Adam P. Bress

Jianlin Shi, Qiwei Gan, Elizabeth Hanchrow et al.

Clinical natural language processing (NLP) is increasingly in demand in both clinical research and operational practice. However, most of the state-of-the-art solutions are transformers-based and require high computational resources, limiting their accessibility. We propose a hybrid NLP framework that integrates rule-based filtering, a Support Vector Machine (SVM) classifier, and a BERT-based model to improve efficiency while maintaining accuracy. We applied this framework in a dementia identification case study involving 4.9 million veterans with incident hypertension, analyzing 2.1 billion clinical notes. At the patient level, our method achieved a precision of 0.90, a recall of 0.84, and an F1-score of 0.87. Additionally, this NLP approach identified over three times as many dementia cases as structured data methods. All processing was completed in approximately two weeks using a single machine with dual A40 GPUs. This study demonstrates the feasibility of hybrid NLP solutions for large-scale clinical text analysis, making state-of-the-art methods more accessible to healthcare organizations with limited computational resources.

Ashkan Sharabiani, Adam Bress, William Galanter et al.

Determining the optimal initial dose for warfarin is a critically important task. Several factors have an impact on the therapeutic dose for individual patients, such as patients' physical attributes (Age, Height, etc.), medication profile, co-morbidities, and metabolic genotypes (CYP2C9 and VKORC1). These wide range factors influencing therapeutic dose, create a complex environment for clinicians to determine the optimal initial dose. Using a sample of 4,237 patients, we have proposed a companion classification model to one of the most popular dosing algorithms (International Warfarin Pharmacogenetics Consortium (IWPC) clinical model), which identifies the appropriate cohort of patients for applying this model. The proposed model functions as a clinical decision support system which assists clinicians in dosing. We have developed a classification model using Support Vector Machines, with a polynomial kernel function to determine if applying the dose prediction model is appropriate for a given patient. The IWPC clinical model will only be used if the patient is classified as "Safe for model". By using the proposed methodology, the dosing mode's prediction accuracy increases by 15 percent in terms of Root Mean Squared Error and 17 percent in terms of Mean Absolute Error in dose estimates of patients classified as "Safe for model".