title: A hierarchical method to automatically encode Chinese diagnoses through semantic similarity estimation.
abstract: BACKGROUND
  The accumulation of medical documents in China has rapidly increased in the past years. We focus on developing a method that automatically performs ICD-10 code assignment to Chinese diagnoses from the electronic medical records to support the medical coding process in Chinese hospitals.
  
  
  METHODS
  We propose two encoding methods: one that directly determines the desired code (flat method), and one that hierarchically determines the most suitable code until the desired code is obtained (hierarchical method). Both methods are based on instances from the standard diagnostic library, a gold standard dataset in China. For the first time, semantic similarity estimation between Chinese words are applied in the biomedical domain with the successful implementation of knowledge-based and distributional approaches. Characteristics of the Chinese language are considered in implementing distributional semantics. We test our methods against 16,330 coding instances from our partner hospital.
  
  
  RESULTS
  The hierarchical method outperforms the flat method in terms of accuracy and time complexity. Representing distributional semantics using Chinese characters can achieve comparable performance to the use of Chinese words. The diagnoses in the test set can be encoded automatically with micro-averaged precision of 92.57 %, recall of 89.63 %, and F-score of 91.08 %. A sharp decrease in encoding performance is observed without semantic similarity estimation.
  
  
  CONCLUSIONS
  The hierarchical nature of ICD-10 codes can enhance the performance of the automated code assignment. Semantic similarity estimation is demonstrated indispensable in dealing with Chinese medical text. The proposed method can greatly reduce the workload and improve the efficiency of the code assignment process in Chinese hospitals.
authors.affiliation: Health Care Services Research Center, Department of Industrial Engineering, Tsinghua University, Beijing, 100084, PR China. nwx14@mails.tsinghua.edu.cn.
authors.forename: Wenxin
authors.initials: W
authors.lastname: Ning
authors.affiliation: Health Care Services Research Center, Department of Industrial Engineering, Tsinghua University, Beijing, 100084, PR China. mingyu@tsinghua.edu.cn.
authors.forename: Ming
authors.initials: M
authors.lastname: Yu
authors.affiliation: Department of Information Management, School of Economics and Management, Beijing Jiaotong University, Beijing, 100084, PR China. rtzhang@bjtu.edu.cn.
authors.forename: Runtong
authors.initials: R
authors.lastname: Zhang
mesh_terms: D002681:China; D059019:Clinical Coding; D006801:Humans; D038801:International Classification of Diseases; D008491:Medical Informatics Applications; D008962:Models, Theoretical; D012660:Semantics; D018875:Vocabulary, Controlled