title: Multi-center colonoscopy quality measurement utilizing natural language processing.
abstract: BACKGROUND
  An accurate system for tracking of colonoscopy quality and surveillance intervals could improve the effectiveness and cost-effectiveness of colorectal cancer (CRC) screening and surveillance. The purpose of this study was to create and test such a system across multiple institutions utilizing natural language processing (NLP).
  
  
  METHODS
  From 42,569 colonoscopies with pathology records from 13 centers, we randomly sampled 750 paired reports. We trained (n=250) and tested (n=500) an NLP-based program with 19 measurements that encompass colonoscopy quality measures and surveillance interval determination, using blinded, paired, annotated expert manual review as the reference standard. The remaining 41,819 nonannotated documents were processed through the NLP system without manual review to assess performance consistency. The primary outcome was system accuracy across the 19 measures.
  
  
  RESULTS
  A total of 176 (23.5%) documents with 252 (1.8%) discrepant content points resulted from paired annotation. Error rate within the 500 test documents was 31.2% for NLP and 25.4% for the paired annotators (P=0.001). At the content point level within the test set, the error rate was 3.5% for NLP and 1.9% for the paired annotators (P=0.04). When eight vaguely worded documents were removed, 125 of 492 (25.4%) were incorrect by NLP and 104 of 492 (21.1%) by the initial annotator (P=0.07). Rates of pathologic findings calculated from NLP were similar to those calculated by annotation for the majority of measurements. Test set accuracy was 99.6% for CRC, 95% for advanced adenoma, 94.6% for nonadvanced adenoma, 99.8% for advanced sessile serrated polyps, 99.2% for nonadvanced sessile serrated polyps, 96.8% for large hyperplastic polyps, and 96.0% for small hyperplastic polyps. Lesion location showed high accuracy (87.0-99.8%). Accuracy for number of adenomas was 92%.
  
  
  CONCLUSIONS
  NLP can accurately report adenoma detection rate and the components for determining guideline-adherent colonoscopy surveillance intervals across multiple sites that utilize different methods for reporting colonoscopy findings.
authors.affiliation: 1] Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA [2] Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA [3] Department of Biomedical Informatics, Regenstrief Institute, LLC, Indianapolis, Indiana, USA.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Imler
authors.affiliation: 1] Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA [2] Department of Biomedical Informatics, Regenstrief Institute, LLC, Indianapolis, Indiana, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Morea
authors.affiliation: 1] Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA [2] Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA [3] Center of Innovation, Health Services Research and Development, Richard L, Roudebush VA Medical Center, Indianapolis, Indiana, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Kahi
authors.forename: Eric A
authors.initials: EA
authors.lastname: Sherer
authors.affiliation: Center of Innovation, Health Services Research and Development, Richard L, Roudebush VA Medical Center, Indianapolis, Indiana, USA.
authors.forename: Jon
authors.initials: J
authors.lastname: Cardwell
authors.affiliation: Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Johnson
authors.affiliation: Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Huiping
authors.initials: H
authors.lastname: Xu
authors.affiliation: Division of Gastroenterology, University of Colorado, Denver, Colorado, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Ahnen
authors.affiliation: Division of Gastroenterology, Wayne State University, Detroit, Michigan, USA.
authors.forename: Fadi
authors.initials: F
authors.lastname: Antaki
authors.affiliation: Division of Gastroenterology, Albany Medical College, Albany, New York, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Ashley
authors.affiliation: Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA.
authors.forename: Gyorgy
authors.initials: G
authors.lastname: Baffy
authors.affiliation: Division of Gastroenterology, New York University School of Medicine, New York, New York, USA.
authors.forename: Ilseung
authors.initials: I
authors.lastname: Cho
authors.affiliation: Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Dominitz
authors.affiliation: Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Hou
authors.affiliation: Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, Bronx, New York, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Korsten
authors.affiliation: Division of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA.
authors.forename: Anil
authors.initials: A
authors.lastname: Nagar
authors.affiliation: Division of Gastroenterology, Brown Medical School, Providence, Rhode Island, USA.
authors.forename: Kittichai
authors.initials: K
authors.lastname: Promrat
authors.affiliation: Division of Gastroenterology, The Dartmouth Institute, Lebanon, New Hampshire, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Robertson
authors.affiliation: Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Saini
authors.affiliation: Division of Gastroenterology, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Amandeep
authors.initials: A
authors.lastname: Shergill
authors.affiliation: Division of Gastroenterology, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Walter
authors.initials: W
authors.lastname: Smalley
authors.affiliation: 1] Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA [2] Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA [3] Center of Innovation, Health Services Research and Development, Richard L, Roudebush VA Medical Center, Indianapolis, Indiana, USA [4] Health Services Research, Regenstrief Institute, Indianapolis, Indiana, USA.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Imperiale
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D003111:Colonic Polyps / Q000175:diagnosis*; D003113:Colonoscopy / Q000592:standards; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods*; D006801:Humans; D006965:Hyperplasia / Q000175:diagnosis; D008499:Medical Records / Q000592:standards*; D009323:Natural Language Processing; D012015:Reference Standards