Automated Clinical Coding for Outpatient Departments (2312.13533v2)
Abstract: Computerised clinical coding approaches aim to automate the process of assigning a set of codes to medical records. While there is active research pushing the state of the art on clinical coding for hospitalized patients, the outpatient setting -- where doctors tend to non-hospitalised patients -- is overlooked. Although both settings can be formalised as a multi-label classification task, they present unique and distinct challenges, which raises the question of whether the success of inpatient clinical coding approaches translates to the outpatient setting. This paper is the first to investigate how well state-of-the-art deep learning-based clinical coding approaches work in the outpatient setting at hospital scale. To this end, we collect a large outpatient dataset comprising over 7 million notes documenting over half a million patients. We adapt four state-of-the-art clinical coding approaches to this setting and evaluate their potential to assist coders. We find evidence that clinical coding in outpatient settings can benefit from more innovations in popular inpatient coding benchmarks. A deeper analysis of the factors contributing to the success -- amount and form of data and choice of document representation -- reveals the presence of easy-to-solve examples, the coding of which can be completely automated with a low error rate.
- WHO, “ICD-10 international classification of diseases,” Geneva: World Health Organization, 1993.
- M. H. Stanfill, M. Williams, S. H. Fenton, R. A. Jenders, and W. R. Hersh, “A systematic literature review of automated clinical coding and classification systems,” Journal of the American Medical Informatics Association, vol. 17, pp. 646–651, 11 2010.
- J. Mullenbach, S. Wiegreffe, J. Duke, J. Sun, and J. Eisenstein, “Explainable Prediction of Medical Codes from Clinical Text,” NAACL HLT 2018 - 2018 Conference of the North American Chapter of the Association for Computational Linguistics: Human Language Technologies - Proceedings of the Conference, vol. 1, pp. 1101–1111, 2018.
- T.-T. Nguyen, V. Schlegel, A. Kashyap, S. Winkler, S.-S. Huang, J.-J. Liu, C.-J. Lin, A. Singapore, and . Taipei, “Mimic-IV-ICD: A new benchmark for eXtreme MultiLabel Classification,” arXiv preprint arXiv:2304.13998, 4 2023.
- R. Kaur, J. A. Ginige, and O. Obst, “AI-based ICD coding and classification approaches using discharge summaries: A systematic literature review,” Expert Systems with Applications, vol. 213, p. 118997, 3 2023.
- T. T. Nguyen, V. Schlegel, A. Kashyap, and S. Winkler, “A Two-Stage Decoder for Efficient ICD Coding,” Proceedings of the Annual Meeting of the Association for Computational Linguistics, pp. 4658–4665, 2023.
- J. Wimsett, A. Harper, and P. Jones, “Review article: Components of a good quality discharge summary: A systematic review,” EMA - Emergency Medicine Australasia, vol. 26, pp. 430–438, 10 2014.
- A. Rule, S. Bedrick, M. F. Chiang, and M. R. Hribar, “Length and Redundancy of Outpatient Progress Notes Across a Decade at an Academic Medical Center,” JAMA Network Open, vol. 4, pp. e2115334–e2115334, 7 2021.
- L. Roberts, S. Araromi, and O. Peatman, “Clinical coding - an insight into healthcare data,” The British Student Doctor, vol. 2, p. 36, 6 2018.
- S. A. R. Nouraei, J. S. Virk, A. Hudovsky, C. Wathen, A. Darzi, and D. Parsons, “Accuracy of clinician-clinical coder information handover following acute medical admissions: implication for using administrative datasets in clinical outcomes management,” Journal of Public Health, vol. 38, pp. 352–362, 6 2016.
- F. W. Liang, L. Y. Wang, L. Y. Liu, C. Y. Li, and T. H. Lu, “Physician code creep after the initiation of outpatient volume control program and implications for appropriate ICD-10-CM coding,” BMC Health Services Research, vol. 20, pp. 1–7, 2 2020.
