title: Using information from the electronic health record to improve measurement of unemployment in service members and veterans with mTBI and post-deployment stress.
abstract: OBJECTIVE
  The purpose of this pilot study is 1) to develop an annotation schema and a training set of annotated notes to support the future development of a natural language processing (NLP) system to automatically extract employment information, and 2) to determine if information about employment status, goals and work-related challenges reported by service members and Veterans with mild traumatic brain injury (mTBI) and post-deployment stress can be identified in the Electronic Health Record (EHR).
  
  
  METHODS
  Retrospective cohort study using data from selected progress notes stored in the EHR.
  
  
  METHODS
  Post-deployment Rehabilitation and Evaluation Program (PREP), an in-patient rehabilitation program for Veterans with TBI at the James A. Haley Veterans' Hospital in Tampa, Florida.
  
  
  METHODS
  Service members and Veterans with TBI who participated in the PREP program (N = 60).
  
  
  METHODS
  Documentation of employment status, goals, and work-related challenges reported by service members and recorded in the EHR.
  
  
  RESULTS
  Two hundred notes were examined and unique vocational information was found indicating a variety of self-reported employment challenges. Current employment status and future vocational goals along with information about cognitive, physical, and behavioral symptoms that may affect return-to-work were extracted from the EHR. The annotation schema developed for this study provides an excellent tool upon which NLP studies can be developed.
  
  
  CONCLUSIONS
  Information related to employment status and vocational history is stored in text notes in the EHR system. Information stored in text does not lend itself to easy extraction or summarization for research and rehabilitation planning purposes. Development of NLP systems to automatically extract text-based employment information provides data that may improve the understanding and measurement of employment in this important cohort.
authors.affiliation: Center of Innovation on Disability & Rehabilitation Research (CINDRR) James A. Haley Veterans Hospital, Tampa, Florida, United States of America; Department of Rehabilitation and Mental Health Counseling, University of South Florida, Tampa, Florida, United States of America.
authors.forename: Christina
authors.initials: C
authors.lastname: Dillahunt-Aspillaga
authors.affiliation: Center of Innovation on Disability & Rehabilitation Research (CINDRR) James A. Haley Veterans Hospital, Tampa, Florida, United States of America.
authors.forename: Dezon
authors.initials: D
authors.lastname: Finch
authors.affiliation: James A. Haley Veterans Hospital, Tampa, Florida, United States of America.
authors.forename: Jill
authors.initials: J
authors.lastname: Massengale
authors.affiliation: James A. Haley Veterans Hospital, Tampa, Florida, United States of America.
authors.forename: Tracy
authors.initials: T
authors.lastname: Kretzmer
authors.affiliation: Center of Innovation on Disability & Rehabilitation Research (CINDRR) James A. Haley Veterans Hospital, Tampa, Florida, United States of America.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Luther
authors.affiliation: Center of Innovation on Disability & Rehabilitation Research (CINDRR) James A. Haley Veterans Hospital, Tampa, Florida, United States of America.
authors.forename: James A
authors.initials: JA
authors.lastname: McCart
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000523:psychology / Q000534:rehabilitation*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D010865:Pilot Projects; D012050:Rehabilitation, Vocational; D062707:Return to Work / Q000523:psychology; D013315:Stress, Psychological; D014478:Unemployment / Q000523:psychology; D014728:Veterans / Q000523:psychology; D055815:Young Adult