arXiv:2507.14079cs.CLcs.AI2025-07

用时间对齐技术从分散病历中生成连贯的住院进展记录。

DENSE: Longitudinal Progress Note Generation with Temporal Modeling of Heterogeneous Clinical Notes Across Hospital Visits

  • 按临床类型细粒度分类病历,按时间顺序整合多访记录
  • 生成病历的时间对齐比率达1.089,超过原始记录
  • 适合需要连续患者叙事的临床研究与决策支持

进展记录是电子健康记录中最具临床意义的文档,提供患者病情、治疗和医疗决策的时序洞察。然而,在大规模EHR数据集中严重缺失。例如在广泛使用的MIMIC-III数据集中,仅约8.56%的住院记录包含进展记录,导致纵向病程叙事断裂。相比之下,该数据集包含多种其他类型的记录,各自反映不同的诊疗环节。我们提出DENSE(从零散证据中生成演变进展记录),其设计符合临床文书流程,模拟医生撰写进展记录时参考既往就诊记录的行为。系统引入细粒度病历分类与时间对齐机制,将跨访记录组织为结构化时序输入。核心采用临床导向的检索策略,从当前及既往就诊中识别时空与语义相关的内容,并用于提示大语言模型(LLM)生成临床一致且时序敏感的进展记录。我们在一个具有多次就诊和完整进展记录的患者队列上评估DENSE,生成记录表现出强纵向一致性,时间对齐比率达1.089,优于原始记录。通过恢复碎片化文档的叙事连贯性,该系统可提升摘要生成、预测建模与临床决策支持等下游任务性能,为真实医疗场景下基于LLM的病历合成提供可扩展解决方案。

原文摘要 · Abstract (English)

Progress notes are among the most clinically meaningful artifacts in an Electronic Health Record (EHR), offering temporally grounded insights into a patient's evolving condition, treatments, and care decisions. Despite their importance, they are severely underrepresented in large-scale EHR datasets. For instance, in the widely used Medical Information Mart for Intensive Care III (MIMIC-III) dataset, only about $8.56\%$ of hospital visits include progress notes, leaving gaps in longitudinal patient narratives. In contrast, the dataset contains a diverse array of other note types, each capturing different aspects of care. We present DENSE (Documenting Evolving Progress Notes from Scattered Evidence), a system designed to align with clinical documentation workflows by simulating how physicians reference past encounters while drafting progress notes. The system introduces a fine-grained note categorization and a temporal alignment mechanism that organizes heterogeneous notes across visits into structured, chronological inputs. At its core, DENSE leverages a clinically informed retrieval strategy to identify temporally and semantically relevant content from both current and prior visits. This retrieved evidence is used to prompt a large language model (LLM) to generate clinically coherent and temporally aware progress notes. We evaluate DENSE on a curated cohort of patients with multiple visits and complete progress note documentation. The generated notes demonstrate strong longitudinal fidelity, achieving a temporal alignment ratio of $1.089$, surpassing the continuity observed in original notes. By restoring narrative coherence across fragmented documentation, our system supports improved downstream tasks such as summarization, predictive modeling, and clinical decision support, offering a scalable solution for LLM-driven note synthesis in real-world healthcare settings.

病历生成时间建模临床决策

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