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ObjectiveThe n2c2/UW SDOH Challenge explores the extraction of social determinant of health (SDOH) information from clinical notes. The objectives include the advancement of natural language processing (NLP) information extraction techniques for SDOH and clinical information more broadly. This article presents the shared task, data, participating teams, performance results, and considerations for future work.Materials and MethodsThe task used the Social History Annotated Corpus (SHAC), which consists of clinical text with detailed event-based annotations for SDOH events, such as alcohol, drug, tobacco, employment, and living situation. Each SDOH event is characterized through attributes related to status, extent, and temporality. The task includes 3 subtasks related to information extraction (Subtask A), generalizability (Subtask B), and learning transfer (Subtask C). In addressing this task, participants utilized a range of techniques, including rules, knowledge bases, n-grams, word embeddings, and pretrained language models (LM).ResultsA total of 15 teams participated, and the top teams utilized pretrained deep learning LM. The top team across all subtasks used a sequence-to-sequence approach achieving 0.901 F1 for Subtask A, 0.774 F1 Subtask B, and 0.889 F1 for Subtask C.ConclusionsSimilar to many NLP tasks and domains, pretrained LM yielded the best performance, including generalizability and learning transfer. An error analysis indicates extraction performance varies by SDOH, with lower performance achieved for conditions, like substance use and homelessness, which increase health risks (risk factors) and higher performance achieved for conditions, like substance abstinence and living with family, which reduce health risks (protective factors).

Objective Neural network deidentification studies have focused on individual datasets. These studies assume the availability of a sufficient amount of human-annotated data to train models that can generalize to corresponding test data. In real-world situations, however, researchers often have limited or no in-house training data. Existing systems and external data can help jump-start deidentification on in-house data; however, the most efficient way of utilizing existing systems and external data is unclear. This article investigates the transferability of a state-of-the-art neural clinical deidentification system, NeuroNER, across a variety of datasets, when it is modified architecturally for domain generalization and when it is trained strategically for domain transfer. Materials and Methods We conducted a comparative study of the transferability of NeuroNER using 4 clinical note corpora with multiple note types from 2 institutions. We modified NeuroNER architecturally to integrate 2 types of domain generalization approaches. We evaluated each architecture using 3 training strategies. We measured transferability from external sources; transferability across note types; the contribution of external source data when in-domain training data are available; and transferability across institutions. Results and Conclusions Transferability from a single external source gave inconsistent results. Using additional external sources consistently yielded an F1-score of approximately 80%. Fine-tuning emerged as a dominant transfer strategy, with or without domain generalization. We also found that external sources were useful even in cases where in-domain training data were available. Transferability across institutions differed by note type and annotation label but resulted in improved performance.

Objective Clinical notes contain an abundance of important, but not-readily accessible, information about patients. Systems that automatically extract this information rely on large amounts of training data of which there exists limited resources to create. Furthermore, they are developed disjointly, meaning that no information can be shared among task-specific systems. This bottleneck unnecessarily complicates practical application, reduces the performance capabilities of each individual solution, and associates the engineering debt of managing multiple information extraction systems. Materials and Methods We address these challenges by developing Multitask-Clinical BERT: a single deep learning model that simultaneously performs 8 clinical tasks spanning entity extraction, personal health information identification, language entailment, and similarity by sharing representations among tasks. Results We compare the performance of our multitasking information extraction system to state-of-the-art BERT sequential fine-tuning baselines. We observe a slight but consistent performance degradation in MT-Clinical BERT relative to sequential fine-tuning. Discussion These results intuitively suggest that learning a general clinical text representation capable of supporting multiple tasks has the downside of losing the ability to exploit dataset or clinical note-specific properties when compared to a single, task-specific model. Conclusions We find our single system performs competitively with all state-the-art task-specific systems while also benefiting from massive computational benefits at inference.

Advanced cyber attackers can penetrate enterprise networks and steal critical documents containing intellectual property despite all access control measures. Cyber deception is one of many solutions to protect critical documents after an attacker penetrates the network. It requires the generation and deployment of decoys such as fake text. The comprehensibility of a fake text document can affect the required time and effort for an attack to succeed. However, existing cybersecurity research has given limited attention to exploring the comprehensibility features of text for fake document generation. This article presents a novel method to generate believable fake text documents by measuring and manipulating the comprehensibility of legit text within a genetic algorithm (GA) framework. For measuring text comprehensibility, we adopt a set of quantitative measures based on qualitative principles of psycholinguistics and reading comprehension: connectivity , dispersion , and sequentiality . Our user-study analysis indicates that the quantitative comprehensibility measures can approximate the degree of human effort required to comprehend a fake text document in contrast to a legit text. For manipulating text comprehensibility, we develop a multiobjective, multimutation GA that modifies a legit document to Pareto-optimally alter its comprehensibility measures and generate hard-to-comprehend, believable fake documents. Our experiments show that the proposed algorithm successfully generates fake documents for a broader class of legit documents with varied text characteristics when compared to baselines from previous research. Hence, the application of our method can help improve cyber deception systems by providing more believable yet hard-to-comprehend fake documents to mislead cyber attackers.

The use of offensive language in user-generated content is a serious problem that needs to be addressed with the latest technology. The field of Natural Language Processing (NLP) can support the automatic detection of offensive language. In this survey, we review previous NLP studies that cover Arabic offensive language detection. This survey investigates the state-of-the-art in offensive language detection for the Arabic language, providing a structured overview of previous approaches, including core techniques, tools, resources, methods, and main features used. This work also discusses the limitations and gaps of the previous studies. Findings from this survey emphasize the importance of investing further effort in detecting Arabic offensive language, including the development of benchmark resources and the invention of novel preprocessing and feature extraction techniques.

An accurate and detailed account of patient medications, including medication changes within the patient timeline, is essential for healthcare providers to provide appropriate patient care. Healthcare providers or the patients themselves may initiate changes to patient medication. Medication changes take many forms, including prescribed medication and associated dosage modification. These changes provide information about the overall health of the patient and the rationale that led to the current care. Future care can then build on the resulting state of the patient. This work explores the automatic extraction of medication change information from free-text clinical notes. The Contextual Medication Event Dataset (CMED) is a corpus of clinical notes with annotations that characterize medication changes through multiple change-related attributes, including the type of change (start, stop, increase, etc.), initiator of the change, temporality, change likelihood, and negation. Using CMED, we identify medication mentions in clinical text and propose three novel high-performing BERT-based systems that resolve the annotated medication change characteristics. We demonstrate that our proposed systems improve medication change classification performance over the initial work exploring CMED.

