- Natural language processing (NLP) is a viable solution for patient portal use, a process that is often limited by low patient health literacy. NLP needs to be employed judiciously, with considerations for suboptimal term linking and algorithmic pitfalls, according to a recent study published in the Journal of Medical Internet Research.
NLP is an emerging strategy for supporting patient portal use. Patient portals, which give patients glimpses into their medical records and clinician notes, aim to better engage patients with more information about their own health. But these tools fall short when patients are bombarded with medical jargon that they do not necessarily understand.
“EHR notes are written for documentation and communication between health care providers and contain abundant medical jargon that can confuse patients,” the researchers from the University of Massachusetts Medical School wrote. “In addition, an estimated 36 percent of adult Americans have limited health literacy. Limited health literacy has been identified as one major barrier to patients’ effective use of their EHRs.”
Healthcare professionals have also cited limited patient health literacy as a reason for limited patient portal uptake or for not buying into certain national programs such as OpenNotes. Providers fear their patients will not understand the terms used in clinician notes, outweighing the benefits of patient access to health data.
NLP algorithms identify complex medical terms and links them with layperson definitions, the researchers said.
“NLP-enabled systems have the merits that they provide patients direct help for EHR comprehension by bundling related health information with individual EHR notes,” the research team explained.
Previous studies published by this research team aimed at developing a viable NLP tool, NoteAid, to enhance patient portal use. NoteAid proved most effective when using CoDeMed and MedLink, two algorithms that identify complex medical jargon and connect patients with appropriate definitions.
The researchers asked ten physician experts to assess the user interface and the content quality of NoteAid.
Overall, physician analysis yielded both positive and negative remarks.
Identified benefits included ease of use, good visual display, satisfactory system speed, and adequate lay person definitions.
Reported areas for improvement included improving the display of definitions for partially matched terms, including more medical terms in CoDeMed, improving the handling of terms whose definitions vary depending on different contexts, and standardizing the scope of definitions for medicines.
Barriers still remain for a fully functioning NLP add-on for clinician notes and patient portals, the researchers acknowledged. Clinicians often use abbreviations, for example. This short-hand might not be consistent across different organizations and could be difficult for creating matching algorithms.
Additionally, misspellings and unclear handwriting can create issues for identifying the word that needs to be linked to a lay definition, creating more complexities for NLP algorithms.
The research team has made some improvements since study’s end, they explained. The researchers have added over 4,500 new lay definitions to CoDeMed, helping to improve the tool’s usability and patient ability to find definitions on the patient portal.
Going forward, the researchers need to test this tool with patients to ensure that it is actually useable for lay populations.
“Next steps include a study engaging patients to test the system,” the researchers concluded. “Tools such as NoteAid may have the potential to improve patient EHR comprehension, which, when used concurrently with patient portals such as VA’s MyHealtheVet, can improve patient experience, engagement, and health knowledge.”
Accounting for lapses in patient education and patient health literacy is critical in the healthcare industry. Attaining a high level of patient understanding increases the likelihood that a patient will become activated and involved in her own care, helping to creating meaningful patient engagement.