LeafAI: query generator for clinical cohort discovery rivaling a human programmer

Objective: Identifying study-eligible patients within clinical databases is a critical step in clinical research. However, accurate query design typically requires extensive technical and biomedical expertise. We sought to create a system capable of generating data model-agnostic queries while also providing novel logical reasoning capabilities for complex clinical trial eligibility criteria. Materials and Methods: The task of query creation from eligibility criteria requires solving several text-processing problems, including named entity recognition and relation extraction, sequence-to-sequence transformation, normalization, and reasoning. We incorporated hybrid deep learning and rule-based modules for these, as well as a knowledge base of the Unified Medical Language System (UMLS) and linked ontologies. To enable data-model agnostic query creation, we introduce a novel method for tagging database schema elements using UMLS concepts. To evaluate our system, called LeafAI, we compared the capability of LeafAI to a human database programmer to identify patients who had been enrolled in 8 clinical trials conducted at our institution. We measured performance by the number of actual enrolled patients matched by generated queries. Results: LeafAI matched a mean 43% of enrolled patients with 27,225 eligible across 8 clinical trials, compared to 27% matched and 14,587 eligible in queries by a human database programmer. The human programmer spent 26 total hours crafting queries compared to several minutes by LeafAI. Conclusions: Our work contributes a state-of-the-art data model-agnostic query generation system capable of conditional reasoning using a knowledge base. We demonstrate that LeafAI can rival a human programmer in finding patients eligible for clinical trials.

Forecasting Daily COVID-19 Related Calls in VA Health Care System: Predictive Model Development

Background: COVID-19 has become a challenge worldwide and properly planning of medical resources is the key to combating COVID-19. In the US Veteran Affairs Health Care System (VA), many of the enrollees are susceptible to COVID-19. Predicting the COVID-19 to allocate medical resources promptly becomes a critical issue. When the VA enrollees have COVID-19 symptoms, it is recommended that their first step should be to call the VA Call Center. For confirmed COVID-19 patients, the median time from the first symptom to hospital admission was seven days. By predicting the number of COVID-19 related calls, we could predict imminent surges in healthcare use and plan medical resources ahead. Objective: The study aims to develop a method to forecast the daily number of COVID-19 related calls for each of the 110 VA medical centers. Methods: In the proposed method, we pre-trained a model using a cluster of medical centers and fine-tuned it for individual medical centers. At the cluster level, we performed feature selection to select significant features and automatic hyper-parameter search to select optimal hyper-parameter value combinations for the model. Conclusions: This study proposed an accurate method to forecast the daily number of COVID-19 related calls for VA medical centers. The proposed method was able to overcome modeling challenges by grouping similar medical centers into clusters to enlarge the dataset for training models, and using hyper-parameter search to automatically find optimal hyper-parameter value combinations for models. With the proposed method, surges in health care can be predicted ahead. This allows health care practitioners to better plan medical resources and combat COVID-19.