title: Using natural language processing on the free text of clinical documents to screen for evidence of homelessness among US veterans.
abstract: Information retrieval algorithms based on natural language processing (NLP) of the free text of medical records have been used to find documents of interest from databases. Homelessness is a high priority non-medical diagnosis that is noted in electronic medical records of Veterans in Veterans Affairs (VA) facilities. Using a human-reviewed reference standard corpus of clinical documents of Veterans with evidence of homelessness and those without, an open-source NLP tool (Automated Retrieval Console v2.0, ARC) was trained to classify documents. The best performing model based on document level work-flow performed well on a test set (Precision 94%, Recall 97%, F-Measure 96). Processing of a naïve set of 10,000 randomly selected documents from the VA using this best performing model yielded 463 documents flagged as positive, indicating a 4.7% prevalence of homelessness. Human review noted a precision of 70% for these flags resulting in an adjusted prevalence of homelessness of 3.3% which matches current VA estimates. Further refinements are underway to improve the performance. We demonstrate an effective and rapid lifecycle of using an off-the-shelf NLP tool for screening targets of interest from medical records.
authors.affiliation: VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT;
authors.forename: Adi V
authors.initials: AV
authors.lastname: Gundlapalli
authors.affiliation: VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT;
authors.forename: Marjorie E
authors.initials: ME
authors.lastname: Carter
authors.affiliation: VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT;
authors.forename: Miland
authors.initials: M
authors.lastname: Palmer
authors.affiliation: VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT;
authors.forename: Thomas
authors.initials: T
authors.lastname: Ginter
authors.affiliation: VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT;
authors.forename: Andrew
authors.initials: A
authors.lastname: Redd
authors.affiliation: VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT;
authors.forename: Steven
authors.initials: S
authors.lastname: Pickard
authors.affiliation: VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT;
authors.forename: Shuying
authors.initials: S
authors.lastname: Shen
authors.affiliation: VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT;
authors.forename: Brett
authors.initials: B
authors.lastname: South
authors.affiliation: VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT;
authors.forename: Guy
authors.initials: G
authors.lastname: Divita
authors.affiliation: VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT;
authors.forename: Scott
authors.initials: S
authors.lastname: Duvall
authors.affiliation: VA Boston Healthcare System, Jamaica Plain, MA.
authors.forename: Thien M
authors.initials: TM
authors.lastname: Nguyen
authors.affiliation: VA Boston Healthcare System, Jamaica Plain, MA.
authors.forename: Leonard W
authors.initials: LW
authors.lastname: D'Avolio
authors.affiliation: VA Salt Lake City Health Care System, Salt Lake City, UT ; University of Utah School of Medicine, Salt Lake City, UT;
authors.forename: Matthew
authors.initials: M
authors.lastname: Samore
mesh_terms: D000465:Algorithms; D057225:Data Mining / Q000379:methods*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D009323:Natural Language Processing; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*