arXiv:2604.17725cs.CLcs.AI2026-04ACL

让大模型更好理解病历时间序列,提升预测准确率。

RePrompT: Recurrent Prompt Tuning for Integrating Structured EHR Encoders with Large Language Models

论文配图:RePrompT: Recurrent Prompt Tuning for Integrating Structured EHR Encoders with Large Language Models
图 1 · 摘自论文原文
  • 用循环提示调优保留就诊时间线索,增强长期轨迹建模
  • 在MIMIC-III/IV上多个任务表现优于基线模型
  • 适合需要融合病历结构化数据的临床预测研究者

大型语言模型(LLMs)在挖掘电子健康记录(EHRs)方面展现出强大潜力,能够对纵向临床信息进行推理,捕捉丰富的患者病程。然而,将LLMs用于结构化EHR(如标准化诊断和用药编码)面临两大挑战:其一,将带时间戳的EHR序列转换为纯文本会模糊时间结构和编码身份,削弱对编码共现及纵向规律的捕捉能力;其二,与在队列上训练的预测模型不同,LLMs通常以孤立病例方式处理,缺乏利用人群层面模式的能力。为此,我们提出RePrompT,一种通过提示调优整合结构化EHR编码器的时间感知框架,不改变底层架构。具体而言,RePrompT通过递归引入前次就诊的隐状态来保留纵向信息,并通过从队列训练、任务对齐的EHR编码器中提取的可训练提示词注入人群级信息。在MIMIC-III和MIMIC-IV上的实验表明,RePrompT在多个临床预测任务中持续优于基于EHR和基于LLM的基线模型。

原文摘要 · Abstract (English)

Large Language Models (LLMs) have shown strong promise for mining Electronic Health Records (EHRs) by reasoning over longitudinal clinical information to capture context-rich patient trajectories. However, leveraging LLMs for structured EHRs (e.g., standardized diagnosis and medication codes) presents two key challenges. First, translating time-stamped EHR sequences into plain text can obscure both temporal structure and code identities, weakening the ability to capture code co-occurrence and longitudinal regularities. Second, unlike cohort-trained predictive models that learn a shared, task-aligned representation space across patients, LLMs are often applied in a case-isolated inference setting where each patient is processed independently without leveraging population-level patterns. To address these challenges, we introduce RePrompT, a time-aware LLM framework that integrates structured EHR encoders through prompt tuning, without modifying underlying architectures. Specifically, RePrompT recurrently incorporates latent states from prior visits to preserve longitudinal information, and injects population-level information through trainable prompt tokens derived from a cohort-trained, task-aligned EHR encoder. Experiments on MIMIC-III and MIMIC-IV demonstrate that RePrompT consistently outperforms both EHR-based and LLM-based baselines across multiple clinical prediction tasks.

医疗AI大模型病历分析

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