Efficient Standardization of Clinical Notes using Large Language Models

Clinician notes are a rich source of patient information but often contain inconsistencies due to varied writing styles, colloquialisms, abbreviations, medical jargon, grammatical errors, and non-standard formatting. These inconsistencies hinder the extraction of meaningful data from electronic health records (EHRs), posing challenges for quality improvement, population health, precision medicine, decision support, and research. We present a large language model approach to standardizing a corpus of 1,618 clinical notes. Standardization corrected an average of $4.9 +/- 1.8$ grammatical errors, $3.3 +/- 5.2$ spelling errors, converted $3.1 +/- 3.0$ non-standard terms to standard terminology, and expanded $15.8 +/- 9.1$ abbreviations and acronyms per note. Additionally, notes were re-organized into canonical sections with standardized headings. This process prepared notes for key concept extraction, mapping to medical ontologies, and conversion to interoperable data formats such as FHIR. Expert review of randomly sampled notes found no significant data loss after standardization. This proof-of-concept study demonstrates that standardization of clinical notes can improve their readability, consistency, and usability, while also facilitating their conversion into interoperable data formats.

High-Throughput Phenotyping of Clinical Text Using Large Language Models

High-throughput phenotyping automates the mapping of patient signs to standardized ontology concepts and is essential for precision medicine. This study evaluates the automation of phenotyping of clinical summaries from the Online Mendelian Inheritance in Man (OMIM) database using large language models. Due to their rich phenotype data, these summaries can be surrogates for physician notes. We conduct a performance comparison of GPT-4 and GPT-3.5-Turbo. Our results indicate that GPT-4 surpasses GPT-3.5-Turbo in identifying, categorizing, and normalizing signs, achieving concordance with manual annotators comparable to inter-rater agreement. Despite some limitations in sign normalization, the extensive pre-training of GPT-4 results in high performance and generalizability across several phenotyping tasks while obviating the need for manually annotated training data. Large language models are expected to be the dominant method for automating high-throughput phenotyping of clinical text.

A Large Language Model Outperforms Other Computational Approaches to the High-Throughput Phenotyping of Physician Notes

High-throughput phenotyping, the automated mapping of patient signs and symptoms to standardized ontology concepts, is essential to gaining value from electronic health records (EHR) in the support of precision medicine. Despite technological advances, high-throughput phenotyping remains a challenge. This study compares three computational approaches to high-throughput phenotyping: a Large Language Model (LLM) incorporating generative AI, a Natural Language Processing (NLP) approach utilizing deep learning for span categorization, and a hybrid approach combining word vectors with machine learning. The approach that implemented GPT-4 (a Large Language Model) demonstrated superior performance, suggesting that Large Language Models are poised to be the preferred method for high-throughput phenotyping of physician notes.

High Throughput Phenotyping of Physician Notes with Large Language and Hybrid NLP Models

Deep phenotyping is the detailed description of patient signs and symptoms using concepts from an ontology. The deep phenotyping of the numerous physician notes in electronic health records requires high throughput methods. Over the past thirty years, progress toward making high throughput phenotyping feasible. In this study, we demonstrate that a large language model and a hybrid NLP model (combining word vectors with a machine learning classifier) can perform high throughput phenotyping on physician notes with high accuracy. Large language models will likely emerge as the preferred method for high throughput deep phenotyping of physician notes.