Abstract
BackgroundPatient travel history can be crucial in evaluating evolving infectious disease events. Such information can be challenging to acquire in electronic health records, as it is often available only in unstructured text.ObjectiveThis study aims to assess the feasibility of annotating and automatically extracting travel history mentions from unstructured clinical documents in the Department of Veterans Affairs across disparate health care facilities and among millions of patients. Information about travel exposure augments existing surveillance applications for increased preparedness in responding quickly to public health threats.MethodsClinical documents related to arboviral disease were annotated following selection using a semiautomated bootstrapping process. Using annotated instances as training data, models were developed to extract from unstructured clinical text any mention of affirmed travel locations outside of the continental United States. Automated text processing models were evaluated, involving machine learning and neural language models for extraction accuracy.ResultsAmong 4584 annotated instances, 2659 (58%) contained an affirmed mention of travel history, while 347 (7.6%) were negated. Interannotator agreement resulted in a document-level Cohen kappa of 0.776. Automated text processing accuracy (F1 85.6, 95% CI 82.5-87.9) and computational burden were acceptable such that the system can provide a rapid screen for public health events.ConclusionsAutomated extraction of patient travel history from clinical documents is feasible for enhanced passive surveillance public health systems. Without such a system, it would usually be necessary to manually review charts to identify recent travel or lack of travel, use an electronic health record that enforces travel history documentation, or ignore this potential source of information altogether. The development of this tool was initially motivated by emergent arboviral diseases. More recently, this system was used in the early phases of response to COVID-19 in the United States, although its utility was limited to a relatively brief window due to the rapid domestic spread of the virus. Such systems may aid future efforts to prevent and contain the spread of infectious diseases.
Highlights
Epidemiologic clues are critical to understand how infectious diseases spread
Automated extraction of patient travel history from clinical documents is feasible for enhanced passive surveillance public health systems
It would usually be necessary to manually review charts to identify recent travel or lack of travel, use an electronic health record that enforces travel history documentation, or ignore this potential source of information altogether. The development of this tool was initially motivated by emergent arboviral diseases. This system was used in the early phases of response to COVID-19 in the United States, its utility was limited to a relatively https://publichealth.jmir.org/2021/3/e26719
Summary
Epidemiologic clues are critical to understand how infectious diseases spread. When working up a rapidly unfolding event, a history of travel to an endemic region can be a valuable piece of evidence for public health authorities and biosurveillance experts who must often work quickly in tracing linkages to manage outbreaks. Information about patient travel in the electronic health record (EHR) is still not typically recorded in a structured format but in unstructured clinical documents [3], especially when screening questions have not been mandated for emergency department triage. Instead, much of this information can be recorded in notes by specialists or others who suspect a travel-related disease. Patient travel history can be crucial in evaluating evolving infectious disease events Such information can be challenging to acquire in electronic health records, as it is often available only in unstructured text
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