Text mining is one of the branches of data mining and refers to as the computing process of finding new patterns and relations among datasets which appear not to be related. Data mining is an interdisciplinary field which uses statistics, artificial intelligence, and database systems to generate new tools for discovering patterns among datasets. Similarly, when dealing with textual data, we need to use various methods in different branches of computer science (e.g. linguistics) and statistics. This study reviews the techniques of text-based sentiment analysis pipeline including preprocessing, aspect extraction, feature selection, and classification techniques used by scholars recently. It also surveys different applications of semantic analysis in the context of social media, marketing, and product reviews.

Emotion is a primary aspect of communication and can be expressed in many modalities. Text-Based Emotion Detection (TBED), one of the fastest growing branches of Natural Language Processing (NLP), is the process of classifying syntactic or semantic units of a corpus into a given set of emotion classes proposed by a psychological model. Automatic TBED mechanisms use machine learning approaches to create computational platforms automating the process of extracting emotions. TBED has a wide variety of applications in the area of artificial intelligence: Semantic analysis of documents and public messages related to terrorist attacks (to mitigate risks), automated analysis of historical corpora, and study of product reviews (to assess customer satisfaction). This work reviews the current literature of TBED and the psychological models associated with them.

Social media bots can change society's perspective in different aspects of life. This paper analyzes sentiment features and their effect on the accuracy of machine learning models for social media bot detection. Social bots can use tweet sentiment to create a backfire effect and confirmation bias to create a fake trend or change public opinion. We analyze bot detection problems based on sentiment features inspired by the work by Micheal Workman [1] and create new features based on textual information of online comments. We offer a quantitative approach to create new features and compare machine learning models for bot detection. This work is based on psychological and social effects inherent in tweets' text content based on the work by [1]. The new set of sentiment features are extracted from a tweet's text and used to train bot detection models. Also, we implement the new model for the Dutch language and achieve more than 87% accuracy for the Dutch tweets based on new sentiment features. Considering new sentiment features based on psychological and social factors for a tweet's text will open a potential research area for social media bot detection.

Many modern entity recognition systems, including the current state-of-the-art de-identification systems, are based on bidirectional long short-term memory (biLSTM) units augmented by a conditional random field (CRF) sequence optimizer. These systems process the input sentence by sentence. This approach prevents the systems from capturing dependencies over sentence boundaries and makes accurate sentence boundary detection a prerequisite. Since sentence boundary detection can be problematic especially in clinical reports, where dependencies and co-references across sentence boundaries are abundant, these systems have clear limitations. In this study, we built a new system on the framework of one of the current state-of-the-art de-identification systems, NeuroNER, to overcome these limitations. This new system incorporates context embeddings through forward and backward n -grams without using sentence boundaries. Our context-enhanced de-identification (CEDI) system captures dependencies over sentence boundaries and bypasses the sentence boundary detection problem altogether. We enhanced this system with deep affix features and an attention mechanism to capture the pertinent parts of the input. The CEDI system outperforms NeuroNER on the 2006 i2b2 de-identification challenge dataset, the 2014 i2b2 shared task de-identification dataset, and the 2016 CEGS N-GRID de-identification dataset ( p < 0.01 ). All datasets comprise narrative clinical reports in English but contain different note types varying from discharge summaries to psychiatric notes. Enhancing CEDI with deep affix features and the attention mechanism further increased performance.

This paper presents the Source-Free Domain Adaptation shared task held within SemEval-2021. The aim of the task was to explore adaptation of machine-learning models in the face of data sharing constraints. Specifically, we consider the scenario where annotations exist for a domain but cannot be shared. Instead, participants are provided with models trained on that (source) data. Participants also receive some labeled data from a new (development) domain on which to explore domain adaptation algorithms. Participants are then tested on data representing a new (target) domain. We explored this scenario with two different semantic tasks: negation detection (a text classification task) and time expression recognition (a sequence tagging task).

Information relevant to mental health is commonly recorded as unstructured narrative text. This text may be part of a clinical record, a social media post, a diary, or a transcribed conversation between two or more people. Although the quantity and richness of this unstructured narrative text is vast, it is inaccessible to traditional computer systems which rely on structured data. Natural language processing (NLP) is a technology that solves the problem of making this information accessible to computer systems. NLP is a technology for converting unstructured narrative texts into a format that is more easily accessible to computerized systems. NLP is also a scientific field—the field concerned with developing and applying methods for making unstructured narrative texts computable. NLP is a field in computer science that combines artificial intelligence, statistics, and linguistics to process unstructured text and make it more easily accessible by computerized systems. In this chapter, we provide an overview of NLP within the mental health domain. We discuss different data sources, including electronic health records and social media text, and describe how to collect, process, and analyze these texts for mental health research and practice. Finally, we provide an overview of applications, challenges, limitations, and ethical considerations.

This paper details a Consumer Health Question (CHQ) summarization model submitted to MEDIQA 2021 for shared task 1: Question Summarization. Many CHQs are composed of multiple sentences with typos or unnecessary information, which can interfere with automated question answering systems. Question summarization mitigates this issue by removing this unnecessary information, aiding automated systems in generating a more accurate summary. Our summarization approach focuses on applying multiple pre-processing techniques, including question focus identification on the input and the development of an ensemble method to combine question focus with an abstractive summarization method. We use the state-of-art abstractive summarization model, PEGASUS (Pre-training with Extracted Gap-sentences for Abstractive Summarization), to generate abstractive summaries. Our experiments show that using our ensemble method, which combines abstractive summarization with question focus identification, improves performance over using summarization alone. Our model shows a ROUGE-2 F-measure of 11.14% against the official test dataset.

We propose Segment Convolutional Neural Networks (Seg-CNNs) for classifying relations from clinical notes. Seg-CNNs use only word-embedding features without manual feature engineering. Unlike typical CNN models, relations between 2 concepts are identified by simultaneously learning separate representations for text segments in a sentence: preceding, concept1, middle, concept2, and succeeding. We evaluate Seg-CNN on the i2b2/VA relation classification challenge dataset. We show that Seg-CNN achieves a state-of-the-art micro-average F-measure of 0.742 for overall evaluation, 0.686 for classifying medical problem–treatment relations, 0.820 for medical problem–test relations, and 0.702 for medical problem–medical problem relations. We demonstrate the benefits of learning segment-level representations. We show that medical domain word embeddings help improve relation classification. Seg-CNNs can be trained quickly for the i2b2/VA dataset on a graphics processing unit (GPU) platform. These results support the use of CNNs computed over segments of text for classifying medical relations, as they show state-of-the-art performance while requiring no manual feature engineering.

