title: Extracting diagnoses and investigation results from unstructured text in electronic health records by semi-supervised machine learning.
abstract: BACKGROUND
  Electronic health records are invaluable for medical research, but much of the information is recorded as unstructured free text which is time-consuming to review manually.
  
  
  OBJECTIVE
  To develop an algorithm to identify relevant free texts automatically based on labelled examples.
  
  
  METHODS
  We developed a novel machine learning algorithm, the 'Semi-supervised Set Covering Machine' (S3CM), and tested its ability to detect the presence of coronary angiogram results and ovarian cancer diagnoses in free text in the General Practice Research Database. For training the algorithm, we used texts classified as positive and negative according to their associated Read diagnostic codes, rather than by manual annotation. We evaluated the precision (positive predictive value) and recall (sensitivity) of S3CM in classifying unlabelled texts against the gold standard of manual review. We compared the performance of S3CM with the Transductive Vector Support Machine (TVSM), the original fully-supervised Set Covering Machine (SCM) and our 'Freetext Matching Algorithm' natural language processor.
  
  
  RESULTS
  Only 60% of texts with Read codes for angiogram actually contained angiogram results. However, the S3CM algorithm achieved 87% recall with 64% precision on detecting coronary angiogram results, outperforming the fully-supervised SCM (recall 78%, precision 60%) and TSVM (recall 2%, precision 3%). For ovarian cancer diagnoses, S3CM had higher recall than the other algorithms tested (86%). The Freetext Matching Algorithm had better precision than S3CM (85% versus 74%) but lower recall (62%).
  
  
  CONCLUSIONS
  Our novel S3CM machine learning algorithm effectively detected free texts in primary care records associated with angiogram results and ovarian cancer diagnoses, after training on pre-classified test sets. It should be easy to adapt to other disease areas as it does not rely on linguistic rules, but needs further testing in other electronic health record datasets.
authors.affiliation: Department of Computer Science, University College London, London, United Kingdom.
authors.forename: Zhuoran
authors.initials: Z
authors.lastname: Wang
authors.forename: Anoop D
authors.initials: AD
authors.lastname: Shah
authors.forename: A Rosemary
authors.initials: AR
authors.lastname: Tate
authors.forename: Spiros
authors.initials: S
authors.lastname: Denaxas
authors.forename: John
authors.initials: J
authors.lastname: Shawe-Taylor
authors.forename: Harry
authors.initials: H
authors.lastname: Hemingway
mesh_terms: D000465:Algorithms; D001185:Artificial Intelligence; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D010051:Ovarian Neoplasms / Q000175:diagnosis