HSR&D Citation Abstract
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Sitting on Pins and Needles
Forbush T, Gundlapalli AV, Palmer M, Shen S, South B, Divita G, Carter M, Redd AM, Butler J, Samore MH. Sitting on Pins and Needles. Paper presented at: American Medical Informatics Association Spring Congress; 2012 Mar 20; San Francisco, CA.
Patients report their symptoms and subjective experiences in their own words. These expressions may be clinically
meaningful yet are difficult to capture using automated methods. We annotated subjective symptom expressions in
750 clinical notes from the Veterans Affairs EHR. Within each document, subjective symptom expressions were
compared to mentions of symptoms in clinical terms and to the assigned ICD-9-CM codes for the encounter. A total
of 543 subjective symptom expressions were identified, of which 66.5% were categorized as mental/behavioral
experiences and 33.5% somatic experiences. Only two subjective expressions were coded using ICD-9-CM.
Subjective expressions were restated in semantically related clinical terms in 246 (45.3%) instances. Nearly one
third (31%) of subjective expressions were not coded or restated in standard terminology. The results highlight the
diversity of symptom descriptions and the opportunities to further develop natural language processing to extract
symptom expressions that are unobtainable by other automated methods.