Clinical decision support with automated text processing for cervical cancer screening

Kavishwar B. Wagholikar, Kathy L. MacLaughlin, Michael R. Henry, Robert Greenes, Ronald A. Hankey, Hongfang Liu, Rajeev C. Chaudhry

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Objective 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 49 293 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.

Original languageEnglish (US)
Pages (from-to)833-839
Number of pages7
JournalJournal of the American Medical Informatics Association
Volume19
Issue number5
DOIs
StatePublished - Sep 2012

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Clinical Decision Support Systems
Early Detection of Cancer
Uterine Cervical Neoplasms
Guidelines
Papanicolaou Test
Electronic Health Records
Physicians
Natural Language Processing
Gynecology
Referral and Consultation

ASJC Scopus subject areas

  • Health Informatics
  • Medicine(all)

Cite this

Clinical decision support with automated text processing for cervical cancer screening. / Wagholikar, Kavishwar B.; MacLaughlin, Kathy L.; Henry, Michael R.; Greenes, Robert; Hankey, Ronald A.; Liu, Hongfang; Chaudhry, Rajeev C.

In: Journal of the American Medical Informatics Association, Vol. 19, No. 5, 09.2012, p. 833-839.

Research output: Contribution to journalArticle

Wagholikar, Kavishwar B. ; MacLaughlin, Kathy L. ; Henry, Michael R. ; Greenes, Robert ; Hankey, Ronald A. ; Liu, Hongfang ; Chaudhry, Rajeev C. / Clinical decision support with automated text processing for cervical cancer screening. In: Journal of the American Medical Informatics Association. 2012 ; Vol. 19, No. 5. pp. 833-839.
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