State-of-the-art research on emotion classification from text primarily focuses on binary or ternary classification. Yet, humans express a variety of emotions. Here we approach the classification of emotions from short, informal text as a multi-class problem, employing popular psychology models of basic and advanced human emotions. We account for imbalanced datasets differing in annotation schema, psychological models considered, and number of annotated emotions. We show that a multi-channel, multi-filter CNN-BiLSTM outperforms existing models, achieving 82.3% accuracy on the multi-label SemEval18-EC dataset.

This paper describes SalamNET, an Arabic offensive language detection system that has been submitted to SemEval 2020 shared task 12: Multilingual Offensive Language Identification in Social Media. Our approach focuses on applying multiple deep learning models and conducting in depth error analysis of results to provide system implications for future development considerations. To pursue our goal, a Recurrent Neural Network (RNN), a Gated Recurrent Unit (GRU), and Long-Short Term Memory (LSTM) models with different design architectures have been developed and evaluated. The SalamNET, a Bi-directional Gated Recurrent Unit (Bi-GRU) based model, reports a macro-F1 score of 0.83., Comment: In Proceedings of the International Workshop on Semantic Evaluation (SemEval) 2020

Clinical narratives are used as a key communication stream within healthcare and associated research. In comparison to structured elements of electronic health records, free text conveys individualized patient history and assessments, providing a rich context for clinical decision making. Natural language processing (NLP), one foundational technique used in text analytics, has repeatedly demonstrated its feasibility to unlock information described in free text efficiently and effectively. The development of text analytics beyond basic NLP has been facilitated by increased adoption of machine learning techniques. In particular, recent years have witnessed the greatest leap in performance in the history of computer science following the arrival of deep learning. Human-like performance in a wide range of text analytics tasks has opened the gate to its routine use in various clinical care settings. Unfortunately, clinical narratives are yet to be routinely analysed on a large scale. This is largely associated with accessibility of clinical narratives in relation to privacy concerns. Another reason for the slow adoption of text analytics in routine clinical care is the scarcity of evidence that clearly demonstrates its utility in the wider context of clinical applications.

OBJECTIVE: The 2018 National NLP Clinical Challenge (2018 n2c2) focused on the task of cohort selection for clinical trials, where participating systems were tasked with analyzing longitudinal patient records to determine if the patients met or did not meet any of the 13 selection criteria. This article describes our participation in this shared task. MATERIALS AND METHODS: We followed a hybrid approach combining pattern-based, knowledge-intensive, and feature weighting techniques. After preprocessing the notes using publicly available natural language processing tools, we developed individual criterion-specific components that relied on collecting knowledge resources relevant for these criteria and pattern-based and weighting approaches to identify “met” and “not met” cases. RESULTS: As part of the 2018 n2c2 challenge, 3 runs were submitted. The overall micro-averaged F1 on the training set was 0.9444. On the test set, the micro-averaged F1 for the 3 submitted runs were 0.9075, 0.9065, and 0.9056. The best run was placed second in the overall challenge and all 3 runs were statistically similar to the top-ranked system. A reimplemented system achieved the best overall F1 of 0.9111 on the test set. DISCUSSION: We highlight the need for a focused resource-intensive effort to address the class imbalance in the cohort selection identification task. CONCLUSION: Our hybrid approach was able to identify all selection criteria with high F1 performance on both training and test sets. Based on our participation in the 2018 n2c2 task, we conclude that there is merit in continuing a focused criterion-specific analysis and developing appropriate knowledge resources to build a quality cohort selection system.

Prescription information and adverse drug reactions (ADR) are two components of detailed medication instructions that can benefit many aspects of clinical research. Automatic extraction of this information from free-text narratives via Information Extraction (IE) can open it up to downstream uses. IE is commonly tackled by supervised Natural Language Processing (NLP) systems which rely on annotated training data. However, training data generation is manual, time-consuming, and labor-intensive. It is desirable to develop automatic methods for augmenting manually labeled data. We propose pseudo-data generation as one such automatic method. Pseudo-data are synthetic data generated by combining elements of existing labeled data. We propose and evaluate two sets of pseudo-data generation methods: knowledge-driven methods based on gazetteers and data-driven methods based on deep learning. We use the resulting pseudo-data to improve medication and ADR extraction. Data-driven pseudo-data are suitable for concept categories with high semantic regularities and short textual spans. Knowledge-driven pseudo-data are effective for concept categories with longer textual spans, assuming the knowledge base offers good coverage of these concepts. Combining the knowledge- and data-driven pseudo-data achieves significant performance improvement on medication names and ADRs over baselines limited to the use of available labeled data.

De-identification aims to remove 18 categories of protected health information from electronic health records. Ideally, de-identification systems should be reliable and generalizable. Previous research has focused on improving performance but has not examined generalizability. This paper investigates both performance and generalizability. To improve current state-of-the-art performance based on long short-term memory (LSTM) units, we introduce a system that uses gated recurrent units (GRUs) and deep contextualized word representations, both of which have never been applied to de-identification. We measure performance and generalizability of each system using the 2014 i2b2/UTHealth and 2016 CEGS N-GRID de-identification datasets. We show that deep contextualized word representations improve state-of-the-art performance, while the benefit of switching LSTM units with GRUs is not significant. The generalizability of de-identification system significantly improved with deep contextualized word representations; in addition, LSTM units-based system is more generalizable than the GRUs-based system.

Objective This article summarizes the preparation, organization, evaluation, and results of Track 2 of the 2018 National NLP Clinical Challenges shared task. Track 2 focused on extraction of adverse drug events (ADEs) from clinical records and evaluated 3 tasks: concept extraction, relation classification, and end-to-end systems. We perform an analysis of the results to identify the state of the art in these tasks, learn from it, and build on it. Materials and Methods For all tasks, teams were given raw text of narrative discharge summaries, and in all the tasks, participants proposed deep learning–based methods with hand-designed features. In the concept extraction task, participants used sequence labelling models (bidirectional long short-term memory being the most popular), whereas in the relation classification task, they also experimented with instance-based classifiers (namely support vector machines and rules). Ensemble methods were also popular. Results A total of 28 teams participated in task 1, with 21 teams in tasks 2 and 3. The best performing systems set a high performance bar with F1 scores of 0.9418 for concept extraction, 0.9630 for relation classification, and 0.8905 for end-to-end. However, the results were much lower for concepts and relations of Reasons and ADEs. These were often missed because local context is insufficient to identify them. Conclusions This challenge shows that clinical concept extraction and relation classification systems have a high performance for many concept types, but significant improvement is still required for ADEs and Reasons. Incorporating the larger context or outside knowledge will likely improve the performance of future systems.

