CC BY-NC-ND 4.0 · Methods Inf Med 2020; 59(S 02): e64-e78
DOI: 10.1055/s-0040-1716403
Original Article

Designing an openEHR-Based Pipeline for Extracting and Standardizing Unstructured Clinical Data Using Natural Language Processing

Antje Wulff
1  Peter L. Reichertz Institute for Medical Informatics, TU Braunschweig and Hannover Medical School, Hannover, Germany
Marcel Mast
1  Peter L. Reichertz Institute for Medical Informatics, TU Braunschweig and Hannover Medical School, Hannover, Germany
Marcus Hassler
2  Econob, Informationsdienstleistungs GmbH, Klagenfurt am Wörthersee, Austria
Sara Montag
1  Peter L. Reichertz Institute for Medical Informatics, TU Braunschweig and Hannover Medical School, Hannover, Germany
Michael Marschollek
1  Peter L. Reichertz Institute for Medical Informatics, TU Braunschweig and Hannover Medical School, Hannover, Germany
Thomas Jack
3  Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
› Author Affiliations
Funding None.


Background Merging disparate and heterogeneous datasets from clinical routine in a standardized and semantically enriched format to enable a multiple use of data also means incorporating unstructured data such as medical free texts. Although the extraction of structured data from texts, known as natural language processing (NLP), has been researched at least for the English language extensively, it is not enough to get a structured output in any format. NLP techniques need to be used together with clinical information standards such as openEHR to be able to reuse and exchange still unstructured data sensibly.

Objectives The aim of the study is to automatically extract crucial information from medical free texts and to transform this unstructured clinical data into a standardized and structured representation by designing and implementing an exemplary pipeline for the processing of pediatric medical histories.

Methods We constructed a pipeline that allows reusing medical free texts such as pediatric medical histories in a structured and standardized way by (1) selecting and modeling appropriate openEHR archetypes as standard clinical information models, (2) defining a German dictionary with crucial text markers serving as expert knowledge base for a NLP pipeline, and (3) creating mapping rules between the NLP output and the archetypes. The approach was evaluated in a first pilot study by using 50 manually annotated medical histories from the pediatric intensive care unit of the Hannover Medical School.

Results We successfully reused 24 existing international archetypes to represent the most crucial elements of unstructured pediatric medical histories in a standardized form. The self-developed NLP pipeline was constructed by defining 3.055 text marker entries, 132 text events, 66 regular expressions, and a text corpus consisting of 776 entries for automatic correction of spelling mistakes. A total of 123 mapping rules were implemented to transform the extracted snippets to an openEHR-based representation to be able to store them together with other structured data in an existing openEHR-based data repository. In the first evaluation, the NLP pipeline yielded 97% precision and 94% recall.

Conclusion The use of NLP and openEHR archetypes was demonstrated as a viable approach for extracting and representing important information from pediatric medical histories in a structured and semantically enriched format. We designed a promising approach with potential to be generalized, and implemented a prototype that is extensible and reusable for other use cases concerning German medical free texts. In a long term, this will harness unstructured clinical data for further research purposes such as the design of clinical decision support systems. Together with structured data already integrated in openEHR-based representations, we aim at developing an interoperable openEHR-based application that is capable of automatically assessing a patient's risk status based on the patient's medical history at time of admission.

Authors' Contributions

A.W. was responsible for drafting the methodological approach, managed the overall project work, led the proof-of-concept evaluation, and has authored the manuscript. M. M. developed the described NLP pipeline, designed the openEHR archetypes and template, and co-authored the manuscript. T. J. and S. M. provided clinical expertise for requirement analysis and dictionary construction. M. H. gave subject-specific advices on the design of NLP pipelines and provided the NLP software. M. M. provided further technical and medical expertise and, together with all authors, co-authored and proofread the manuscript. All authors read and approved the final manuscript.

Supplementary Material

Publication History

Received: 12 May 2020

Accepted: 18 July 2020

Publication Date:
14 October 2020 (online)

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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