Volume 17 Supplement 2
Entity recognition from clinical texts via recurrent neural network
- Zengjian Liu†1,
- Ming Yang†2,
- Xiaolong Wang1,
- Qingcai Chen1,
- Buzhou Tang1, 3Email author,
- Zhe Wang3 and
- Hua Xu4
© The Author(s). 2017
Published: 5 July 2017
Entity recognition is one of the most primary steps for text analysis and has long attracted considerable attention from researchers. In the clinical domain, various types of entities, such as clinical entities and protected health information (PHI), widely exist in clinical texts. Recognizing these entities has become a hot topic in clinical natural language processing (NLP), and a large number of traditional machine learning methods, such as support vector machine and conditional random field, have been deployed to recognize entities from clinical texts in the past few years. In recent years, recurrent neural network (RNN), one of deep learning methods that has shown great potential on many problems including named entity recognition, also has been gradually used for entity recognition from clinical texts.
In this paper, we comprehensively investigate the performance of LSTM (long-short term memory), a representative variant of RNN, on clinical entity recognition and protected health information recognition. The LSTM model consists of three layers: input layer – generates representation of each word of a sentence; LSTM layer – outputs another word representation sequence that captures the context information of each word in this sentence; Inference layer – makes tagging decisions according to the output of LSTM layer, that is, outputting a label sequence.
Experiments conducted on corpora of the 2010, 2012 and 2014 i2b2 NLP challenges show that LSTM achieves highest micro-average F1-scores of 85.81% on the 2010 i2b2 medical concept extraction, 92.29% on the 2012 i2b2 clinical event detection, and 94.37% on the 2014 i2b2 de-identification, which is considerably competitive with other state-of-the-art systems.
LSTM that requires no hand-crafted feature has great potential on entity recognition from clinical texts. It outperforms traditional machine learning methods that suffer from fussy feature engineering. A possible future direction is how to integrate knowledge bases widely existing in the clinical domain into LSTM, which is a case of our future work. Moreover, how to use LSTM to recognize entities in specific formats is also another possible future direction.
KeywordsEntity recognition Recurrent neural network Clinical notes Deep learning Sequence labeling
With rapid development of electronic medical record (EMR) systems, more and more EMRs are available for researches and applications. Entity recognition, one of the most primary clinical natural language processing (NLP) tasks, has attracted considerable attention. As a large number of various types of entities widely exist in clinical texts, studies on entity recognition from clinical texts cover clinical entity recognition, clinical event recognition, protected health information recognition (PHI), etc. Compared to entity recognition in the newswire domain, studies on entity recognition in the clinical domain are slower initially.
The early entity recognition systems in the clinical domain are mainly rule-based, such as MedLEE , SymText/MPlus [2, 3], MetaMap , KnowledgeMap , cTAKES , and HiTEX . In the past several years, lots of machine learning-based clinical entity recognition systems have been proposed, may due to some publicly available corpora provided by organizers of some shared tasks, such as the Center for Informatics for Integrating Biology & the Beside (i2b2) 2009 , 2010 [9–13], 2012 [14–18] and 2014 track1 [19–23] datasets, ShARe/CLEF eHealth Evaluation Lab (SHEL) 2013 dataset , and SemEval (Semantic Evaluation) 2014 task 7 , 2015 task 6  2015 task 14 , and 2016 task 12  datasets. The main machine learning algorithms used in these systems are those once widely used for entity recognition in the newswire domain, including support vector machine (SVM), hidden markov model (HMM), conditional random field (CRF) and structured support vector machine (SSVM), etc. Among the algorithms, CRF is the most popular one. Most state-of-the-art systems adopt CRF. For example, in the 2014 i2b2 de-identification challenge, 6 out of 10 were based on CRF, including all top 4 systems. The key to the CRF-based systems lies in a variety of features, which are time-consuming.
In recent years, deep learning, which has advantages in feature engineering, has been widely introduced into various fields, such as image processing, speech recognition and NLP, and has shown great potential. In the case of NLP, deep learning has been deployed to tackle machine translation , relation extraction , entity recognition [31–35], word sense disambiguation , syntax parsing [37, 38], emotion classification , etc. Most related studies are limited to the newswire domain rather than other domains such as the clinical domain.
In this study, we comprehensively investigate entity recognition from clinical texts based on deep learning. Long-short term memory (LSTM), a representative variant of one type of deep learning method (i.e., recurrent neural network ), is deployed to recognize clinical entities and PHI instances in clinical texts. Specifically, we investigate the effects of two different types of character-level word representations on LSTM when they are used as parts of input of LSTM, and compare LSTM with CRF and other state-of-the-art systems. Experiments conducted on corpora of the 2010, 2012 and 2014 i2b2 NLP challenges show that: 1) each type of character-level word representation is beneficial to LSTM on entity extraction from clinical texts, but it is not easy to determine which one is better. 2) LSTM achieves highest micro-average F1-scores of 85.81% on the 2010 i2b2 medical concept extraction, 92.29% on the 2012 i2b2 clinical event detection, and 94.37% on the 2014 i2b2 de-identification, which outperforms CRF by 2.12%, 1.47% and 1.79% respectively. 3) Compared with other state-of-the-art systems, the LSTM-based system is considerably competitive.
The following sections are organized as: section 2 introduces RNN in detail, experiments and results are presented in section 3, section 4 discusses the experimental results and section 5 draws conclusions.
where σ is the element-wise sigmoid function, ☉is the element-wise product, i t , f t and o t are the input, forget, and output gates, c t is the cell vector, W i , W f , W c , W o (with subscripts: x, h and c) are the weight matrices for input x t , hidden state h t and memory cell c t respectively, and b i , b f , b c and b o denote the bias vectors.
A bidirectional LSTM is used to generate context representation at every position. Given a sentence s = w 1 w 2 …w n with each word w t (1 ≤ t ≤ n) represented by x t (i.e., concatenation of token-level and character-level representations of the word), the bidirectional LSTM takes a sequence of word representations x = x 1 x 2 …x n as input and produces a sequence of context representations h = h 1 h 2 …h n , where h t = [h ft T, h bt T]T (1 ≤ t ≤ n) is a concatenation of outputs of both forward and backward LSTMs.
Y(x (i)) denotes the set of possible label sequences for x (i).
It is clear that if interactions between successive labels are not considered, the inference layer will be simplified into a softmax output layer to classify each token individually.
In order to investigate the performance of LSTM on entity recognition from clinical texts, we start with two baseline systems: 1) a CRF-based system using rich features (denoted by CRF); 2) a LSTM-based system only using token-level word representations in the input layer (denoted by LSTM-BASELINE), then compare them with the LSTM-based systems using token-level word representations and two different types of character-level word representations. Moreover, we also compare the LSTM-based systems with other state-of-the-art systems. Three benchmark datasets from three clinical NLP challenges: i2b2 (the Center for Informatics for Integrating Biology & the Beside) 2010, 2012 and 2014 are used to evaluate the performance of all systems. Both 2010 and 2012 i2b2 NLP challenges have a subtask of clinical entity recognition, and the 2014 i2b2 NLP challenge have a subtask of PHI recognition.
Datasets and evaluation
Statistics of entity recognition datasets used in our study
Evaluation criteria for the three entity recognition tasks
Entities have the same boundary and same type.
Entities overlap and have the same type.
Entities overlap and have the same type.
Entities have the same boundary and same type.
“Exact” criterion at token-level.
Sentence split: separate sentences using ‘\n’, ‘.’, ‘?’ and ‘!’.
Tokenization: split sentences into tokens by blank characters at first, and then separate those tokens composed of more than two types of characters (letters, digitals and other characters) into smaller parts that only contains only one type of characters. For example, “4/16/91CPT Code:” is split into “4/16/91CPT” and “Code:” at first, and then further separated into ‘4’, ‘/’, “16”, ‘/’, “91”, “CPT”, “Code” and ‘:’.
Hyperparameters chosen for all our experiments
Dimension of token-level word representation
Dimension of character representation
Character-level LSTM size
Character-level CNN filter size
Character-level CNN filter number
Token-level LSTM size
Performances of LSTM and CRF-based models for the three tasks (F1-score %)
2010 i2b2 challenge (Concept Extraction)
2012 i2b2 challenge (Event Detection)
2014 i2b2 challenge (De-Identification)
LSTM + char-LSTM
LSTM + char-CNN
LSTM + char-LSTM + CNN
When one type of character-level word representations (i.e., character-level word representations generated by LSTM or CNN, denoted by char-LSTM and char-CNN respectively in Table 4) is added in the input layer as shown in Fig. 1, the performance of LSTM is slightly improved, LSTM considering char-LSTM (i.e., LSTM + char-LSTM) achieves a little better performance on the 2010 and 2012 i2b2 NLP challenge test sets, while the LSTM considering char-CNN (i.e., LSTM + char-CNN) achieves a little better performance on the 2014 i2b2 NLP challenge. No remarkable sign shows which character-level word representation is better. When both two types of character-level word representations are added, the performance of LSTM is not further improved. The highest F1-scores of LSTM are 85.81% and 92.91% under “exact” and “inexact” criteria on the 2010 i2b2 challenge test set, 92.29% and 86.94% under “span” and “type” criteria on the 2012 i2b2 challenge test set, and 94.37% and 96.67% under “exact” and “token” criteria on the 2014 i2b2 challenge test set.
Comparison of the performances of various systems on the three tasks (%)
LSTM + char-LSTM
Tang et al (2013) 
Bruijin et al (2011)* 
Kim et al (2015) 
Jiang et al (2011) 
LSTM + char-LSTM
Xu et al. (2013)* 
Tang et al. (2013) 
CRFs + SVM
Sohn et al. (2013) 
Aleksandar et al. (2013) 
LSTM + char-LSTM
Yang et al. (2015) 
He et al. (2015) 
Liu et al. (2015) 
CRFs + rule
Dehghan et al. (2015) 
CRFs + rule
In this study, we investigate the performance of LSTM on entity recognition from clinical texts. The LSTM-based systems achieves highest F1-scores of 85.81% under “exact” criterion on the 2010 i2b2 challenge test set, 92.29% under “span” criterion on the 2012 i2b2 challenge test set, and 94.37% under “exact” criterion on the 2014 i2b2 challenge test set, which are competitive with other state-of-the-art systems. The major advantage of the LSTM-based system is that it does not rely on a large number of hand-crafted features any more. Similar to previous studies in the newswire domain, LSTM shows great potential on entity recognition in the clinical domain, outperforming most traditional state-of-the-art methods that suffer from fussy feature engineering such as CRF.
Experiments shown in Table 4 demonstrate that any one type of the two character-level word representations is beneficial to entity recognition from clinical texts. The reason may lie in that both the two types of character-level word representations have ability to capture some morphological information of each word such as suffixes and prefixes, which cannot be captured by the token-level word representation that relies on word context. Then, when any one of the character-level word representations is added into the input layer of LSTM, errors like “Test” event “URINE” missed in “2014-11-29 05:11 PM URINE” and hospital “FPC” correctly identified in “… have a PCP at FPC …” but missed in “… Dr. Harry Tolliver, FPC cardiology unit …” are fixed.