ObjectiveTrack 1 of the 2018 National NLP Clinical Challenges shared tasks focused on identifying which patients in a corpus of longitudinal medical records meet and do not meet identified selection criteria.Materials and MethodsTo address this challenge, we annotated American English clinical narratives for 288 patients according to whether they met these criteria. We chose criteria from existing clinical trials that represented a variety of natural language processing tasks, including concept extraction, temporal reasoning, and inference.ResultsA total of 47 teams participated in this shared task, with 224 participants in total. The participants represented 18 countries, and the teams submitted 109 total system outputs. The best-performing system achieved a micro F1 score of 0.91 using a rule-based approach. The top 10 teams used rule-based and hybrid systems to approach the problems.DiscussionClinical narratives are open to interpretation, particularly in cases where the selection criterion may be underspecified. This leaves room for annotators to use domain knowledge and intuition in selecting patients, which may lead to error in system outputs. However, teams who consulted medical professionals while building their systems were more likely to have high recall for patients, which is preferable for patient selection systems.ConclusionsThere is not yet a 1-size-fits-all solution for natural language processing systems approaching this task. Future research in this area can look to examining criteria requiring even more complex inferences, temporal reasoning, and domain knowledge.

Objective The 2019 National Natural language processing (NLP) Clinical Challenges (n2c2)/Open Health NLP (OHNLP) shared task track 3, focused on medical concept normalization (MCN) in clinical records. This track aimed to assess the state of the art in identifying and matching salient medical concepts to a controlled vocabulary. In this paper, we describe the task, describe the data set used, compare the participating systems, present results, identify the strengths and limitations of the current state of the art, and identify directions for future research. Materials and methods Participating teams were provided with narrative discharge summaries in which text spans corresponding to medical concepts were identified. This paper refers to these text spans as mentions. Teams were tasked with normalizing these mentions to concepts, represented by concept unique identifiers, within the Unified Medical Language System. Submitted systems represented 4 broad categories of approaches: cascading dictionary matching, cosine distance, deep learning, and retrieve-and-rank systems. Disambiguation modules were common across all approaches. Results A total of 33 teams participated in the MCN task. The best-performing team achieved an accuracy of 0.8526. The median and mean performances among all teams were 0.7733 and 0.7426, respectively. Conclusions Overall performance among the top 10 teams was high. However, several mention types were challenging for all teams. These included mentions requiring disambiguation of misspelled words, acronyms, abbreviations, and mentions with more than 1 possible semantic type. Also challenging were complex mentions of long, multi-word terms that may require new ways of extracting and representing mention meaning, the use of domain knowledge, parse trees, or hand-crafted rules.

E-petitioning technology platforms elicit the participation of citizens in the policy-making process but at the same time create large volumes of unstructured textual data that are difficult to analyze. Fortunately, computational tools can assist policy analysts in uncovering latent patterns from these large textual datasets. This study uses such computational tools to explore e-petitions, viewing them as persuasive texts with linguistic and semantic features that may be related to the popularity of petitions, as indexed by the number of signatures they attract. Using We the People website data, we analyzed linguistic features, such as extremity and repetition, and semantic features, such as named entities and topics, to determine whether and to what extent they are related to petition popularity. The results show that each block of variables independently explains statistically significant variation in signature accumulation, and that 1) language extremity is persistently and negatively associated with petition popularity, 2) petitions with many names tend not to become popular, and 3) petition popularity is associated with petitions that include topics familiar to the public or about important social events. We believe explorations along these lines will yield useful strategies to address the wicked problem of too much text data and to facilitate the enhancement of public participation in policy-making.

We present a novel approach for analysing the qualitative content of annual reports. Using natural language processing techniques we determine if sentiment expressed in the text matters in fraud detection. We focus on the Management Discussion and Analysis MD&A section of annual reports because of the nonfactual content present in this section, unlike other components of the annual reports. We measure the sentiment expressed in the text on the dimensions of polarity, subjectivity, and intensity and investigate in depth whether truthful and fraudulent MD&As differ in terms of sentiment polarity, sentiment subjectivity and sentiment intensity. Our results show that fraudulent MD&As on average contain three times more positive sentiment and four times more negative sentiment compared with truthful MD&As. This suggests that use of both positive and negative sentiment is more pronounced in fraudulent MD&As. We further find that, compared with truthful MD&As, fraudulent MD&As contain a greater proportion of subjective content than objective content. This suggests that the use of subjectivity clues such as presence of too many adjectives and adverbs could be an indicator of fraud. Clear cases of fraud show a higher intensity of sentiment exhibited by more use of adverbs in the "adverb modifying adjective" pattern. Based on the results of this study, frequent use of intensifiers, particularly in this pattern, could be another indicator of fraud. Moreover, the dimensions of subjectivity and intensity help in accurately classifying borderline examples of MD&As that are equal in sentiment polarity into fraudulent and truthful categories. When taken together, these findings suggest that fraudulent MD&As in contrast to truthful MD&As contain higher sentiment content. Copyright © 2016 John Wiley & Sons, Ltd.

Adverse drug events (ADEs) are unintended incidents that involve the taking of a medication. ADEs pose significant health and financial problems worldwide. Information about ADEs can inform health care and improve patient safety. However, much of this information is buried in narrative texts and needs to be extracted with Natural Language Processing techniques, in order to be useful to computerized methods. ADEs can be found on drug labels, contained in the different sections such as descriptions of the drug's active components or more prominently in descriptions of studied side-effects. Extracting these automatically could be useful in triaging and processing drug reports. In this paper, we present three base methods consisting of a Conditional Random Field (CRF), a bi-directional Long Short Term Memory unit with a CRF layer (biLSTM+CRF), and a pre-trained Bi-directional Encoder Representations from Transformers (BERT) model. We also present several ensembles of the CRF and biLSTM+CRF methods for extracting ADEs and their Reason from FDA drug labels. We show that all three methods perform well on our task, and that combining the models through different ensemble methods can improve results, providing increases in recall for the majority class and improving precision for all other classes. We also show the potential of framing ADE extraction from drug labels as a multi-class classification task on the Reason, or type, of ADE.

