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Electronic health records capture patient information using structuredcontrolled vocabularies and unstructured narrative text. While structured datatypically encodes lab values, encounters and medication lists, unstructureddata captures the physician's interpretation of the patient's condition,prognosis, and response to therapeutic intervention. In this paper, wedemonstrate that information extraction from unstructured clinical narrativesis essential to most clinical applications. We perform an empirical study tovalidate the argument and show that structured data alone is insufficient inresolving eligibility criteria for recruiting patients onto clinical trials forchronic lymphocytic leukemia (CLL) and prostate cancer. Unstructured data isessential to solving 59% of the CLL trial criteria and 77% of the prostatecancer trial criteria. More specifically, for resolving eligibility criteriawith temporal constraints, we show the need for temporal reasoning andinformation integration with medical events within and across unstructuredclinical narratives and structured data.

How essential are unstructured clinical narratives and information fusion to clinical trial recruitment?