用大模型精准识别病历中每句话的来源科室,提升多学科病历总结质量。
Towards Multidisciplinary Summarization of Hospital Stays: Efficient Sentence-Level Clinical Provenance Categorization
- 用微调大模型识别病历句子的临床来源,实现跨专业信息归类。
- 70B模型经微调后在新生儿重症病房数据上准确率提升7%,达92%以上。
- 量化后的模型性能更强且更省算力,适合实际医疗系统部署。
在新生儿重症监护室等高复杂度场景中,实现高效多学科协作总结需整合来自医生、护士、治疗师等多方的数千条自由文本记录。直接拼接异源文本常导致输出混乱。结构化总结首先依赖于对多源记录中句子级来源的精确分类。本研究提出基于监督微调(SFT)的大语言模型临床来源分类流程,适配了两个Llama-3模型(8B和70B),在包含2,002条MIMIC-III(成人ICU)病历的MedSecId数据集上,两种模型均实现超过92%的领域内宏平均F1得分。为评估跨域泛化能力,我们在由三个多学科新生儿重症监护室总结生成的227个句子级标注数据集上测试了模型表现。结果表明存在规模依赖的迁移效应:8B模型经微调后性能提升有限,而70B模型显著提升,宏平均F1提高7%。值得注意的是,量化后的微调70B模型不仅优于全精度基线,还大幅降低计算开销。这说明足够容量的模型对保持跨领域语义灵活性至关重要,且高效的量化微调可为下游总结任务提供可行的结构化来源建模方案。
原文摘要 · Abstract (English)
Effective "all-team" summarization in high-complexity settings like the Neonatal Intensive Care Unit (NICU) requires aggregating insights from diverse disciplines (physicians, nurses, therapists) spread across hundreds of clinical free-text notes. Simply pooling heterogeneous text often leads to incoherent outputs. Structured summarization therefore first requires accurate categorization of sentence-level provenance across multi-source notes. This pilot study introduces a clinical provenance categorization pipeline using supervised fine-tuning (SFT) of large language models (LLMs). We adapted two Llama-3 models (8B and 70B) to MedSecId, a corpus of 2,002 MIMIC-III (Adult ICU) notes annotated with clinical provenance headers, achieving in-domain Macro F1 scores above 92% for both models. To evaluate cross-domain generalization, we assessed model capacity (8B vs. 70B) and quantization on a gold-standard dataset of 227 sentence-level spans derived from three multi-disciplinary NICU summaries. Experimental results demonstrate a scale-dependent transfer effect: while SFT produced only marginal changes for the 8B model, it substantially improved the 70B model, increasing Macro F1 by 7%. Notably, the quantized fine-tuned 70B model outperformed its full-precision baseline while substantially reducing computational requirements. These findings suggest that sufficient model capacity is critical for preserving semantic flexibility during cross-domain clinical transfer and that efficient quantized adaptation can enable structured provenance modeling for downstream summarization.
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