fast accurate diagnosis of aortic stenosis with Natural Language Processing

A recent short paper by Solomon et al from Kaiser Permanente Northern California (KPNC) used Natural Language Processing (NLP) algorithms to extract detailed clinical information from echocardiography (ECG) reports. NLP is an Artificial Intelligence (AI) technology used to transform free, unstructured text in documents and databases into normalized, structured data suitable for analysis. Their results were more accurate than using diagnosis codes to identify aortic stenosis, for a patient cohort of over 500,000 individuals.

Recently, I was fortunate to chair a panel discussion where the potentials of Artificial Intelligence (AI) and Machine Learning (ML) were fiercely discussed. AI/ML seems to be talked about everywhere at the moment, heralded as a solution for many challenges in pharma and healthcare (and indeed many other industries). But, does AI/ML really warrant this level of excitement and hype?

AI/ML leaders in advanced statistics, NLP, deep learning, neural networks come together

One thing that is often overlooked in these discussions is that AI/ML is a broad group of diverse disciplines, not a singular item. AI/ML includes advanced statistics, Natural Language Processing (NLP), deep learning, neural networks, and many other mathematical and computer science specialities. The event I attended was a Linguamatics-hosted dinner. The panel of five experts covered a broad span of expertise across different AI/ML disciplines, and ranged from academia to small and large pharma: