A recent trend in the literature has been to characterize healthcare activities in terms of complex systems theory. Complexity has often been loosely and variously defined, with meanings ranging from "not simple" to "complicated" to "intractable." In this paper, we consider various aspects of complexity and how they relate to modern healthcare practice, with the aim of developing research approaches for studying complex healthcare environments. We propose a theoretical lens for understanding and studying complexity in healthcare systems based on degrees of interrelatedness of system components. We also describe, with relevant caveats, how complex healthcare systems are generally decomposable, rendering them more tractable for further study. The ideas of interrelatedness among the components of a system as a measure of complexity and functional decomposition as a mechanism for studying meaningful subcomponents of a complex system can be used as a framework for understanding complex healthcare systems. Using examples drawn from current literature and our own research, we explain the feasibility of this approach for understanding, studying, and managing complex healthcare systems.

The discovery of implicit connections between terms that do not occur together in any scientific document underlies the model of literature-based knowledge discovery first proposed by Swanson. Corpus-derived statistical models of semantic distance such as Latent Semantic Analysis (LSA) have been evaluated previously as methods for the discovery of such implicit connections. However, LSA in particular is dependent on a computationally demanding method of dimension reduction as a means to obtain meaningful indirect inference, limiting its ability to scale to large text corpora. In this paper, we evaluate the ability of Random Indexing (RI), a scalable distributional model of word associations, to draw meaningful implicit relationships between terms in general and biomedical language. Proponents of this method have achieved comparable performance to LSA on several cognitive tasks while using a simpler and less computationally demanding method of dimension reduction than LSA employs. In this paper, we demonstrate that the original implementation of RI is ineffective at inferring meaningful indirect connections, and evaluate Reflective Random Indexing (RRI), an iterative variant of the method that is better able to perform indirect inference. RRI is shown to lead to more clearly related indirect connections and to outperform existing RI implementations in the prediction of future direct co-occurrence in the MEDLINE corpus.

Over the past fifteen years, a range of methods have been developed that are able to learn human-like estimates of the semantic relatedness between terms from the way in which these terms are distributed in a corpus of unannotated natural language text. These methods have also been evaluated in a number of applications in the cognitive science, computational linguistics and the information retrieval literatures. In this paper, we review the available methodologies for derivation of semantic relatedness from free text, as well as their evaluation in a variety of biomedical and other applications. Recent methodological developments, and their applicability to several existing applications are also discussed.

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Extracting concepts (such as drugs, symptoms, and diagnoses) from clinical narratives constitutes a basic enabling technology to unlock the knowledge within and support more advanced reasoning applications such as diagnosis explanation, disease progression modeling, and intelligent analysis of the effectiveness of treatment. The recent release of annotated training sets of de-identified clinical narratives has contributed to the development and refinement of concept extraction methods. However, as the annotation process is labor-intensive, training data are necessarily limited in the concepts and concept patterns covered, which impacts the performance of supervised machine learning applications trained with these data. This paper proposes an approach to minimize this limitation by combining supervised machine learning with empirical learning of semantic relatedness from the distribution of the relevant words in additional unannotated text. The approach uses a sequential discriminative classifier (Conditional Random Fields) to extract the mentions of medical problems, treatments and tests from clinical narratives. It takes advantage of all Medline abstracts indexed as being of the publication type “clinical trials” to estimate the relatedness between words in the i2b2/VA training and testing corpora. In addition to the traditional features such as dictionary matching, pattern matching and part-of-speech tags, we also used as a feature words that appear in similar contexts to the word in question (that is, words that have a similar vector representation measured with the commonly used cosine metric, where vector representations are derived using methods of distributional semantics). To the best of our knowledge, this is the first effort exploring the use of distributional semantics, the semantics derived empirically from unannotated text often using vector space models, for a sequence classification task such as concept extraction. Therefore, we first experimented with different sliding window models and found the model with parameters that led to best performance in a preliminary sequence labeling task. The evaluation of this approach, performed against the i2b2/VA concept extraction corpus, showed that incorporating features based on the distribution of words across a large unannotated corpus significantly aids concept extraction. Compared to a supervised-only approach as a baseline, the micro-averaged f-measure for exact match increased from 80.3% to 82.3% and the micro-averaged f-measure based on inexact match increased from 89.7% to 91.3%. These improvements are highly significant according to the bootstrap resampling method and also considering the performance of other systems. Thus, distributional semantic features significantly improve the performance of concept extraction from clinical narratives by taking advantage of word distribution information obtained from unannotated data.