The shared task for the 2019 Workshop on Computational Linguistics and Clinical Psychology (CLPsych’19) introduced an assessment of suicide risk based on social media postings, using data from Reddit to identify users at no, low, moderate, or severe risk. Two variations of the task focused on users whose posts to the r/SuicideWatch subreddit indicated they might be at risk; a third task looked at screening users based only on their more everyday (non-SuicideWatch) posts. We received submissions from 15 different teams, and the results provide progress and insight into the value of language signal in helping to predict risk level.

Social Media Mining for Health Applications (SMM4H) Adverse Effect Mentions Shared Task challenges participants to accurately identify spans of text within a tweet that correspond to Adverse Effects (AEs) resulting from medication usage (Weissenbacher et al., 2019). This task features a training data set of 2,367 tweets, in addition to a 1,000 tweet evaluation data set. The solution presented here features a bidirectional Long Short-term Memory Network (bi-LSTM) for the generation of character-level embeddings. It uses a second bi-LSTM trained on both character and token level embeddings to feed a Conditional Random Field (CRF) which provides the final classification. This paper further discusses the deep learning algorithms used in our solution.

Objectives: To review the latest scientific challenges organized in clinical Natural Language Processing (NLP) by highlighting the tasks, the most effective methodologies used, the data, and the sharing strategies. Methods: We harvested the literature by using Google Scholar and PubMed Central to retrieve all shared tasks organized since 2015 on clinical NLP problems on English data. Results: We surveyed 17 shared tasks. We grouped the data into four types (synthetic, drug labels, social data, and clinical data) which are correlated with size and sensitivity. We found named entity recognition and classification to be the most common tasks. Most of the methods used to tackle the shared tasks have been data-driven. There is homogeneity in the methods used to tackle the named entity recognition tasks, while more diverse solutions are investigated for relation extraction, multi-class classification, and information retrieval problems. Conclusions: There is a clear trend in using data-driven methods to tackle problems in clinical NLP. The availability of more and varied data from different institutions will undoubtedly lead to bigger advances in the field, for the benefit of healthcare as a whole.

Display Omitted New corpus of 1304 de-identified medical records.Longitudinal records represent 296 patients.Three patient cohorts: with Coronary Artery Disease (CAD), no CAD, develop CAD.Overview of novel uses for this corpus. The 2014 i2b2/UTHealth Natural Language Processing (NLP) shared task featured a new longitudinal corpus of 1304 records representing 296 diabetic patients. The corpus contains three cohorts: patients who have a diagnosis of coronary artery disease (CAD) in their first record, and continue to have it in subsequent records; patients who do not have a diagnosis of CAD in the first record, but develop it by the last record; patients who do not have a diagnosis of CAD in any record. This paper details the process used to select records for this corpus and provides an overview of novel research uses for this corpus. This corpus is the only annotated corpus of longitudinal clinical narratives currently available for research to the general research community.

Display Omitted Systematic assessment of common machine learning methods on document phenotype classification.Five diseases studied: Obesity, CAD, hyperlipidemia, hypertension, and diabetes.Statistical testing of model performance using approximate randomization techniques.As expected, semantic features (UMLS-CUI) present in most top performing models.Unexpectedly, many models without semantic features not statistically significantly different from top performing model in each disease. Automated phenotype identification plays a critical role in cohort selection and bioinformatics data mining. Natural Language Processing (NLP)-informed classification techniques can robustly identify phenotypes in unstructured medical notes. In this paper, we systematically assess the effect of naive, lexically normalized, and semantic feature spaces on classifier performance for obesity, atherosclerotic cardiovascular disease (CAD), hyperlipidemia, hypertension, and diabetes. We train support vector machines (SVMs) using individual feature spaces as well as combinations of these feature spaces on two small training corpora (730 and 790 documents) and a combined (1520 documents) training corpus. We assess the importance of feature spaces and training data size on SVM model performance. We show that inclusion of semantically-informed features does not statistically improve performance for these models. The addition of training data has weak effects of mixed statistical significance across disease classes suggesting larger corpora are not necessary to achieve relatively high performance with these models.

Display Omitted The first study to assess the ease of adoption of the state-of-the-art clinical NLP systems.Five clinical NLP systems were carefully examined by four expert evaluators and eight end user evaluators.The results show that the adoptability of clinical NLP systems is generally unsatisfactory. ObjectiveIn recognition of potential barriers that may inhibit the widespread adoption of biomedical software, the 2014 i2b2 Challenge introduced a special track, Track 3 - Software Usability Assessment, in order to develop a better understanding of the adoption issues that might be associated with the state-of-the-art clinical NLP systems. This paper reports the ease of adoption assessment methods we developed for this track, and the results of evaluating five clinical NLP system submissions. Materials and methodsA team of human evaluators performed a series of scripted adoptability test tasks with each of the participating systems. The evaluation team consisted of four "expert evaluators" with training in computer science, and eight "end user evaluators" with mixed backgrounds in medicine, nursing, pharmacy, and health informatics. We assessed how easy it is to adopt the submitted systems along the following three dimensions: communication effectiveness (i.e., how effective a system is in communicating its designed objectives to intended audience), effort required to install, and effort required to use. We used a formal software usability testing tool, TURF, to record the evaluators' interactions with the systems and 'think-aloud' data revealing their thought processes when installing and using the systems and when resolving unexpected issues. ResultsOverall, the ease of adoption ratings that the five systems received are unsatisfactory. Installation of some of the systems proved to be rather difficult, and some systems failed to adequately communicate their designed objectives to intended adopters. Further, the average ratings provided by the end user evaluators on ease of use and ease of interpreting output are -0.35 and -0.53, respectively, indicating that this group of users generally deemed the systems extremely difficult to work with. While the ratings provided by the expert evaluators are higher, 0.6 and 0.45, respectively, these ratings are still low indicating that they also experienced considerable struggles. DiscussionThe results of the Track 3 evaluation show that the adoptability of the five participating clinical NLP systems has a great margin for improvement. Remedy strategies suggested by the evaluators included (1) more detailed and operation system specific use instructions; (2) provision of more pertinent onscreen feedback for easier diagnosis of problems; (3) including screen walk-throughs in use instructions so users know what to expect and what might have gone wrong; (4) avoiding jargon and acronyms in materials intended for end users; and (5) packaging prerequisites required within software distributions so that prospective adopters of the software do not have to obtain each of the third-party components on their own.

