Utility analysis and demonstration of real-world clinical texts: A case study on Japanese cancer-related EHRs

Real-world data (RWD) in the medical field, such as electronic health records (EHRs) and medication orders, are receiving increasing attention from researchers and practitioners. While structured data have played a vital role thus far, unstructured data represented by text (e.g., discharge summaries) are not effectively utilized because of the difficulty in extracting medical information. We evaluated the information gained by supplementing structured data with clinical concepts extracted from unstructured text by leveraging natural language processing techniques. Using a machine learning-based pretrained named entity recognition tool, we extracted disease and medication names from real discharge summaries in a Japanese hospital and linked them to medical concepts using medical term dictionaries. By comparing the diseases and medications mentioned in the text with medical codes in tabular diagnosis records, we found that: (1) the text data contained richer information on patient symptoms than tabular diagnosis records, whereas the medication-order table stored more injection data than text. In addition, (2) extractable information regarding specific diseases showed surprisingly small intersections among text, diagnosis records, and medication orders. Text data can thus be a useful supplement for RWD mining, which is further demonstrated by (3) our practical application system for drug safety evaluation, which exhaustively visualizes suspicious adverse drug effects caused by the simultaneous use of anticancer drug pairs. We conclude that proper use of textual information extraction can lead to better outcomes in medical RWD mining.