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Data curation for a hospital-based cancer registry heavily relies on the labor-intensive manual abstraction process by cancer registrars to identify cancer-related information from free-text electronic health records. To streamline this process, a natural language processing system incorporating a hybrid of deep learning-based and rule-based approaches for identifying lung cancer registry-related concepts, along with a symbolic expert system that generates registry coding based on weighted rules, was developed. The system is integrated with the hospital information system at a medical center to provide cancer registrars with a patient journey visualization platform. The embedded system offers a comprehensive view of patient reports annotated with significant registry concepts to facilitate the manual coding process and elevate overall quality. Extensive evaluations, including comparisons with state-of-the-art methods, were conducted using a lung cancer dataset comprising 1428 patients from the medical center. The experimental results illustrate the effectiveness of the developed system, consistently achieving F1-scores of 0.85 and 1.00 across 30 coding items. Registrar feedback highlights the system’s reliability as a tool for assisting and auditing the abstraction. By presenting key registry items along the timeline of a patient’s reports with accurate code predictions, the system improves the quality of registrar outcomes and reduces the labor resources and time required for data abstraction. Our study highlights advancements in cancer registry coding practices, demonstrating that the proposed hybrid weighted neural-symbolic cancer registry system is reliable and efficient for assisting cancer registrars in the coding workflow and contributing to clinical outcomes.

Code-mixing is a phenomenon where at least two languages are combined in a hybrid manner in the context of a single conversation. The use of mixed language is widespread in multilingual and multicultural countries and poses significant challenges for the development of automated language processing tools. In Taiwan’s electronic health record (EHR) systems, unstructured EHR texts are usually represented in a mixture of English and Chinese which increases the difficulty for de-identification and synthetization of protected health information (PHI). We explored this problem by applying several state-of-the-art pre-trained mono- and multilingual language models and propose to exploit the principle-based approach (PBA) for the tasks of PHI recognition and resynthesis on a code-mixed EHR corpus annotated with 6 main categories and 25 subcategories of PHIs. A hierarchical principle slot schema is defined in the PBA to encode knowledge of code-mixed PHIs and utilize slots to learn from the training set to assemble principles for recognizing PHI mentions and synthesizing surrogates simultaneously. In addition, a semantic disambiguation process is implemented to disambiguate ambiguous PHI categories in the de-identification process and to dynamically extend the knowledge encoded in PBA during the knowledge augmentation process. The experiment results demonstrate that the proposed method can achieve the best micro- and macro-F-scores in comparison to the other mono- and multilingual language models fine-tuned on our code-mixed corpus.