Integrating novel medical concepts and relationships into existing ontologies can significantly enhance their coverage and utility for both biomedical research and clinical applications. Clinical notes, as unstructured documents rich with detailed patient observations, offer valuable context-specific insights and represent a promising yet underutilized source for ontology extension. Despite this potential, directly leveraging clinical notes for ontology extension remains largely unexplored. To address this gap, we propose CLOZE, a novel framework that uses large language models (LLMs) to automatically extract medical entities from clinical notes and integrate them into hierarchical medical ontologies. By capitalizing on the strong language understanding and extensive biomedical knowledge of pre-trained LLMs, CLOZE effectively identifies disease-related concepts and captures complex hierarchical relationships. The zero-shot framework requires no additional training or labeled data, making it a cost-efficient solution. Furthermore, CLOZE ensures patient privacy through automated removal of protected health information (PHI). Experimental results demonstrate that CLOZE provides an accurate, scalable, and privacy-preserving ontology extension framework, with strong potential to support a wide range of downstream applications in biomedical research and clinical informatics.

Reference ontologies provide a shared vocabulary and knowledge resource for their domain. Manual construction enables them to maintain a high quality, allowing them to be widely accepted across their community. However, the manual development process does not scale for large domains. We present a new methodology for automatic ontology extension and apply it to the ChEBI ontology, a prominent reference ontology for life sciences chemistry. We trained a Transformer-based deep learning model on the leaf node structures from the ChEBI ontology and the classes to which they belong. The model is then capable of automatically classifying previously unseen chemical structures. The proposed model achieved an overall F1 score of 0.80, an improvement of 6 percentage points over our previous results on the same dataset. Additionally, we demonstrate how visualizing the model's attention weights can help to explain the results by providing insight into how the model made its decisions.