Table 2

Solutions for mnimising false positives and negatives identified through NLP and DDSS by clinician review

False negative/positive problem	Solution included in GPACSS
Minimising false negatives on NLP flagging of findings	Include parent and child codes (eg, finding of intellectual disability in DDSS includes codes for developmental delay and particular types of intellectual disability).
Minimising false positives through the DDSS Usefulness metric	Use DDSS usefulness algorithm30 to display flagged findings; thus prioritising data of greater relevance and de-prioritising data of low relevance for clinician review.
Minimising false positives through clinician verification	Use flag icon to indicate findings identified through NLP (figure 3). Clinician clicks the flag icon to display information needed to assess reliability, presence or absence, and onset. Information displayed from the EHR includes date of chart note, observer identity and three sentences of chart note (sentence with finding plus preceding and subsequent sentence).

DDSS, diagnostic decision support system; EHR, electronic health record; GPACSS, Genotype-Phenotype Archiving and Communication System with SimulConsult; NLP, natural language processing.