A method to automate the discharge summary hospital course for neurology patients

• Published in: Journal of the American Medical Informatics Association : JAMIA 2023-11, Vol.30 (12), p.1995-2003
• Main Authors: Hartman, Vince C, Bapat, Sanika S, Weiner, Mark G, Navi, Babak B, Sholle, Evan T, Campion, Thomas R
• Format: Article
• Language: English
• Subjects: Electronic Health Records; Hospitals; Humans; Inpatients; Patient Discharge; Research and Applications; Software
• ISSN: 1067-5027; 1527-974X; 1527-974X
• DOI: 10.1093/jamia/ocad177

Abstract Objective Generation of automated clinical notes has been posited as a strategy to mitigate physician burnout. In particular, an automated narrative summary of a patient’s hospital stay could supplement the hospital course section of the discharge summary that inpatient physicians document in electronic health record (EHR) systems. In the current study, we developed and evaluated an automated method for summarizing the hospital course section using encoder-decoder sequence-to-sequence transformer models. Materials and Methods We fine-tuned BERT and BART models and optimized for factuality through constraining beam search, which we trained and tested using EHR data from patients admitted to the neurology unit of an academic medical center. Results The approach demonstrated good ROUGE scores with an R-2 of 13.76. In a blind evaluation, 2 board-certified physicians rated 62% of the automated summaries as meeting the standard of care, which suggests the method may be useful clinically. Discussion and conclusion To our knowledge, this study is among the first to demonstrate an automated method for generating a discharge summary hospital course that approaches a quality level of what a physician would write.