J Am Med Inform Assoc - Clinical decision support with automated text processing for cervical cancer screening.

Tópicos

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Resumo

JECTIVE: To develop a computerized clinical decision support system (CDSS) for cervical cancer screening that can interpret free-text Papanicolaou (Pap) reports.MATERIALS AND METHODS: The CDSS was constituted by two rulebases: the free-text rulebase for interpreting Pap reports and a guideline rulebase. The free-text rulebase was developed by analyzing a corpus of 49293 Pap reports. The guideline rulebase was constructed using national cervical cancer screening guidelines. The CDSS accesses the electronic medical record (EMR) system to generate patient-specific recommendations. For evaluation, the screening recommendations made by the CDSS for 74 patients were reviewed by a physician.RESULTS AND DISCUSSION: Evaluation revealed that the CDSS outputs the optimal screening recommendations for 73 out of 74 test patients and it identified two cases for gynecology referral that were missed by the physician. The CDSS aided the physician to amend recommendations in six cases. The failure case was because human papillomavirus (HPV) testing was sometimes performed separately from the Pap test and these results were reported by a laboratory system that was not queried by the CDSS. Subsequently, the CDSS was upgraded to look up the HPV results missed earlier and it generated the optimal recommendations for all 74 test cases.LIMITATIONS: Single institution and single expert study.CONCLUSION: An accurate CDSS system could be constructed for cervical cancer screening given the standardized reporting of Pap tests and the availability of explicit guidelines. Overall, the study demonstrates that free text in the EMR can be effectively utilized through natural language processing to develop clinical decision support tools.

Resumo Limpo

jectiv develop computer clinic decis support system cdss cervic cancer screen can interpret freetext papanicolaou pap reportsmateri method cdss constitut two rulebas freetext rulebas interpret pap report guidelin rulebas freetext rulebas develop analyz corpus pap report guidelin rulebas construct use nation cervic cancer screen guidelin cdss access electron medic record emr system generat patientspecif recommend evalu screen recommend made cdss patient review physicianresult discuss evalu reveal cdss output optim screen recommend test patient identifi two case gynecolog referr miss physician cdss aid physician amend recommend six case failur case human papillomavirus hpv test sometim perform separ pap test result report laboratori system queri cdss subsequ cdss upgrad look hpv result miss earlier generat optim recommend test caseslimit singl institut singl expert studyconclus accur cdss system construct cervic cancer screen given standard report pap test avail explicit guidelin overal studi demonstr free text emr can effect util natur languag process develop clinic decis support tool

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