Prevalence of Sensitive Terms in Clinical Notes Using Natural Language Processing Techniques: Observational Study

Jennifer Lee; Samuel Yang; Cynthia Holland-Hall; Emre Sezgin; Manjot Gill; Simon Linwood; Yungui Huang; Jeffrey Hoffman

doi:10.2196/38482

Prevalence of Sensitive Terms in Clinical Notes Using Natural Language Processing Techniques: Observational Study

JMIR Med Inform. 2022 Jun 10;10(6):e38482. doi: 10.2196/38482.

Authors

Jennifer Lee^#^{1

2}, Samuel Yang^#^{1

2}, Cynthia Holland-Hall^{1

2}, Emre Sezgin¹, Manjot Gill², Simon Linwood¹, Yungui Huang¹, Jeffrey Hoffman^{1

2}

Affiliations

¹ Nationwide Children's Hospital, Columbus, OH, United States.
² The Ohio State University College of Medicine, Columbus, OH, United States.

^# Contributed equally.

PMID: 35687381
PMCID: PMC9233261
DOI: 10.2196/38482

Abstract

Background: With the increased sharing of electronic health information as required by the US 21st Century Cures Act, there is an increased risk of breaching patient, parent, or guardian confidentiality. The prevalence of sensitive terms in clinical notes is not known.

Objective: The aim of this study is to define sensitive terms that represent the documentation of content that may be private and determine the prevalence and characteristics of provider notes that contain sensitive terms.

Methods: Using keyword expansion, we defined a list of 781 sensitive terms. We searched all provider history and physical, progress, consult, and discharge summary notes for patients aged 0-21 years written between January 1, 2019, and December 31, 2019, for a direct string match of sensitive terms. We calculated the prevalence of notes with sensitive terms and characterized clinical encounters and patient characteristics.

Results: Sensitive terms were present in notes from every clinical context in all pediatric ages. Terms related to the mental health category were most used overall (254,975/1,338,297, 19.5%), but terms related to substance abuse and reproductive health were most common in patients aged 0-3 years. History and physical notes (19,854/34,771, 57.1%) and ambulatory progress notes (265,302/563,273, 47.1%) were most likely to include sensitive terms. The highest prevalence of notes with sensitive terms was found in pain management (950/1112, 85.4%) and child abuse (1092/1282, 85.2%) clinics.

Conclusions: Notes containing sensitive terms are not limited to adolescent patients, specific note types, or certain specialties. Recognition of sensitive terms across all ages and clinical settings complicates efforts to protect patient and caregiver privacy in the era of information-blocking regulations.

Keywords: adolescent; child; eHealth; natural language processing; patient portals; privacy.

©Jennifer Lee, Samuel Yang, Cynthia Holland-Hall, Emre Sezgin, Manjot Gill, Simon Linwood, Yungui Huang, Jeffrey Hoffman. Originally published in JMIR Medical Informatics (https://medinform.jmir.org), 10.06.2022.