Objective: Develop a cost-effective, large language model (LLM)-based pipeline for automatically extracting Review of Systems (ROS) entities from clinical notes. Materials and Methods: The pipeline extracts ROS sections using SecTag, followed by few-shot LLMs to identify ROS entity spans, their positive/negative status, and associated body systems. We implemented the pipeline using open-source LLMs (Mistral, Llama, Gemma) and ChatGPT. The evaluation was conducted on 36 general medicine notes containing 341 annotated ROS entities. Results: When integrating ChatGPT, the pipeline achieved the lowest error rates in detecting ROS entity spans and their corresponding statuses/systems (28.2% and 14.5%, respectively). Open-source LLMs enable local, cost-efficient execution of the pipeline while delivering promising performance with similarly low error rates (span: 30.5-36.7%; status/system: 24.3-27.3%). Discussion and Conclusion: Our pipeline offers a scalable and locally deployable solution to reduce ROS documentation burden. Open-source LLMs present a viable alternative to commercial models in resource-limited healthcare environments.
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