- L. M. Schilling, L. A. Crane, A. Kempe, D. S. Main, M. R. Sills, and A. J. Davidson, “Perceived frequency and impact of missing information at pediatric emergency and general ambulatory encounters,” Applied Clinical Informatics, vol. 1, no. 3, pp. 318–330, 2010.
- S. E. Pollard, P. M. Neri, A. R. Wilcox, L. A. Volk, D. H. Williams, G. D. Schiff, H. Z. Ramelson, and D. W. Bates, “How physicians document outpatient visit notes in an electronic health record,” International Journal of Medical Informatics, vol. 82, pp. 39–46, 1 2013.
- A. E. Johnson, T. J. Pollard, L. Shen, L. W. H. Lehman, M. Feng, M. Ghassemi, B. Moody, P. Szolovits, L. Anthony Celi, and R. G. Mark, “MIMIC-III, a freely accessible critical care database,” Scientific Data 2016 3:1, vol. 3, pp. 1–9, 5 2016.
- A. E. Johnson, L. Bulgarelli, L. Shen, A. Gayles, A. Shammout, S. Horng, T. J. Pollard, B. Moody, B. Gow, L. w. H. Lehman, L. A. Celi, and R. G. Mark, “MIMIC-IV, a freely accessible electronic health record dataset,” Scientific Data, vol. 10, 12 2023.
- T. Vu, D. Q. Nguyen, and A. Nguyen, “A Label Attention Model for ICD Coding from Clinical Text,” IJCAI International Joint Conference on Artificial Intelligence, vol. 4, pp. 3335–3341, 7 2020.
- Z. Yuan, C. Tan, and S. Huang, “Code Synonyms Do Matter: Multiple Synonyms Matching Network for Automatic ICD Coding,” Proceedings of the Annual Meeting of the Association for Computational Linguistics, vol. 2, pp. 808–814, 2022.
- O. Bodenreider, “The Unified Medical Language System (UMLS): integrating biomedical terminology,” Nucleic Acids Research, vol. 32, pp. D267–D270, 1 2004.
- C. W. Huang, S. C. Tsai, and Y. N. Chen, “PLM-ICD: Automatic ICD Coding with Pretrained Language Models,” ClinicalNLP 2022 - 4th Workshop on Clinical Natural Language Processing, Proceedings, pp. 10–20, 2022.
- M. Stanfill, “Coding Professionals’ Feelings toward Computers and Automated Coding,” Perspectives in Health Information Management, CAC Proceedings, 2008.
- Z. Yang, S. Wang, B. Pratap, S. Rawat, A. Mitra, and H. Yu, “Knowledge Injected Prompt Based Fine-tuning for Multi-label Few-shot ICD Coding,” in Findings of the Association for Computational Linguistics: EMNLP 2022, pp. 1767–1781, 2022.
- S. Campbell and K. Giadresco, “Computer-assisted clinical coding: A narrative review of the literature on its benefits, limitations, implementation and impact on clinical coding professionals,” Health Information Management Journal, vol. 49, pp. 5–18, 1 2020.
- R. W. Engle, “What is working memory capacity?,” The nature of remembering: Essays in honor of Robert G. Crowder., pp. 297–314, 10 2004.
- E. Lehman, E. Hernandez, D. Mahajan, J. Wulff, M. J. Smith, Z. Ziegler, D. Nadler, P. Szolovits, A. Johnson, and E. Alsentzer, “Do We Still Need Clinical Language Models?,” arXiv preprint arXiv:2302.08091, 2 2023.
- P. Lewis, M. Ott, J. Du, and V. Stoyanov, “Pretrained Language Models for Biomedical and Clinical Tasks: Understanding and Extending the State-of-the-Art,” in Proceedings of the 3rd Clinical Natural Language Processing Workshop, pp. 146–157, Association for Computational Linguistics (ACL), 11 2020.
- J. Devlin, M.-W. Chang, K. Lee, and K. Toutanova, “BERT: Pre-training of Deep Bidirectional Transformers for Language Understanding,” in Proceedings of the 2019 Conference of the North American Chapter of the Association for Computational Linguistics: Human Language Technologies, Volume 1 (Long and Short Papers), (Stroudsburg, PA, USA), pp. 4171–4186, Association for Computational Linguistics, 2019.
