OBJECTIVES: Clinical text processing offers a promising avenue for improving multiple aspects of healthcare, though operational deployment remains a substantial challenge. This case report details the implementation of a national clinical text processing infrastructure within the Department of Veterans Affairs (VA). METHODS: Two foundational use cases, cancer case management and suicide and overdose prevention, illustrate how text processing can be practically implemented at scale for diverse clinical applications using shared services. RESULTS: Insights from these use cases underline both commonalities and differences, providing a replicable model for future text processing applications. CONCLUSIONS: This project enables more efficient initiation, testing, and future deployment of text processing models, streamlining the integration of these use cases into healthcare operations. This project implementation is in a large integrated health delivery system in the United States, but we expect the lessons learned to be relevant to any health system, including smaller local and regional health systems in the United States.

Clinical decision support (CDS) systems powered by predictive models have the potential to improve the accuracy and efficiency of clinical decision-making. However, without sufficient validation, these systems have the potential to mislead clinicians and harm patients. This is especially true for CDS systems used by opioid prescribers and dispensers, where a flawed prediction can directly harm patients. To prevent these harms, regulators and researchers have proposed guidance for validating predictive models and CDS systems. However, this guidance is not universally followed and is not required by law. We call on CDS developers, deployers, and users to hold these systems to higher standards of clinical and technical validation. We provide a case study on two CDS systems deployed on a national scale in the United States for predicting a patient's risk of adverse opioid-related events: the Stratification Tool for Opioid Risk Mitigation (STORM), used by the Veterans Health Administration, and NarxCare, a commercial system.

One of the key, emerging challenges that connects the "Big Data" and the AI domain is the availability of sufficient volumes of training data for AI/Machine Learning tasks. SynthNotes is a framework for generating standards-compliant, realistic mental health progress report notes at the very large, population-level scale, and in a strict privacy-preserving manner. Our framework, inspired by the needs to explore, evaluate, and train computational methods for the emerging mental health crisis in the US, is useful for benchmarking, optimization, and training of biomedical natural language processing, information extraction, and machine learning systems intended to operate at "Big Data" scale (billions of notes). The free text notes generated by SynthNotes are based on the literature and public statistical models allowing for realistic, natural language representation of a patient, and his or her mental health characteristics. Additionally, SynthNotes can partially simulate stylistic, grammatical, and expressive characteristics of a licensed mental health professional. SynthNotes is modular and flexible, allowing for representation of variety of conditions, incorporation of alternative foundational models, and parametrization of the variability of the structure, content, and size of the synthetically generated corpus. In this paper, we report on the initial use and performance characteristics of our SynthNotes framework and on the ongoing work for inclusion of content planning and deep learning-based generative methods trained on real data.

The main goal of knowledge base population (KBP) is to distill entity information (e.g., facts of a person) from multiple unstructured and semi-structured data sources, and incorporate the information into a knowledge base (KB). In this work, we intend to release an open source KBP toolkit that is publicly available for research purposes.