title: NLP based congestive heart failure case finding: A prospective analysis on statewide electronic medical records.
abstract: BACKGROUND
  In order to proactively manage congestive heart failure (CHF) patients, an effective CHF case finding algorithm is required to process both structured and unstructured electronic medical records (EMR) to allow complementary and cost-efficient identification of CHF patients.
  
  
  RESULTS
  We set to identify CHF cases from both EMR codified and natural language processing (NLP) found cases. Using narrative clinical notes from all Maine Health Information Exchange (HIE) patients, the NLP case finding algorithm was retrospectively (July 1, 2012-June 30, 2013) developed with a random subset of HIE associated facilities, and blind-tested with the remaining facilities. The NLP based method was integrated into a live HIE population exploration system and validated prospectively (July 1, 2013-June 30, 2014). Total of 18,295 codified CHF patients were included in Maine HIE. Among the 253,803 subjects without CHF codings, our case finding algorithm prospectively identified 2411 uncodified CHF cases. The positive predictive value (PPV) is 0.914, and 70.1% of these 2411 cases were found to be with CHF histories in the clinical notes.
  
  
  CONCLUSIONS
  A CHF case finding algorithm was developed, tested and prospectively validated. The successful integration of the CHF case findings algorithm into the Maine HIE live system is expected to improve the Maine CHF care.
authors.affiliation: State Key Laboratory of Industrial Control Technology, Zhejiang University, Hangzhou 310027, PR China; Departments of Surgery, Stanford University, Stanford, CA 94305, USA.
authors.forename: Yue
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Departments of Surgery, Stanford University, Stanford, CA 94305, USA.
authors.forename: Jin
authors.initials: J
authors.lastname: Luo
authors.affiliation: Departments of Surgery, Stanford University, Stanford, CA 94305, USA.
authors.forename: Shiying
authors.initials: S
authors.lastname: Hao
authors.affiliation: HBISolutions Inc., Palo Alto, CA 94301, USA.
authors.forename: Haihua
authors.initials: H
authors.lastname: Xu
authors.affiliation: Departments of Pediatrics, Stanford University, Stanford, CA 94305, USA.
authors.forename: Andrew Young
authors.initials: AY
authors.lastname: Shin
authors.affiliation: HBISolutions Inc., Palo Alto, CA 94301, USA.
authors.forename: Bo
authors.initials: B
authors.lastname: Jin
authors.affiliation: Departments of Surgery, Stanford University, Stanford, CA 94305, USA.
authors.forename: Rui
authors.initials: R
authors.lastname: Liu
authors.affiliation: Chongqing Key Lab of Catalysis & Functional Organic Molecules, Chongqing Technology and Business University, Chongqing, China.
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Deng
authors.affiliation: HBISolutions Inc., Palo Alto, CA 94301, USA.
authors.forename: Lijuan
authors.initials: L
authors.lastname: Wang
authors.affiliation: Departments of Surgery, Stanford University, Stanford, CA 94305, USA.
authors.forename: Le
authors.initials: L
authors.lastname: Zheng
authors.affiliation: HBISolutions Inc., Palo Alto, CA 94301, USA.
authors.forename: Yifan
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: HBISolutions Inc., Palo Alto, CA 94301, USA.
authors.forename: Chunqing
authors.initials: C
authors.lastname: Zhu
authors.affiliation: HBISolutions Inc., Palo Alto, CA 94301, USA.
authors.forename: Zhongkai
authors.initials: Z
authors.lastname: Hu
authors.affiliation: HBISolutions Inc., Palo Alto, CA 94301, USA.
authors.forename: Changlin
authors.initials: C
authors.lastname: Fu
authors.affiliation: Departments of Surgery, Stanford University, Stanford, CA 94305, USA.
authors.forename: Yanpeng
authors.initials: Y
authors.lastname: Hao
authors.affiliation: Departments of Surgery, Stanford University, Stanford, CA 94305, USA.
authors.forename: Yingzhen
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Departments of Surgery, Stanford University, Stanford, CA 94305, USA.
authors.forename: Yunliang
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: HBISolutions Inc., Palo Alto, CA 94301, USA.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Dai
authors.affiliation: HealthInfoNet, Portland, ME 04103, USA.
authors.forename: Devore S
authors.initials: DS
authors.lastname: Culver
authors.affiliation: HealthInfoNet, Portland, ME 04103, USA.
authors.forename: Shaun T
authors.initials: ST
authors.lastname: Alfreds
authors.affiliation: HealthInfoNet, Portland, ME 04103, USA.
authors.forename: Rogow
authors.initials: R
authors.lastname: Todd
authors.affiliation: HBISolutions Inc., Palo Alto, CA 94301, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Stearns
authors.affiliation: Departments of Surgery, Stanford University, Stanford, CA 94305, USA.
authors.forename: Karl G
authors.initials: KG
authors.lastname: Sylvester
authors.affiliation: HBISolutions Inc., Palo Alto, CA 94301, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Widen
authors.affiliation: Departments of Surgery, Stanford University, Stanford, CA 94305, USA. Electronic address: bxling@stanford.edu.
authors.forename: Xuefeng B
authors.initials: XB
authors.lastname: Ling
mesh_terms: D000465:Algorithms; D057225:Data Mining / Q000379:methods*; D020000:Decision Support Systems, Clinical / Q000458:organization & administration; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D008281:Maine / Q000453:epidemiology; D009323:Natural Language Processing; D010363:Pattern Recognition, Automated / Q000379:methods*; D015995:Prevalence; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018875:Vocabulary, Controlled
keywords: Congestive heart failure; Electronic Medical record; Natural language processing; Prospective validation; Random forests