title: A proof of concept for assessing emergency room use with primary care data and natural language processing.
abstract: OBJECTIVE
  The objective of this study was to undertake a proof of concept that demonstrated the use of primary care data and natural language processing and term extraction to assess emergency room use. The study extracted biopsychosocial concepts from primary care free text and related them to inappropriate emergency room use through the use of odds ratios.
  
  
  METHODS
  De-identified free text notes were extracted from a primary care clinic in Guelph, Ontario and analyzed with a software toolkit that incorporated General Architecture for Text Engineering (GATE) and MetaMap components for natural language processing and term extraction.
  
  
  RESULTS
  Over 10 million concepts were extracted from 13,836 patient records. Codes found in at least 1% percent of the sample were regressed against inappropriate emergency room use. 77 codes fell within the realm of biopsychosocial, were very statistically significant (p < 0.001) and had an OR > 2.0. Thematically, these codes involved mental health and pain related concepts.
  
  
  CONCLUSIONS
  Analyzed thematically, mental health issues and pain are important themes; we have concluded that pain and mental health problems are primary drivers for inappropriate emergency room use. Age and sex were not significant. This proof of concept demonstrates the feasibly of combining natural language processing and primary care data to analyze a system use question. As a first work it supports further research and could be applied to investigate other, more complex problems.
authors.affiliation: School of Health and Life Sciences and Community Services, Conestoga College Institute of Technology and Advanced Learning, Kitchener, Ontario, Canada. stmaurice@gmail.com
authors.forename: J
authors.initials: J
authors.lastname: St-Maurice
authors.forename: M-H
authors.initials: MH
authors.lastname: Kuo
authors.forename: P
authors.initials: P
authors.lastname: Gooch
mesh_terms: D003199:Computer Systems; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006801:Humans; D038801:International Classification of Diseases; D016347:Medical Records Systems, Computerized; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy; D009323:Natural Language Processing; D009864:Ontario; D010146:Pain / Q000453:epidemiology / Q000209:etiology; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D012984:Software; D014600:Utilization Review / Q000706:statistics & numerical data