The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
The Division of Data Driven and Digital Medicine (D3M), Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
J Am Med Inform Assoc. 2024 Sep 1;31(9):2097-2102. doi: 10.1093/jamia/ocae085.
The study developed framework that leverages an open-source Large Language Model (LLM) to enable clinicians to ask plain-language questions about a patient's entire echocardiogram report history. This approach is intended to streamline the extraction of clinical insights from multiple echocardiogram reports, particularly in patients with complex cardiac diseases, thereby enhancing both patient care and research efficiency.
Data from over 10 years were collected, comprising echocardiogram reports from patients with more than 10 echocardiograms on file at the Mount Sinai Health System. These reports were converted into a single document per patient for analysis, broken down into snippets and relevant snippets were retrieved using text similarity measures. The LLaMA-2 70B model was employed for analyzing the text using a specially crafted prompt. The model's performance was evaluated against ground-truth answers created by faculty cardiologists.
The study analyzed 432 reports from 37 patients for a total of 100 question-answer pairs. The LLM correctly answered 90% questions, with accuracies of 83% for temporality, 93% for severity assessment, 84% for intervention identification, and 100% for diagnosis retrieval. Errors mainly stemmed from the LLM's inherent limitations, such as misinterpreting numbers or hallucinations.
The study demonstrates the feasibility and effectiveness of using a local, open-source LLM for querying and interpreting echocardiogram report data. This approach offers a significant improvement over traditional keyword-based searches, enabling more contextually relevant and semantically accurate responses; in turn showing promise in enhancing clinical decision-making and research by facilitating more efficient access to complex patient data.
本研究开发了一个框架,利用开源的大型语言模型(LLM),使临床医生能够用通俗易懂的语言询问患者整个超声心动图报告历史的问题。这种方法旨在简化从多个超声心动图报告中提取临床见解,特别是在患有复杂心脏病的患者中,从而提高患者护理和研究效率。
收集了超过 10 年的数据,包括来自西奈山卫生系统的 10 多份超声心动图报告。这些报告被转换为每个患者的单个文档进行分析,分为片段,并使用文本相似性度量检索相关片段。使用专门设计的提示,使用 LLaMA-2 70B 模型分析文本。模型的性能是通过由教师心脏病专家创建的地面实况答案进行评估的。
该研究分析了 37 名患者的 432 份报告,共 100 个问答对。LLM 正确回答了 90%的问题,时间性的准确率为 83%,严重程度评估的准确率为 93%,干预识别的准确率为 84%,诊断检索的准确率为 100%。错误主要源于 LLM 的固有局限性,例如误解数字或产生幻觉。
该研究证明了使用本地、开源 LLM 查询和解释超声心动图报告数据的可行性和有效性。这种方法比传统的基于关键字的搜索有了显著的改进,提供了更具上下文相关性和语义准确性的响应;反过来,通过更有效地访问复杂的患者数据,有望提高临床决策和研究的效率。