Display Omitted First de-identification shared task on clinical narratives.10 teams participated, submitting 22 system output.Top-performing system achieved micro-averaged F1 measure of .936 using strictest evaluation metric. The 2014 i2b2/UTHealth Natural Language Processing (NLP) shared task featured four tracks. The first of these was the de-identification track focused on identifying protected health information (PHI) in longitudinal clinical narratives. The longitudinal nature of clinical narratives calls particular attention to details of information that, while benign on their own in separate records, can lead to identification of patients in combination in longitudinal records. Accordingly, the 2014 de-identification track addressed a broader set of entities and PHI than covered by the Health Insurance Portability and Accountability Act - the focus of the de-identification shared task that was organized in 2006. Ten teams tackled the 2014 de-identification task and submitted 22 system outputs for evaluation. Each team was evaluated on their best performing system output. Three of the 10 systems achieved F1 scores over .90, and seven of the top 10 scored over .75. The most successful systems combined conditional random fields and hand-written rules. Our findings indicate that automated systems can be very effective for this task, but that de-identification is not yet a solved problem.

Objective Extracting medical knowledge from electronic medical records requires automated approaches to combat scalability limitations and selection biases. However, existing machine learning approaches are often regarded by clinicians as black boxes. Moreover, training data for these automated approaches at often sparsely annotated at best. The authors target unsupervised learning for modeling clinical narrative text, aiming at improving both accuracy and interpretability. Methods The authors introduce a novel framework named subgraph augmented non-negative tensor factorization (SANTF). In addition to relying on atomic features (e.g., words in clinical narrative text), SANTF automatically mines higher-order features (e.g., relations of lymphoid cells expressing antigens) from clinical narrative text by converting sentences into a graph representation and identifying important subgraphs. The authors compose a tensor using patients, higher-order features, and atomic features as its respective modes. We then apply non-negative tensor factorization to cluster patients, and simultaneously identify latent groups of higher-order features that link to patient clusters, as in clinical guidelines where a panel of immunophenotypic features and laboratory results are used to specify diagnostic criteria. Results and Conclusion SANTF demonstrated over 10% improvement in averaged F-measure on patient clustering compared to widely used non-negative matrix factorization (NMF) and k-means clustering methods. Multiple baselines were established by modeling patient data using patient-by-features matrices with different feature configurations and then performing NMF or k-means to cluster patients. Feature analysis identified latent groups of higher-order features that lead to medical insights. We also found that the latent groups of atomic features help to better correlate the latent groups of higher-order features.

Participants in the 2012 i2b2 Shared-Task and Workshop on Challenges in Natural Language Processing for Clinical Data created a variety of systems for processing temporal relations in clinical records. The different ways of conceptualizing the shared-task Tracks reflects the complexity of temporal analysis of narratives even for humans, and the use of hybrid systems, world knowledge, and other sources of linguistic information reflect the difficulty of formulating temporal analysis for automated methods. Despite their promising results, and significant advancement on the state of the art in temporal relations in medical records, the 2012 i2b2 challenge systems only scratched the surface in this task. Open questions remain about the applicability of the developed systems for real life practical questions, such as the determination of the progression of diseases in patients, for example, heart disease in diabetic populations. Nevertheless, the 2012 i2b2 Challenge corpus of temporal annotations remains a valuable asset to the medical NLP community, and we hope will serve as the basis for further innovation in temporal relations, resulting in systems that can be applied to real life clinical problems.

Background The Sixth Informatics for Integrating Biology and the Bedside (i2b2) Natural Language Processing Challenge for Clinical Records focused on the temporal relations in clinical narratives. The organizers provided the research community with a corpus of discharge summaries annotated with temporal information, to be used for the development and evaluation of temporal reasoning systems. 18 teams from around the world participated in the challenge. During the workshop, participating teams presented comprehensive reviews and analysis of their systems, and outlined future research directions suggested by the challenge contributions. Methods The challenge evaluated systems on the information extraction tasks that targeted: (1) clinically significant events, including both clinical concepts such as problems, tests, treatments, and clinical departments, and events relevant to the patient's clinical timeline, such as admissions, transfers between departments, etc; (2) temporal expressions, referring to the dates, times, durations, or frequencies phrases in the clinical text. The values of the extracted temporal expressions had to be normalized to an ISO specification standard; and (3) temporal relations, between the clinical events and temporal expressions. Participants determined pairs of events and temporal expressions that exhibited a temporal relation, and identified the temporal relation between them. Results For event detection, statistical machine learning (ML) methods consistently showed superior performance. While ML and rule based methods seemed to detect temporal expressions equally well, the best systems overwhelmingly adopted a rule based approach for value normalization. For temporal relation classification, the systems using hybrid approaches that combined ML and heuristics based methods produced the best results.

The 2016 CEGS N-GRID shared tasks for clinical records contained three tracks. Track 1 focused on de-identification of a new corpus of 1,000 psychiatric intake records. This track tackled de-identification in two sub-tracks: Track 1.A was a “sight unseen” task, where nine teams ran existing de-identification systems, without any modifications or training, on 600 new records in order to gauge how well systems generalize to new data. The best-performing system for this track scored an F1 of 0.799. Track 1.B was a traditional Natural Language Processing (NLP) shared task on de-identification, where 15 teams had two months to train their systems on the new data, then test it on an unannotated test set. The best-performing system from this track scored an F1 of 0.914. The scores for Track 1.A show that unmodified existing systems do not generalize well to new data without the benefit of training data. The scores for Track 1.B are slightly lower than the 2014 de-identification shared task (which was almost identical to 2016 Track 1.B), indicating that these new psychiatric records pose a more difficult challenge to NLP systems. Overall, de-identification is still not a solved problem, though it is important to the future of clinical NLP.

Before medical records can be shared outside of a hospital or medical group, all of the information that identifies the patient (called protected health information, or PHI) must be removed. In this paper, we examine different methodologies for performing de-identification annotation in order to determine which is most effective at ensuring that all identifying information is removed. We used serial (i.e., multiple annotators working in succession) and parallel (i.e., multiple annotators working independently) annotation paradigms on two different corpora, one unannotated and the other pre-annotated for PHI. Our evaluation revealed that neither annotation paradigm was superior to the other, regardless of whether the corpus was pre-annotated or unannotated.

Objective Narratives of electronic medical records contain information that can be useful for clinical practice and multi-purpose research. This information needs to be put into a structured form before it can be used by automated systems. Coreference resolution is a step in the transformation of narratives into a structured form. Methods This study presents a medical coreference resolution system (MCORES) for noun phrases in four frequently used clinical semantic categories: persons, problems, treatments, and tests. MCORES treats coreference resolution as a binary classification task. Given a pair of concepts from a semantic category, it determines coreferent pairs and clusters them into chains. MCORES uses an enhanced set of lexical, syntactic, and semantic features. Some MCORES features measure the distance between various representations of the concepts in a pair and can be asymmetric. Results and Conclusion MCORES was compared with an in-house baseline that uses only single-perspective ‘token overlap’ and ‘number agreement’ features. MCORES was shown to outperform the baseline; its enhanced features contribute significantly to performance. In addition to the baseline, MCORES was compared against two available third-party, open-domain systems, RECONCILEACL09 and the Beautiful Anaphora Resolution Toolkit (BART). MCORES was shown to outperform both of these systems on clinical records.

