Emily Druhl

Zonghai Yao, Jack Tsai, Weisong Liu et al.

Objective: Evictions are important social and behavioral determinants of health. Evictions are associated with a cascade of negative events that can lead to unemployment, housing insecurity/homelessness, long-term poverty, and mental health problems. In this study, we developed a natural language processing system to automatically detect eviction status from electronic health record (EHR) notes. Materials and Methods: We first defined eviction status (eviction presence and eviction period) and then annotated eviction status in 5000 EHR notes from the Veterans Health Administration (VHA). We developed a novel model, KIRESH, that has shown to substantially outperform other state-of-the-art models such as fine-tuning pre-trained language models like BioBERT and BioClinicalBERT. Moreover, we designed a novel prompt to further improve the model performance by using the intrinsic connection between the two sub-tasks of eviction presence and period prediction. Finally, we used the Temperature Scaling-based Calibration on our KIRESH-Prompt method to avoid over-confidence issues arising from the imbalance dataset. Results: KIRESH-Prompt substantially outperformed strong baseline models including fine-tuning the BioClinicalBERT model to achieve 0.74672 MCC, 0.71153 Macro-F1, and 0.83396 Micro-F1 in predicting eviction period and 0.66827 MCC, 0.62734 Macro-F1, and 0.7863 Micro-F1 in predicting eviction presence. We also conducted additional experiments on a benchmark social determinants of health (SBDH) dataset to demonstrate the generalizability of our methods. Conclusion and Future Work: KIRESH-Prompt has substantially improved eviction status classification. We plan to deploy KIRESH-Prompt to the VHA EHRs as an eviction surveillance system to help address the US Veterans' housing insecurity.

Sunjae Kwon, Xun Wang, Weisong Liu et al.

Opioid related aberrant behaviors (ORABs) present novel risk factors for opioid overdose. This paper introduces a novel biomedical natural language processing benchmark dataset named ODD, for ORAB Detection Dataset. ODD is an expert-annotated dataset designed to identify ORABs from patients' EHR notes and classify them into nine categories; 1) Confirmed Aberrant Behavior, 2) Suggested Aberrant Behavior, 3) Opioids, 4) Indication, 5) Diagnosed opioid dependency, 6) Benzodiazepines, 7) Medication Changes, 8) Central Nervous System-related, and 9) Social Determinants of Health. We explored two state-of-the-art natural language processing models (fine-tuning and prompt-tuning approaches) to identify ORAB. Experimental results show that the prompt-tuning models outperformed the fine-tuning models in most categories and the gains were especially higher among uncommon categories (Suggested Aberrant Behavior, Confirmed Aberrant Behaviors, Diagnosed Opioid Dependence, and Medication Change). Although the best model achieved the highest 88.17% on macro average area under precision recall curve, uncommon classes still have a large room for performance improvement. ODD is publicly available.

Zonghai Yao, Youxia Zhao, Avijit Mitra et al.

Eviction is a significant yet understudied social determinants of health (SDoH), linked to housing instability, unemployment, and mental health. While eviction appears in unstructured electronic health records (EHRs), it is rarely coded in structured fields, limiting downstream applications. We introduce SynthEHR-Eviction, a scalable pipeline combining LLMs, human-in-the-loop annotation, and automated prompt optimization (APO) to extract eviction statuses from clinical notes. Using this pipeline, we created the largest public eviction-related SDoH dataset to date, comprising 14 fine-grained categories. Fine-tuned LLMs (e.g., Qwen2.5, LLaMA3) trained on SynthEHR-Eviction achieved Macro-F1 scores of 88.8% (eviction) and 90.3% (other SDoH) on human validated data, outperforming GPT-4o-APO (87.8%, 87.3%), GPT-4o-mini-APO (69.1%, 78.1%), and BioBERT (60.7%, 68.3%), while enabling cost-effective deployment across various model sizes. The pipeline reduces annotation effort by over 80%, accelerates dataset creation, enables scalable eviction detection, and generalizes to other information extraction tasks.

Avijit Mitra, Zhichao Yang, Emily Druhl et al.

Social and behavioral determinants of health (SBDH) play a crucial role in health outcomes and are frequently documented in clinical text. Automatically extracting SBDH information from clinical text relies on publicly available good-quality datasets. However, existing SBDH datasets exhibit substantial limitations in their availability and coverage. In this study, we introduce Synth-SBDH, a novel synthetic dataset with detailed SBDH annotations, encompassing status, temporal information, and rationale across 15 SBDH categories. We showcase the utility of Synth-SBDH on three tasks using real-world clinical datasets from two distinct hospital settings, highlighting its versatility, generalizability, and distillation capabilities. Models trained on Synth-SBDH consistently outperform counterparts with no Synth-SBDH training, achieving up to 63.75% macro-F improvements. Additionally, Synth-SBDH proves effective for rare SBDH categories and under-resource constraints while being substantially cheaper than expert-annotated real-world data. Human evaluation reveals a 71.06% Human-LLM alignment and uncovers areas for future refinements.