Extracting language information from clinical notes using large language models.

Abstract

Patient language proficiency plays a critical role in equitable, patient-centered care and language-related clinical research. However, language information recorded in structured fields of electronic health records (EHRs) is often incomplete or inaccurate, especially in multi-institutional settings with heterogeneous documentation practices. To develop and evaluate a named entity recognition (NER) pipeline that accurately extracts detailed patient language status from unstructured clinical notes using large language models (LLMs), thereby enabling scalable and generalizable language information extraction. We defined four categories of language status-fluent use, partial ability, lack of understanding, and language mentions unrelated to the patient-and annotated two datasets from Yale New Haven Hospital (YNHH) and MIMIC-III. We evaluated the performance of proprietary and open-source LLMs, including GPT-4o, LLaMA3, and BERT, under zero-shot and fine-tuning settings. Cross-site validation was conducted to assess generalizability across institutions. GPT-4o achieved F1 scores of 87 % and 82 % on YNHH and MIMIC datasets, respectively, without fine-tuning. Fine-tuned open-source models such as BERT and LLaMA3 reached comparable or superior performance when trained on sufficient annotated data. Cross-institutional evaluations confirmed that LLMs, particularly LLaMA3, exhibited stronger generalizability than traditional models. Language mentions unrelated to patient fluency remained the most challenging category across all models. Our NER framework enables automated extraction of nuanced language information from clinical narratives with high accuracy and generalizability. This work supports large-scale, language-focused research and has practical implications for improving patient-provider communication, interpreter service allocation, and equitable healthcare delivery.