Objective Model the temporal information contained in medical narrative reports as a simple temporal constraint satisfaction problem.

Design A constraint satisfaction problem is defined by time points and constraints (inequalities between points). A time interval comprises a pair of points and a constraint. Five complete electronic discharge summaries and paragraphs from 226 other discharge summaries were studied. Medical events were represented as intervals, and assertions about events were represented as constraints. Through a consensus process, a set of encoding procedures and a list of issues related to encoding were generated.

Measurements Instances of temporal disjunction and contradiction, distribution of temporal constraints.

Results An average of 95 medical events (range 46-151) and 234 temporal assertions (range 118-388) were identified per complete discharge summary. Non-definitional assertions were explicit (36%) or implicit (64%), and absolute (17%), qualitative (72%), or metric (11%). Implicit assertions were based on domain knowledge and assumptions; e.g., the section of the report determined the ordering of events. Issues included linking events, intermittence, periodicity, granularity, vagueness, ambiguity, uncertainty, and plans. Abstractions like intermittence were not represented explicitly. The temporal network was sparse: only 0.80% (range 0.42%-1.38%) of possible constraints were instantiated. No instances of discontinuous temporal disjunction were found in the complete summaries or the 226 paragraphs. One instance of temporal contradiction was found (intra-report rate 0.2 with 95% CI 0.005-1.114).

Conclusion A simple temporal constraint satisfaction problem appears sufficient to represent most temporal assertions in discharge summaries, and may be useful for encoding electronic medical records.