- J. Vaicenavicius, D. Widmann, C. Andersson, F. Lindsten, J. Roll, and T. B. Schön, “Evaluating model calibration in classification,” in Proceedings of the Twenty-Second International Conference on Artificial Intelligence and Statistics, pp. 3459–3467, PMLR, 4 2019.
- B. Zadrozny and C. Elkan, “Transforming classifier scores into accurate multiclass probability estimates,” Proceedings of the ACM SIGKDD International Conference on Knowledge Discovery and Data Mining, pp. 694–699, 2002.
- D. Pascual, S. Luck, and R. Wattenhofer, “Towards BERT-based Automatic ICD Coding: Limitations and Opportunities,” Proceedings of the 20th Workshop on Biomedical Language Processing, BioNLP 2021, pp. 54–63, 2021.
- T. Zhou, P. Cao, Y. Chen, K. Liu, J. Zhao, K. Niu, W. Chong, and S. Liu, “Automatic ICD Coding via Interactive Shared Representation Networks with Self-distillation Mechanism,” ACL-IJCNLP 2021 - 59th Annual Meeting of the Association for Computational Linguistics and the 11th International Joint Conference on Natural Language Processing, Proceedings of the Conference, pp. 5948–5957, 2021.
- P. Xie, H. Shi, M. Zhang, and E. P. Xing, “A Neural Architecture for Automated ICD Coding,” ACL 2018 - 56th Annual Meeting of the Association for Computational Linguistics, Proceedings of the Conference (Long Papers), vol. 1, pp. 1066–1076, 2018.
- M. Falis, M. Pajak, A. Lisowska, P. Schrempf, L. Deckers, S. Mikhael, S. A. Tsaftaris, and A. Q. O’Neil, “Ontological attention ensembles for capturing semantic concepts in ICD code prediction from clinical text,” LOUHI@EMNLP 2019 - 10th International Workshop on Health Text Mining and Information Analysis, Proceedings, pp. 168–177, 2019.
- P. Cao, Y. Chen, K. Liu, J. Zhao, S. Liu, and W. Chong, “HyperCore: Hyperbolic and Co-graph Representation for Automatic ICD Coding,” Proceedings of the Annual Meeting of the Association for Computational Linguistics, pp. 3105–3114, 2020.
- M. Feucht, Z. Wu, S. Althammer, and V. Tresp, “Description-based Label Attention Classifier for Explainable ICD-9 Classification,” W-NUT 2021 - 7th Workshop on Noisy User-Generated Text, Proceedings of the Conference, pp. 62–66, 2021.
- T. Wang, L. Zhang, C. Ye, J. Liu, and D. Zhou, “A Novel Framework Based on Medical Concept Driven Attention for Explainable Medical Code Prediction via External Knowledge,” Proceedings of the Annual Meeting of the Association for Computational Linguistics, pp. 1407–1416, 2022.
- A. Rios and R. Kavuluru, “Few-Shot and Zero-Shot Multi-Label Learning for Structured Label Spaces,” Proceedings of the 2018 Conference on Empirical Methods in Natural Language Processing, EMNLP 2018, pp. 3132–3142, 2018.
- J. Lu, L. Du, M. Liu, and J. Dipnall, “Multi-label Few/Zero-shot Learning with Knowledge Aggregated from Multiple Label Graphs,” EMNLP 2020 - 2020 Conference on Empirical Methods in Natural Language Processing, Proceedings of the Conference, pp. 2935–2943, 2020.
- J. Edin, A. Junge, J. D. Havtorn, L. Borgholt, M. Maistro, T. Ruotsalo, and L. Maaløe, “Automated Medical Coding on MIMIC-III and MIMIC-IV: A Critical Review and Replicability Study,” in Proceedings of the 46th International ACM SIGIR Conference on Research and Development in Information Retrieval, (New York, NY, USA), pp. 2572–2582, ACM, 7 2023.
