SNOMED CT is a biomedical ontology with a hierarchical representation of large-scale concepts. Knowledge retrieval in SNOMED CT is critical for its application, but often proves challenging due to language ambiguity, synonyms, polysemies and so on. This problem is exacerbated when the queries are out-of-vocabulary (OOV), i.e., having no equivalent matchings in the ontology. In this work, we focus on the problem of hierarchical concept retrieval from SNOMED CT with OOV queries, and propose an approach based on language model-based ontology embeddings. For evaluation, we construct OOV queries annotated against SNOMED CT concepts, testing the retrieval of the most direct subsumers and their less relevant ancestors. We find that our method outperforms the baselines including SBERT and two lexical matching methods. While evaluated against SNOMED CT, the approach is generalisable and can be extended to other ontologies. We release code, tools, and evaluation datasets at https://github.com/jonathondilworth/HR-OOV.

Progress in biomedical Named Entity Recognition (NER) and Entity Linking (EL) is currently hindered by a fragmented data landscape, a lack of resources for building explainable models, and the limitations of semantically-blind evaluation metrics. To address these challenges, we present MedPath, a large-scale and multi-domain biomedical EL dataset that builds upon nine existing expert-annotated EL datasets. In MedPath, all entities are 1) normalized using the latest version of the Unified Medical Language System (UMLS), 2) augmented with mappings to 62 other biomedical vocabularies and, crucially, 3) enriched with full ontological paths -- i.e., from general to specific -- in up to 11 biomedical vocabularies. MedPath directly enables new research frontiers in biomedical NLP, facilitating training and evaluation of semantic-rich and interpretable EL systems, and the development of the next generation of interoperable and explainable clinical NLP models.

We introduce the world's first clinical terminology for the Chinese healthcare community, namely MedCT, accompanied by a clinical foundation model MedBERT and an entity linking model MedLink. The MedCT system enables standardized and programmable representation of Chinese clinical data, successively stimulating the development of new medicines, treatment pathways, and better patient outcomes for the populous Chinese community. Moreover, the MedCT knowledge graph provides a principled mechanism to minimize the hallucination problem of large language models (LLMs), therefore achieving significant levels of accuracy and safety in LLM-based clinical applications. By leveraging the LLMs' emergent capabilities of generativeness and expressiveness, we were able to rapidly built a production-quality terminology system and deployed to real-world clinical field within three months, while classical terminologies like SNOMED CT have gone through more than twenty years development. Our experiments show that the MedCT system achieves state-of-the-art (SOTA) performance in semantic matching and entity linking tasks, not only for Chinese but also for English. We also conducted a longitudinal field experiment by applying MedCT and LLMs in a representative spectrum of clinical tasks, including electronic health record (EHR) auto-generation and medical document search for diagnostic decision making. Our study shows a multitude of values of MedCT for clinical workflows and patient outcomes, especially in the new genre of clinical LLM applications. We present our approach in sufficient engineering detail, such that implementing a clinical terminology for other non-English societies should be readily reproducible. We openly release our terminology, models and algorithms, along with real-world clinical datasets for the development.

The extraction and analysis of insights from medical data, primarily stored in free-text formats by healthcare workers, presents significant challenges due to its unstructured nature. Medical coding, a crucial process in healthcare, remains minimally automated due to the complexity of medical ontologies and restricted access to medical texts for training Natural Language Processing models. In this paper, we proposed a method, "SNOBERT," of linking text spans in clinical notes to specific concepts in the SNOMED CT using BERT-based models. The method consists of two stages: candidate selection and candidate matching. The models were trained on one of the largest publicly available dataset of labeled clinical notes. SNOBERT outperforms other classical methods based on deep learning, as confirmed by the results of a challenge in which it was applied.

Interpreting hierarchical structures latent in language is a key limitation of current language models (LMs). While previous research has implicitly leveraged these hierarchies to enhance LMs, approaches for their explicit encoding are yet to be explored. To address this, we introduce a novel approach to re-train transformer encoder-based LMs as Hierarchy Transformer encoders (HiTs), harnessing the expansive nature of hyperbolic space. Our method situates the output embedding space of pre-trained LMs within a Poincar\'e ball with a curvature that adapts to the embedding dimension, followed by re-training on hyperbolic cluster and centripetal losses. These losses are designed to effectively cluster related entities (input as texts) and organise them hierarchically. We evaluate HiTs against pre-trained and fine-tuned LMs, focusing on their capabilities in simulating transitive inference, predicting subsumptions, and transferring knowledge across hierarchies. The results demonstrate that HiTs consistently outperform both pre-trained and fine-tuned LMs in these tasks, underscoring the effectiveness and transferability of our re-trained hierarchy encoders.

