让医疗对话主动追问缺失信息,智能规划下一步问诊。
Proactive Knowledge Inquiry in Doctor-Patient Dialogue: Stateful Extraction, Belief Updating, and Path-Aware Action Planning
- 构建动态知识追踪框架,实时更新患者认知状态
- 在模拟对话中实现83.3%信息覆盖与80.0%风险项召回
- 适合研究对话式病历生成的学者或系统设计者
当前自动化电子病历(EMR)流程多为输出导向:仅在会诊后转录、提取和总结,未显式建模已有知识、缺失信息、关键不确定性及下一步应问的问题。本文将医患对话建模为部分可观测下的主动知识询问问题。提出的框架结合状态化信息抽取、序列信念更新、缺漏感知状态建模、对象化医学知识混合检索以及轻量级部分可观测马尔可夫决策过程(POMDP-lite)行动规划。不将病历视为唯一目标产物,而是将其看作持续探究循环的结构化投影。通过在10个标准化多轮对话上进行受控试点评估,并整合跨对话的300次查询检索基准测试,完整框架达到83.3%覆盖率、80.0%风险召回率、81.4%结构完整性,且冗余度低于仅分块和模板主导的交互基线。这些初步结果未证明临床泛化能力,但表明在严格控制条件下,主动询问具有方法论吸引力,值得进一步探索对话式病历生成。本工作应视为受控模拟环境下的概念演示,而非临床部署依据。不得由此推断其临床适用性、安全性或真实世界效用。
原文摘要 · Abstract (English)
Most automated electronic medical record (EMR) pipelines remain output-oriented: they transcribe, extract, and summarize after the consultation, but they do not explicitly model what is already known, what is still missing, which uncertainty matters most, or what question or recommendation should come next. We formulate doctor-patient dialogue as a proactive knowledge-inquiry problem under partial observability. The proposed framework combines stateful extraction, sequential belief updating, gap-aware state modeling, hybrid retrieval over objectified medical knowledge, and a POMDP-lite action planner. Instead of treating the EMR as the only target artifact, the framework treats documentation as the structured projection of an ongoing inquiry loop. To make the formulation concrete, we report a controlled pilot evaluation on ten standardized multi-turn dialogues together with a 300-query retrieval benchmark aggregated across dialogues. On this pilot protocol, the full framework reaches 83.3% coverage, 80.0% risk recall, 81.4% structural completeness, and lower redundancy than the chunk-only and template-heavy interactive baselines. These pilot results do not establish clinical generalization; rather, they suggest that proactive inquiry may be methodologically interesting under tightly controlled conditions and can be viewed as a conceptually appealing formulation worth further investigation for dialogue-based EMR generation. This work should be read as a pilot concept demonstration under a controlled simulated setting rather than as evidence of clinical deployment readiness. No implication of clinical deployment readiness, clinical safety, or real-world clinical utility should be inferred from this pilot protocol.
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