應用自然語言處理與機器學習於疾病分類編碼之探討

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陳美君(Mei-Chun Chen) 查詢紙本館藏

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論文名稱

應用自然語言處理與機器學習於疾病分類編碼之探討
(Natural Language Processing and Machine Learning Techniques for Disease Classification of Medical Records)

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至系統瀏覽論文 (2025-7-1以後開放)

摘要(中)

臺灣醫療品質享譽國際，全民納保的健康保險制度在1995年開辦後，龐大的就醫資料為臺灣醫療發展在世界上建立影響力的基石。然而，大量的就醫需求造成醫療費用不斷上漲，使全民健保制度長期運作受到重大挑戰。為使醫療資源更加妥善利用，衛生福利部積極修訂支付制度，因此，以疾病分類碼為基礎的申報制度和費用給付密切相關，編碼的適當性、正確性及完整性成為醫療給付的重要關鍵。

為了解決醫療提供者於臨床醫學疾病名詞多樣性與複雜度，及病歷文字非結構化資料必須運用人力閱讀及理解方能正確分類診斷的困境，本研究應用自然語言處理N-Gram和TF-IDF技術從去識別化的真實病歷資料提取文字特徵向量，搭配機器學習建構四個預測分類模型：SVM、MLP、GBDT與LightGBM，使用交叉驗證減少模型偏差的狀況，評估模型的方式使用Confusion Matrix的Accuracy、Precision、Recall、F1 Score和AUC來檢驗模型的分類效果並比較與分析。並透過三個實驗設計探討臨床醫學上常見的類別不平衡、醫學名詞還原和醫師個人撰寫風格差異問題。

最後結果顯示LightGBM的預測結果優於其他模型，尤其在訓練時間有出色的表現。類別平衡處理有助於提高分類器效果。醫學名詞縮寫具有獨特性，有助於分類判斷。疾病為專有的醫學名詞，雖然醫師表達方式不同，但並不影響對同一疾病的描述方式，不同科別的醫師撰寫病歷風格不影響分類模型結果。

摘要(英)

Taiwan’s qualities of medicine and health cares are on the top of the world. Millions of electronic medicine recorders (EMR) from citizens can be collected from the National Health Insurance (NHI), which was founded in 1995. Moreover, these EMRs have become the basis of the medical technologies evolutions in Taiwan. Although NHI is good, it needs lots of money to perform social operations, and the rapidly increasing costs from all perspective of medical needs make its situation even worse. To overcome the problem and improve the resource efficiency, the NHI Administration defines lots of systems to ensure all resources are used in the correct way, and one of these systems is ICD-10-CM/PCS. The correct code in ICD-10-CM/PCS is the key of NHI benefits.

To address the complexity of medical terminologies, the N-gram and TF-IDF technologies of NLP were applied on real EMRs with De-identification in this research. In addition, SVM, MLP, GBDT, and LightGBM models with Cross-validation are constructed. All of these four models are compared and analyzed in terms of Accuracy, Precision, Recall, F1 Score and AUC in Confusion Matrix. On the other hand, three experiments are designed for the impacts of the personal writing style, the screw of terminologies in different subjects, and the needs of abbreviation restoration.

The result reveals that LightGBM provides better performance and, especially, its training time is superior to others, as well as the classification model has better performances if the original imbalanced training set is balanced after some preprocess stage. The abbreviation of medical terminologies, not like general ones used by normal people, it could contribute to the model because of uniqueness. Diseases are all proper nouns, thus the same disease might be described differently by different doctors due to personal writing styles, but the features selected in the training model would remain the same; the writing styles has no influences to the model and its result.

關鍵字(中)

★ 疾病分類
★ 自然語言處理
★ 機器學習
★ LightGBM

關鍵字(英)

★ Disease Classification
★ Natural Language Processing
★ Machine Learning
★ LightGBM

論文目次

摘要 I
Abstract II
目錄 III
圖目錄 V
表目錄 VII
第一章、緒論 1
1-1 研究背景 1
1-2 研究動機 3
1-3 研究目的 4
1-4 論文架構 5
第二章、文獻探討 7
2-1 疾病分類意義 7
2-1-1 醫學詞庫 8
2-2 機器學習運用在輔助臨床決策 9
2-2-1 醫療AI先行者－專家系統 9
2-2-2 AI輔助決策系統－精準醫療 10
2-3 疾病分類相關的研究及文獻 11
第三章、研究方法 13
3-1 研究架構 13
3-2 資料來源 15
3-3 資料前處理 15
3-3-1 文字前處理 (Pre-Processing) 15
3-3-2 詞幹提取 (Stemming) 17
3-4 文字向量處理 19
3-4-1 詞袋模型 (Bag of Words Model, BoW Model) 19
3-4-2 TF-IDF (Term Frequency-Inverse Document Frequency) 21
3-4-3 N元語法 (N-Gram) 25
3-5 建構機器學習分類模型 26
3-5-1 支援向量機 (Support Vector Machine, SVM) 26
3-5-2 多層感知器 (Multilayer perceptron, MLP) 27
3-5-3 梯度提升決策樹 (Gradient Boosting Decision Tree, GBDT) 28
3-5-4 LightGBM (Light Gradient Boosting Machine) 29
3-5-5 One-Versus-All (OVA) 29
3-5-6 交叉驗證 (Cross Validation) 30
3-5-7 處理過度擬合 (Overfitting) 31
3-6 評估方法 33
3-6-1 混亂矩陣 (Confusion Matrix) 33
3-7 實驗設計 40
3-7-1 實驗一設計 40
3-7-2 實驗二設計 41
3-7-3 實驗三設計 42
第四章、實驗結果與分析 43
4-1 實驗資料 43
4-2 系統環境 47
4-3 實驗結果 48
4-3-1 實驗一分析 49
4-3-2 實驗二分析 59
4-3-3 實驗三分析 65
4-4 實驗分析總結 71
第五章、結論 73
5-1 研究結論 73
5-2 研究限制 74
5-3 未來研究方向與建議 75
參考文獻 77
附錄一 82
附錄二 83
附錄三 84
附錄四 101
附錄五 113

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指導教授

蔡志豐(Chih-Fong Tsai)

審核日期

2020-7-3

推文