This issue of JAMIA focuses on natural language processing (NLP) techniques for clinical-text information extraction. Several articles are offshoots of the yearly ‘Informatics for Integrating Biology and the Bedside’ (i2b2) (http://www.i2b2.org) NLP shared-task challenge, introduced by Uzuner et al ( see page 552 )1 and co-sponsored by the Veteran's Administration for the last 2 years. This shared task follows long-running challenge evaluations in other fields, such as the Message Understanding Conference (MUC) for information extraction,2 TREC3 for text information retrieval, and CASP4 for protein structure prediction. Shared tasks in the clinical domain are recent and include annual i2b2 Challenges that began in 2006, a challenge for multi-label classification of radiology reports sponsored by Cincinnati Children's Hospital in 2007,5 a 2011 Cincinnati Children's Hospital challenge on suicide notes,6 and the 2011 TREC information retrieval shared task involving retrieval of clinical cases from narrative records.7 Although NLP research in the clinical domain has been active since the 1960s, progress in the development of NLP applications for clinical text has been slow and lags behind progress in the general NLP domain. There are several barriers to NLP development in the clinical domain, and shared tasks like the i2b2/VA Challenge address some of these barriers. Nevertheless, many barriers remain and unless the community takes a more active role in developing novel approaches for addressing the barriers, advancement and innovation will continue to be slow. Historically, there have been substantial barriers to NLP development in the clinical domain. These barriers are not unique to the clinical domain: they also occur in the fields of software engineering and general NLP. ### Lack of access to shared data Because of concerns regarding patient privacy and worry about revealing unfavorable institutional practices, hospitals and clinics have been extremely reluctant to allow access to clinical data for researchers from outside … Correspondence to Dr Wendy W Chapman, Department of Biomedical Informatics, University of California San Diego, 9500 Gilman Dr, Bldg 2 #0728, La Jolla, California, USA; wwchapman{at}ucsd.edu

The 2010 i2b2/VA Workshop on Natural Language Processing Challenges for Clinical Records presented three tasks: a concept extraction task focused on the extraction of medical concepts from patient reports; an assertion classification task focused on assigning assertion types for medical problem concepts; and a relation classification task focused on assigning relation types that hold between medical problems, tests, and treatments. i2b2 and the VA provided an annotated reference standard corpus for the three tasks. Using this reference standard, 22 systems were developed for concept extraction, 21 for assertion classification, and 16 for relation classification. These systems showed that machine learning approaches could be augmented with rule-based systems to determine concepts, assertions, and relations. Depending on the task, the rule-based systems can either provide input for machine learning or post-process the output of machine learning. Ensembles of classifiers, information from unlabeled data, and external knowledge sources can help when the training data are inadequate.

Objective: We describe semantic relation (SR) classification on medical discharge summaries. We focus on relations targeted to the creation of problem-oriented records. Thus, we define relations that involve the medical problems of patients. Methods and materials: We represent patients' medical problems with their diseases and symptoms. We study the relations of patients' problems with each other and with concepts that are identified as tests and treatments. We present an SR classifier that studies a corpus of patient records one sentence at a time. For all pairs of concepts that appear in a sentence, this SR classifier determines the relations between them. In doing so, the SR classifier takes advantage of surface, lexical, and syntactic features and uses these features as input to a support vector machine. We apply our SR classifier to two sets of medical discharge summaries, one obtained from the Beth Israel-Deaconess Medical Center (BIDMC), Boston, MA and the other from Partners Healthcare, Boston, MA. Results: On the BIDMC corpus, our SR classifier achieves micro-averaged F-measures that range from 74% to 95% on the various relation types. On the Partners corpus, the micro-averaged F-measures on the various relation types range from 68% to 91%. Our experiments show that lexical features (in particular, tokens that occur between candidate concepts, which we refer to as inter-concept tokens) are very informative for relation classification in medical discharge summaries. Using only the inter-concept tokens in the corpus, our SR classifier can recognize 84% of the relations in the BIDMC corpus and 72% of the relations in the Partners corpus. Conclusion: These results are promising for semantic indexing of medical records. They imply that we can take advantage of lexical patterns in discharge summaries for relation classification at a sentence level.

Objective: Within the context of the Third i2b2 Workshop on Natural Language Processing Challenges for Clinical Records, the authors (also referred to as ‘the i2b2 medication challenge team’ or ‘the i2b2 team’ for short) organized a community annotation experiment. Design: For this experiment, the authors released annotation guidelines and a small set of annotated discharge summaries. They asked the participants of the Third i2b2 Workshop to annotate 10 discharge summaries per person; each discharge summary was annotated by two annotators from two different teams, and a third annotator from a third team resolved disagreements. Measurements: In order to evaluate the reliability of the annotations thus produced, the authors measured community inter-annotator agreement and compared it with the inter-annotator agreement of expert annotators when both the community and the expert annotators generated ground truth based on pooled system outputs. For this purpose, the pool consisted of the three most densely populated automatic annotations of each record. The authors also compared the community inter-annotator agreement with expert inter-annotator agreement when the experts annotated raw records without using the pool. Finally, they measured the quality of the community ground truth by comparing it with the expert ground truth. Results and conclusions: The authors found that the community annotators achieved comparable inter-annotator agreement to expert annotators, regardless of whether the experts annotated from the pool. Furthermore, the ground truth generated by the community obtained F-measures above 0.90 against the ground truth of the experts, indicating the value of the community as a source of high-quality ground truth even on intricate and domain-specific annotation tasks.

Extensive research has been done on the analytical and empirical examination of financial data in annual reports to detect fraud; however, there is scant research on the analysis of text in annual reports to detect fraud. The basic premise of this research is that there are clues hidden in the text that can be detected to determine the likelihood of fraud. In this research, we examine both the verbal content and the presentation style of the qualitative portion of the annual reports using natural language processing tools and explore linguistic features that distinguish fraudulent annual reports from nonfraudulent annual reports. Our results indicate that employment of linguistic features is an effective means for detecting fraud. We were able to improve the prediction accuracy of our fraud detection model from initial baseline results of 56.75 percent accuracy, using a “bag of words” approach, to 89.51 percent accuracy when we incorporated linguistically motivated features inspired by our informed reasoning and domain knowledge.