Coding of unstructured clinical free-text to produce interoperable structured data is essential to improve direct care, support clinical communication and to enable clinical research.However, manual clinical coding is difficult and time consuming, which motivates the development and use of natural language processing for automated coding. This work evaluates the quality and consistency of both manual and automated clinical coding of diagnoses from hospital outpatient letters. Using 100 randomly selected letters, two human clinicians performed coding of diagnosis lists to SNOMED CT. Automated coding was also performed using IMO's Concept Tagger. A gold standard was constructed by a panel of clinicians from a subset of the annotated diagnoses. This was used to evaluate the quality and consistency of both manual and automated coding via (1) a distance-based metric, treating SNOMED CT as a graph, and (2) a qualitative metric agreed upon by the panel of clinicians. Correlation between the two metrics was also evaluated. Comparing human and computer-generated codes to the gold standard, the results indicate that humans slightly out-performed automated coding, while both performed notably better when there was only a single diagnosis contained in the free-text description. Automated coding was considered acceptable by the panel of clinicians in approximately 90% of cases.

Pain is a complex concept that can interconnect with other concepts such as a disorder that might cause pain, a medication that might relieve pain, and so on. To fully understand the context of pain experienced by either an individual or across a population, we may need to examine all concepts related to pain and the relationships between them. This is especially useful when modeling pain that has been recorded in electronic health records. Knowledge graphs represent concepts and their relations by an interlinked network, enabling semantic and context-based reasoning in a computationally tractable form. These graphs can, however, be too large for efficient computation. Knowledge graph embeddings help to resolve this by representing the graphs in a low-dimensional vector space. These embeddings can then be used in various downstream tasks such as classification and link prediction. The various relations associated with pain which are required to construct such a knowledge graph can be obtained from external medical knowledge bases such as SNOMED CT, a hierarchical systematic nomenclature of medical terms. A knowledge graph built in this way could be further enriched with real-world examples of pain and its relations extracted from electronic health records. This paper describes the construction of such knowledge graph embedding models of pain concepts, extracted from the unstructured text of mental health electronic health records, combined with external knowledge created from relations described in SNOMED CT, and their evaluation on a subject-object link prediction task. The performance of the models was compared with other baseline models.

To easily obtain the knowledge about autism spectrum disorder and help its early screening and diagnosis, we create AsdKB, a Chinese knowledge base on autism spectrum disorder. The knowledge base is built on top of various sources, including 1) the disease knowledge from SNOMED CT and ICD-10 clinical descriptions on mental and behavioural disorders, 2) the diagnostic knowledge from DSM-5 and different screening tools recommended by social organizations and medical institutes, and 3) the expert knowledge on professional physicians and hospitals from the Web. AsdKB contains both ontological and factual knowledge, and is accessible as Linked Data at https://w3id.org/asdkb/. The potential applications of AsdKB are question answering, auxiliary diagnosis, and expert recommendation, and we illustrate them with a prototype which can be accessed at http://asdkb.org.cn/.

Ontology Matching (OM) plays an important role in many domains such as bioinformatics and the Semantic Web, and its research is becoming increasingly popular, especially with the application of machine learning (ML) techniques. Although the Ontology Alignment Evaluation Initiative (OAEI) represents an impressive effort for the systematic evaluation of OM systems, it still suffers from several limitations including limited evaluation of subsumption mappings, suboptimal reference mappings, and limited support for the evaluation of ML-based systems. To tackle these limitations, we introduce five new biomedical OM tasks involving ontologies extracted from Mondo and UMLS. Each task includes both equivalence and subsumption matching; the quality of reference mappings is ensured by human curation, ontology pruning, etc.; and a comprehensive evaluation framework is proposed to measure OM performance from various perspectives for both ML-based and non-ML-based OM systems. We report evaluation results for OM systems of different types to demonstrate the usage of these resources, all of which are publicly available as part of the new Bio-ML track at OAEI 2022.

Electronic health record (EHR) systems are used extensively throughout the healthcare domain. However, data interchangeability between EHR systems is limited due to the use of different coding standards across systems. Existing methods of mapping coding standards based on manual human experts mapping, dictionary mapping, symbolic NLP and classification are unscalable and cannot accommodate large scale EHR datasets. In this work, we present Text2Node, a cross-domain mapping system capable of mapping medical phrases to concepts in a large taxonomy (such as SNOMED CT). The system is designed to generalize from a limited set of training samples and map phrases to elements of the taxonomy that are not covered by training data. As a result, our system is scalable, robust to wording variants between coding systems and can output highly relevant concepts when no exact concept exists in the target taxonomy. Text2Node operates in three main stages: first, the lexicon is mapped to word embeddings; second, the taxonomy is vectorized using node embeddings; and finally, the mapping function is trained to connect the two embedding spaces. We compared multiple algorithms and architectures for each stage of the training, including GloVe and FastText word embeddings, CNN and Bi-LSTM mapping functions, and node2vec for node embeddings. We confirmed the robustness and generalisation properties of Text2Node by mapping ICD-9-CM Diagnosis phrases to SNOMED CT and by zero-shot training at comparable accuracy. This system is a novel methodological contribution to the task of normalizing and linking phrases to a taxonomy, advancing data interchangeability in healthcare. When applied, the system can use electronic health records to generate an embedding that incorporates taxonomical medical knowledge to improve clinical predictive models.