POW! HIT! People & Organizations improving Workflow w/Health Info Tech
POW! HIT! People & Organizations improving Workflow w/Health Info Tech

@EHRworkflow Blog

The is a "sidekick" blog to my main blog EHR Workflow Management Systems at ChuckWebster.com. There I publish long, complicated, thoughtful blogs thousands of words in length. Here? Not so much. It's mostly for snippets of content too big for a tweet but too small to grace the main deck of the mothership.

If you're looking for my POW! HIT! Profiles, they're here (explanation and most recent) and here (alphabetical index). POW! HIT! stands for People and Organizations improving Workflow in Healthcare with Information Technology (or Ideas and Technology, depending on context). However, I'll write or post content relevant to POW! HIT! on this and the mother blog. Thanks for stopping by. Please leave a comment!

Chuck Webster MD MSIE MSIS

With degrees in Accountancy, Industrial Engineering, Computational Linguistics, Artificial Intelligence, and Medicine, Dr. Webster can see around corners. He designed the first undergraduate program in Medical Informatics, was CMIO for an EHR vendor, and wrote the first three winning applications for the HIMSS Davies Award for EHR Ambulatory Excellence. Chuck opines about healthcare workflow and related and unrelated topics from @wareFLO (#HIMSS13 Top Tweeter) and DMV: the District, Maryland, and Virginia.

My main blog is EHR Workflow Management Systems at ChuckWebster.com. Some posts are 5000 words or more! Here is for larger than a tweet, but smaller than a novella.

Dr. Nick of Nuance on Clinical NLP 8: Race Between Point-and-Click vs Free Text?

At a recent workshop on clinical decision support and natural language processing at the National Library of Medicine, clinical NLP researchers cited several concerns. Point-and-click interfaces threaten to reduce amount of free text in EHRs. Since modern computational linguistics algorithms rely on machine learning against large amounts of free text, this is a potential obstacle.

 

8. Is there a "race" between data input modalities? If so, who's winning? If not, why not?

True. But this battle has been going on for years. I have referred to Henry VIII’s medical record many times as a great example why structured data entry will never fulfill the requirements:

If we rely on structured data entry that presupposes that we know everything we need to know then a structured form and selecting from a list will allow you to capture everything you need in the medical record. However, we do not know everything we need to know. By way of an example, Ground Glass opacities appeared in medical notes in narrative form before we knew what this radiological finding meant. If we had not captured this in the narrative there would have been no record of these findings since it was new at the time. We know now that these findings are linked to a number of diseases including pulmonary edema, ARDS, and viral, mycoplasmal, and pneumocystis pneumonias.

The narrative is, and will always remain, essential to a complete medical record – NLP will bridge the gap between the structured data necessary to create semantically interoperable records and just keeps getting better.

Question 9 (Privacy versus free text to learn algorithms?) and Dr. Nick's answer will be published very soon.

Follow @EHRworkflow to be sure not to miss it.

Feel free to catch up on earlier portions of this interview with Dr. Nick of Nuance:

 

 

 

 

 

 

Dr. Nick of Nuance on Clinical NLP 7: Important for Meaningful Use?

The first question asked after the keynote was "Will meaningful use drive [need for/use of] clinical natural language processing?"

 

7. Is SR/NLP more important for some MU measures than others? If so, which ones and why?

The answer lies in the source of data and how it is captured not in the specific data elements in my mind.

So take one measure as an example:

Is an ACE inhibitor prescribed for a patient who is suspected or suffering from a Heart Attack?

The source of this data will come from different sources in different facilities. If you have a CPOE and prescribing system then that data already exists in the system in digital form as structured data – you can answer that question (and guide the clinicians to make sure they comply with best practices and high quality care) with the existing structured data.

However, if this is a patient being seen in the ED and they dictate their notes then that information will be locked away in their documentation (unless they use a digital structured form to create the medical history) and then NLP is needed to extract the information and SR may be needed to facilitate the creation of the note efficiently.

Question 8 (Is there a race between point-and-click and free text?) and Dr. Nick's answer will be published very soon.

Follow @EHRworkflow to be sure not to miss it.

Feel free to catch up on earlier portions of this interview with Dr. Nick of Nuance:

 

 

 

 

 

 

 

 

Dr. Nick of Nuance on Clinical NLP 6: Adding Value to Clinical Narrative?

At the keynote for a workshop in biomedical NLP at NAACL2012, the concluding slide included the bullet: "NLP has potential to extend value of narrative clinical reports." In light of your recent comments on the EMR and EHR blog I'm sure you'd agree.

 

6. Could you expand on those comments? ("NLP has potential to extend value of narrative clinical reports.")

Nuance began investing in Clinical Language Understanding (CLU) technology, a clinical-specific form of NLP, over two years ago.

CLU is a foundational technology being applied to the other areas and applications (DM360 MD Assist and DM360 Analytics) that offers the ability to understand the free form narrative and extract out discreet data and tag it and link to a number of structured medical vocabularies.

Question 7 (Is clinical NLP important for Meaningful Use?) and Dr. Nick's answer will be published very soon.

Follow @EHRworkflow to be sure not to miss it.

Feel free to catch up on earlier portions of this interview with Dr. Nick of Nuance:

 

 

 

 

 

Dr. Nick of Nuance on Clinical NLP 5: Where is Nuance Research Going?

While attending the North American Association for Computational Linguistics meeting recently in Montreal (see my blog post) I noticed that Nuance Communications was a Platinum Sponsor, a higher level of commitment than even Google (Gold) or Microsoft (Silver). While NAACL2012 included some speech recognition research presentations, most presentations dealt with natural language processing further along the so-called NLP "pipeline": morphology, syntax, semantics, pragmatics, and discourse.

5. Where do you see Nuance going in these areas?

Nuance has a serious investment in Research and Development spread across many industries and part of the value we derive as an organization is from the cross fertilization of these efforts to different areas and verticals. The learning we derive of understanding a driver in their noisy car environment can be applied to the physician and their noisy Emergency Room department. Applying understanding to the voice interaction opens up many avenues and we have seen this outside of healthcare (Dragon Go! for example). These principles have tremendous potential to simplify the physician interaction with technology and the complex systems they must master and use on a daily basis. I talked about this recently at a presentation I gave to the Boston AVIOS Chapter. Question 6 (How can NLP create value from narrative clinical resorts?) and Dr. Nick's answer will be published very soon.

Follow @EHRworkflow to be sure not to miss it.

 

Feel free to catch up on earlier portions of this interview with Dr. Nick of Nuance:

 

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