- Z. Zhang, J. Liu, and N. Razavian, “BERT-XML: Large Scale Automated ICD Coding Using BERT Pretraining,” in Proceedings of the 3rd Clinical Natural Language Processing Workshop, pp. 24–34, Association for Computational Linguistics (ACL), 11 2020.
- R. Kavuluru, A. Rios, and Y. Lu, “An empirical evaluation of supervised learning approaches in assigning diagnosis codes to electronic medical records,” Artificial Intelligence in Medicine, vol. 65, pp. 155–166, 10 2015.
- A. Rios and R. Kavuluru, “Neural transfer learning for assigning diagnosis codes to EMRs,” Artificial Intelligence in Medicine, vol. 96, pp. 116–122, 5 2019.
- C. Lin, C. J. Hsu, Y. S. Lou, S. J. Yeh, C. C. Lee, S. L. Su, and H. C. Chen, “Artificial Intelligence Learning Semantics via External Resources for Classifying Diagnosis Codes in Discharge Notes,” J Med Internet Res 2017;19(11):e380 https://www.jmir.org/2017/11/e380, vol. 19, p. e8344, 11 2017.
- E. Moons, A. Khanna, A. Akkasi, and M. F. Moens, “A Comparison of Deep Learning Methods for ICD Coding of Clinical Records,” Applied Sciences 2020, Vol. 10, Page 5262, vol. 10, p. 5262, 7 2020.
- V. Mayya, S. Sowmya Kamath, G. S. Krishnan, and T. Gangavarapu, “Multi-channel, convolutional attention based neural model for automated diagnostic coding of unstructured patient discharge summaries,” Future Generation Computer Systems, vol. 118, pp. 374–391, 5 2021.
- H. Dong, V. Suárez-Paniagua, W. Whiteley, and H. Wu, “Explainable automated coding of clinical notes using hierarchical label-wise attention networks and label embedding initialisation,” Journal of Biomedical Informatics, vol. 116, p. 103728, 4 2021.
- J. Horsky, E. A. Drucker, and H. Z. Ramelson, “Accuracy and Completeness of Clinical Coding Using ICD-10 for Ambulatory Visits,” AMIA Annual Symposium Proceedings, vol. 2017, p. 912, 2017.
- C. Yeoh and H. Davies, “Clinical coding: completeness and accuracy when doctors take it on.,” BMJ : British Medical Journal, vol. 306, p. 972, 4 1993.
- N. A. Heywood, M. D. Gill, N. Charlwood, R. Brindle, C. C. Kirwan, N. Allen, P. Charleston, P. Coe, J. Cunningham, S. Duff, L. Forrest, C. Hall, S. Hassan, B. Hornung, M. al Jarabah, A. Jones, J. Mbuvi, T. Mclaughlin, J. Nicholson, J. Overton, A. Rees, H. Sekhar, J. Smith, S. Smith, N. Sung, N. Tarr, R. Teasdale, and J. Wilkinson, “Improving accuracy of clinical coding in surgery: collaboration is key,” Journal of Surgical Research, vol. 204, pp. 490–495, 8 2016.
- J. H. B. . Kuo, C.-C. . Yeh, C.-Y. . Yang, H.-C. . Lin, J. Hossain, B. Masud, C.-C. Kuo, C.-Y. Yeh, H.-C. Yang, and M.-C. Lin, “Applying Deep Learning Model to Predict Diagnosis Code of Medical Records,” Diagnostics 2023, Vol. 13, Page 2297, vol. 13, p. 2297, 7 2023.
- J. J. Liu, T. H. Yang, S. A. Chen, and C. J. Lin, “Parameter Selection: Why We Should Pay More Attention to It,” ACL-IJCNLP 2021 - 59th Annual Meeting of the Association for Computational Linguistics and the 11th International Joint Conference on Natural Language Processing, Proceedings of the Conference, vol. 2, pp. 825–830, 2021.