RESUMO
BACKGROUND: Traditional Chinese medicine (TCM) practitioners usually follow a 4-step evaluation process during patient diagnosis: observation, auscultation, olfaction, inquiry, pulse feeling, and palpation. The information gathered in this process, along with laboratory test results and other measurements such as vital signs, is recorded in the patient's electronic health record (EHR). In fact, all the information needed to make a treatment plan is contained in the EHR; however, only a seasoned TCM physician could use this information well to make a good treatment plan as the reasoning process is very complicated, and it takes years of practice for a medical graduate to master the reasoning skill. In this digital medicine era, with a deluge of medical data, ever-increasing computing power, and more advanced artificial neural network models, it is not only desirable but also readily possible for a computerized system to mimic the decision-making process of a TCM physician. OBJECTIVE: This study aims to develop an assistive tool that can predict prescriptions for inpatients in a hospital based on patients' clinical EHRs. METHODS: Clinical health records containing medical histories, as well as current symptoms and diagnosis information, were used to train a transformer-based neural network model using the corresponding physician's prescriptions as the target. This was accomplished by extracting relevant information, such as the patient's current illness, medicines taken, nursing care given, vital signs, examinations, and laboratory results from the patient's EHRs. The obtained information was then sorted chronologically to produce a sequence of data for the patient. These time sequence data were then used as input to a modified transformer network, which was chosen as a prescription prediction model. The output of the model was the prescription for the patient. The ultimate goal is for this tool to generate a prescription that matches what an expert TCM physician would prescribe. To alleviate the issue of overfitting, a generative adversarial network was used to augment the training sample data set by generating noise-added samples from the original training samples. RESULTS: In total, 21,295 copies of inpatient electronic medical records from Guang'anmen Hospital were used in this study. These records were generated between January 2017 and December 2018, covering 6352 types of medicines. These medicines were sorted into 819 types of first-category medicines based on their class relationships. As shown by the test results, the performance of a fully trained transformer model can have an average precision rate of 80.58% and an average recall rate of 68.49%. CONCLUSIONS: As shown by the preliminary test results, the transformer-based TCM prescription recommendation model outperformed the existing conventional methods. The extra training samples generated by the generative adversarial network help to overcome the overfitting issue, leading to further improved recall and precision rates.
RESUMO
BACKGROUND: Artificial intelligence-based assistive diagnostic systems imitate the deductive reasoning process of a human physician in biomedical disease diagnosis and treatment decision making. While impressive progress in this area has been reported, most of the reported successes are applications of artificial intelligence in Western medicine. The application of artificial intelligence in traditional Chinese medicine has lagged mainly because traditional Chinese medicine practitioners need to perform syndrome differentiation as well as biomedical disease diagnosis before a treatment decision can be made. Syndrome, a concept unique to traditional Chinese medicine, is an abstraction of a variety of signs and symptoms. The fact that the relationship between diseases and syndromes is not one-to-one but rather many-to-many makes it very challenging for a machine to perform syndrome predictions. So far, only a handful of artificial intelligence-based assistive traditional Chinese medicine diagnostic models have been reported, and they are limited in application to a single disease-type. OBJECTIVE: The objective was to develop an artificial intelligence-based assistive diagnostic system capable of diagnosing multiple types of diseases that are common in traditional Chinese medicine, given a patient's electronic health record notes. The system was designed to simultaneously diagnose the disease and produce a list of corresponding syndromes. METHODS: Unstructured freestyle electronic health record notes were processed by natural language processing techniques to extract clinical information such as signs and symptoms which were represented by named entities. Natural language processing used a recurrent neural network model called bidirectional long short-term memory network-conditional random forest. A convolutional neural network was then used to predict the disease-type out of 187 diseases in traditional Chinese medicine. A novel traditional Chinese medicine syndrome prediction method-an integrated learning model-was used to produce a corresponding list of probable syndromes. By following a majority-rule voting method, the integrated learning model for syndrome prediction can take advantage of four existing prediction methods (back propagation, random forest, extreme gradient boosting, and support vector classifier) while avoiding their respective weaknesses which resulted in a consistently high prediction accuracy. RESULTS: A data set consisting of 22,984 electronic health records from Guanganmen Hospital of the China Academy of Chinese Medical Sciences that were collected between January 1, 2017 and September 7, 2018 was used. The data set contained a total of 187 diseases that are commonly diagnosed in traditional Chinese medicine. The diagnostic system was designed to be able to detect any one of the 187 disease-types. The data set was partitioned into a training set, a validation set, and a testing set in a ratio of 8:1:1. Test results suggested that the proposed system had a good diagnostic accuracy and a strong capability for generalization. The disease-type prediction accuracies of the top one, top three, and top five were 80.5%, 91.6%, and 94.2%, respectively. CONCLUSIONS: The main contributions of the artificial intelligence-based traditional Chinese medicine assistive diagnostic system proposed in this paper are that 187 commonly known traditional Chinese medicine diseases can be diagnosed and a novel prediction method called an integrated learning model is demonstrated. This new prediction method outperformed all four existing methods in our preliminary experimental results. With further improvement of the algorithms and the availability of additional electronic health record data, it is expected that a wider range of traditional Chinese medicine disease-types could be diagnosed and that better diagnostic accuracies could be achieved.
RESUMO
BACKGROUND AND OBJECTIVE: Standardization of electronic medical record, so as to enable resource-sharing and information exchange among medical institutions has become inevitable in view of the ever increasing medical information. The current research is an effort towards the standardization of basic dataset of electronic medical records in traditional Chinese medicine. METHODS: In this work, an outpatient clinical information model and an inpatient clinical information model are created to adequately depict the diagnosis processes and treatment procedures of traditional Chinese medicine. To be backward compatible with the existing dataset standard created for western medicine, the new standard shall be a superset of the existing standard. Thus, the two models are checked against the existing standard in conjunction with 170,000 medical record cases. If a case cannot be covered by the existing standard due to the particularity of Chinese medicine, then either an existing data element is expanded with some Chinese medicine contents or a new data element is created. Some dataset subsets are also created to group and record Chinese medicine special diagnoses and treatments such as acupuncture. RESULTS: The outcome of this research is a proposal of standardized traditional Chinese medicine medical records datasets. The proposal has been verified successfully in three medical institutions with hundreds of thousands of medical records. CONCLUSIONS: A new dataset standard for traditional Chinese medicine is proposed in this paper. The proposed standard, covering traditional Chinese medicine as well as western medicine, is expected to be soon approved by the authority. A widespread adoption of this proposal will enable traditional Chinese medicine hospitals and institutions to easily exchange information and share resources.
