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弥合差距:一种逐步实现医疗保健领域大语言模型安全实施的实用方法。

Bridging the gap: a practical step-by-step approach to warrant safe implementation of large language models in healthcare.

作者信息

Workum Jessica D, van de Sande Davy, Gommers Diederik, van Genderen Michel E

机构信息

Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, Netherlands.

Department of Intensive Care, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands.

出版信息

Front Artif Intell. 2025 Jan 27;8:1504805. doi: 10.3389/frai.2025.1504805. eCollection 2025.

Abstract

Large Language Models (LLMs) offer considerable potential to enhance various aspects of healthcare, from aiding with administrative tasks to clinical decision support. However, despite the growing use of LLMs in healthcare, a critical gap persists in clear, actionable guidelines available to healthcare organizations and providers to ensure their responsible and safe implementation. In this paper, we propose a practical step-by-step approach to bridge this gap and support healthcare organizations and providers in warranting the responsible and safe implementation of LLMs into healthcare. The recommendations in this manuscript include protecting patient privacy, adapting models to healthcare-specific needs, adjusting hyperparameters appropriately, ensuring proper medical prompt engineering, distinguishing between clinical decision support (CDS) and non-CDS applications, systematically evaluating LLM outputs using a structured approach, and implementing a solid model governance structure. We furthermore propose the ACUTE mnemonic; a structured approach for assessing LLM responses based on Accuracy, Consistency, semantically Unaltered outputs, Traceability, and Ethical considerations. Together, these recommendations aim to provide healthcare organizations and providers with a clear pathway for the responsible and safe implementation of LLMs into clinical practice.

摘要

大语言模型(LLMs)在提升医疗保健的各个方面具有巨大潜力,从协助行政任务到临床决策支持。然而,尽管大语言模型在医疗保健领域的应用日益广泛,但对于医疗保健组织和提供者而言,在确保其负责任和安全实施方面,仍存在明显的、可操作的指导方针方面的关键差距。在本文中,我们提出了一种实用的逐步方法来弥合这一差距,并支持医疗保健组织和提供者确保大语言模型在医疗保健中的负责任和安全实施。本手稿中的建议包括保护患者隐私、使模型适应医疗保健特定需求、适当调整超参数、确保正确的医学提示工程、区分临床决策支持(CDS)和非CDS应用、使用结构化方法系统评估大语言模型输出,以及实施稳固的模型治理结构。我们还提出了ACUTE助记法;一种基于准确性、一致性、语义不变输出、可追溯性和伦理考量来评估大语言模型响应的结构化方法。这些建议共同旨在为医疗保健组织和提供者提供一条将大语言模型负责任且安全地实施到临床实践中的清晰途径。

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