Although the LSTM-based system shows better overall performance than almost all state-of-the-art systems mentioned in this study, but it does not show better performance on all types of entities. For example, the best system on the 2012 i2b2 challenge corpus (i.e., Xu et al. (2013) ) achieves better “span” F1-score than the LSTM-based system on “Test” events (94.16% vs 93.69%). The best system on the 2014 i2b2 challenge corpus (i.e., Yang et al. (2015) ) achieves better “exact” F1-score than LSTM-based system on “ID” instances (92.71% vs 91.94%). There are two main reasons: 1) the current LSTM-based system does not use knowledge bases widely existing in the clinical domain, but the other state-of-the-art systems take full advantages of them; 2) although the character-level word representation has ability to capture some morphological information of each word, it cannot cover morphological information of specific words such as fixed size digitals. Therefore, there are two possible directions for further improvement in our opinion: 1) How to integrate widely existing knowledge bases into the input of LSTM; 2) How to use LSTM to recognize entities in specific formats. We will try them in the future.
In recent months, a few studies on deep learning for entity recognition from clinical text are also proposed. For example, Abhyuday et al. proposed two RNN-based models for medical event detection on their own annotated dataset, one of which recognizes medical event detection as a classification problem and the other one as a sequence labeling problem [48, 49]. Both the two RNN-based models adopt traditional RNN, which is not as good as LSTM, and only take token-level word representation as their input. Franck et al. deployed a similar RNN model for the de-identification task on the 2014 i2b2 NLP challenge corpus and the MIMIC dataset . According to the experimental results reported in this study and the similar studies, we may conclude that our LSTM outperforms theirs. For example, the F1-score of the RNN model proposed by Franck et al. on the 2014 i2b2 dataset, as reported, is 97.85% under the binary HIPAA token criterion (only evaluating the HIPAA-defined PHI instances under “token” criterion). Under the same evaluation criterion, the corresponding F1-score of “LSTM + char-LSTM” is 98.05% on i2b2-2014 dataset. The results demonstrate that our LSTM outperforms RNN proposed by Franck et al . Therefore, the results reported in this study can be a new benchmark system based on deep learning methods.
In this study, we comprehensively investigate the performance of recurrent neural network (i.e., LSTM) on clinical entity recognition and protected health information (PHI) recognition. Experiments on the 2010, 2012 and 2014 i2b2 NLP challenge corpora prove that 1) LSTM outperforms CRF; 2) By introducing two types of character-level word representations into the input layer of LSTM, LSTM is further improved; 3) the final LSTM-based system is competitive with other state-of-the-art systems. Furthermore, we also point out two possible directions for further improvement.
This paper is supported in part by grants: National 863 Program of China (2015AA015405), NSFCs (National natural Science Foundations of China) (61573118, 61402128, 61473101, and 61472428), Strategic Emerging Industry Development Special Funds of Shenzhen (JCYJ20140508161040764, JCYJ20140417172417105, JCYJ20140627163809422 and JSGG20151015161015297), Innovation Fund of Harbin Institute of Technology (HIT.NSRIF.2017052) and Program from the Key Laboratory of Symbolic Computation and Knowledge Engineering of Ministry of Education (93K172016K12). The publication costs have been covered by the NSFCs 61402128.
Availability of data and materials
The datasets that support the findings of this study are available from i2b2 challenges, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from i2b2’s website: https://www.i2b2.org/NLP/DataSets/Main.php upon reasonable application with a signed “data use and confidentiality agreement” to the program manager: Barbara Mawn (E-mail: Barbara_Mawn@hms.harvard.edu). The ethics approval would not been required as all the data have been De-Identified within the meaning of the Health Insurance Portability and Accountability Act of 1996 privacy regulations (HIPAA).
The work presented here was carried out in collaboration between all authors. Z.L., M.Y. and B.T. designed the methods and experiments, and contributed to the writing of manuscript. X.W., Q.C., Z.W. and H.X. provided guidance and reviewed the manuscript critically. All authors have approved the final manuscript.
The authors declare that they have no competing interests.
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This article has been published as part of BMC Medical Informatics and Decision Making Volume 17 Supplement 2, 2017: Selected articles from the International Conference on Intelligent Biology and Medicine (ICIBM) 2016: medical informatics and decision making. The full contents of the supplement are available online at https://bmcmedinformdecismak.biomedcentral.com/articles/supplements/volume-17-supplement-2.
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