Objective: Clinical records contain significant medical information that can be useful to researchers in various disciplines. However, these records also contain personal health information (PHI) whose presence limits the use of the records outside of hospitals. The goal of de-identification is to remove all PHI from clinical records. This is a challenging task because many records contain foreign and misspelled PHI; they also contain PHI that are ambiguous with non-PHI. These complications are compounded by the linguistic characteristics of clinical records. For example, medical discharge summaries, which are studied in this paper, are characterized by fragmented, incomplete utterances and domain-specific language; they cannot be fully processed by tools designed for lay language. Methods and results: In this paper, we show that we can de-identify medical discharge summaries using a de-identifier, Stat De-id, based on support vector machines and local context (F-measure=97% on PHI). Our representation of local context aids de-identification even when PHI include out-of-vocabulary words and even when PHI are ambiguous with non-PHI within the same corpus. Comparison of Stat De-id with a rule-based approach shows that local context contributes more to de-identification than dictionaries combined with hand-tailored heuristics (F-measure=85%). Comparison with two well-known named entity recognition (NER) systems, SNoW (F-measure=94%) and IdentiFinder (F-measure=36%), on five representative corpora show that when the language of documents is fragmented, a system with a relatively thorough representation of local context can be a more effective de-identifier than systems that combine (relatively simpler) local context with global context. Comparison with a Conditional Random Field De-identifier (CRFD), which utilizes global context in addition to the local context of Stat De-id, confirms this finding (F-measure=88%) and establishes that strengthening the representation of local context may be more beneficial for de-identification than complementing local with global context.

The authors organized a Natural Language Processing (NLP) challenge on automatically determining the smoking status of patients from information found in their discharge records. This challenge was issued as a part of the i2b2 (Informatics for Integrating Biology to the Bedside) project, to survey, facilitate, and examine studies in medical language understanding for clinical narratives. This article describes the smoking challenge, details the data and the annotation process, explains the evaluation metrics, discusses the characteristics of the systems developed for the challenge, presents an analysis of the results of received system runs, draws conclusions about the state of the art, and identifies directions for future research. A total of 11 teams participated in the smoking challenge. Each team submitted up to three system runs, providing a total of 23 submissions. The submitted system runs were evaluated with microaveraged and macroaveraged precision, recall, and F-measure. The systems submitted to the smoking challenge represented a variety of machine learning and rule-based algorithms. Despite the differences in their approaches to smoking status identification, many of these systems provided good results. There were 12 system runs with microaveraged F-measures above 0.84. Analysis of the results highlighted the fact that discharge summaries express smoking status using a limited number of textual features (e.g., "smok", "tobac", "cigar", Social History, etc.). Many of the effective smoking status identifiers benefit from these features.

To facilitate and survey studies in automatic de-identification, as a part of the i2b2 (Informatics for Integrating Biology to the Bedside) project, authors organized a Natural Language Processing (NLP) challenge on automatically removing private health information (PHI) from medical discharge records. This manuscript provides an overview of this de-identification challenge, describes the data and the annotation process, explains the evaluation metrics, discusses the nature of the systems that addressed the challenge, analyzes the results of received system runs, and identifies directions for future research. The de-indentification challenge data consisted of discharge summaries drawn from the Partners Healthcare system. Authors prepared this data for the challenge by replacing authentic PHI with synthesized surrogates. To focus the challenge on non-dictionary-based de-identification methods, the data was enriched with out-of-vocabulary PHI surrogates, i.e., made up names. The data also included some PHI surrogates that were ambiguous with medical non-PHI terms. A total of seven teams participated in the challenge. Each team submitted up to three system runs, for a total of sixteen submissions. The authors used precision, recall, and F-measure to evaluate the submitted system runs based on their token-level and instance-level performance on the ground truth. The systems with the best performance scored above 98% in F-measure for all categories of PHI. Most out-of-vocabulary PHI could be identified accurately. However, identifying ambiguous PHI proved challenging. The performance of systems on the test data set is encouraging. Future evaluations of these systems will involve larger data sets from more heterogeneous sources.

Electronic petitioning (e-petitioning) provides a unique and promising channel through which people can directly express their policy preferences. E-petitions may be viewed as a natural laboratory for determining subjects of public interest, and thus can be used by policy analysts to understand social needs and constraints. In this paper, we introduce textual analysis tools (such as NER and topic modeling) and extract three types of novel variables (informativeness, named entities, and 21 topics) from We the People petition texts. The regression result shows that informativeness, named location, and several topics are significantly correlated with the log of the signature counts. These exploratory but promising results indicate that textual analysis tools can complement traditional statistical methods by providing descriptive measures that are helpful for making causal inferences from electronic petition data. These new tools, we believe, will facilitate policy analysis and policy informatics by enabling meaningful use of large volumes of online archives containing public expression regarding policy preferences.

Display Omitted De-identification shared task for longitudinal clinical records.Protected Health Information in records replaced with realistic surrogates.First corpus of its kind available for distribution.Used for Track 1 of the 2014 i2b2/UTHealth NLP shared task. The 2014 i2b2/UTHealth natural language processing shared task featured a track focused on the de-identification of longitudinal medical records. For this track, we de-identified a set of 1304 longitudinal medical records describing 296 patients. This corpus was de-identified under a broad interpretation of the HIPAA guidelines using double-annotation followed by arbitration, rounds of sanity checking, and proof reading. The average token-based F1 measure for the annotators compared to the gold standard was 0.927. The resulting annotations were used both to de-identify the data and to set the gold standard for the de-identification track of the 2014 i2b2/UTHealth shared task. All annotated private health information were replaced with realistic surrogates automatically and then read over and corrected manually. The resulting corpus is the first of its kind made available for de-identification research. This corpus was first used for the 2014 i2b2/UTHealth shared task, during which the systems achieved a mean F-measure of 0.872 and a maximum F-measure of 0.964 using entity-based micro-averaged evaluations.

Preparing narrative medical records for use outside of their originating institutions requires that protected health information (PHI) be removed from the records. If researchers intend to use these records for natural language processing, then preparing the medical documents requires two steps: (1) identifying the PHI and (2) replacing the PHI with realistic surrogates. In this chapter we discuss the challenges associated with generating these realistic surrogates and describe the algorithms we used to prepare the 2014 i2b2/UTHealth shared task corpus for distribution and use in a natural language processing task focused on de-identification.