提出可计算临床意图框架，让医疗系统理解医生真实诊疗意图。
Three Generations of Healthcare IT: From the Digital Record to the Computable Care Process
- 以患者特定临床意图为计算单元，构建第三层医疗信息化架构。
- 提出可执行的行动式病历（ACR）作为意图原子对象，支持流程追踪。
- 适合医疗信息化研究者、临床决策系统开发者参考使用。
医疗信息技术通常按采用的技术组织，本文则依据系统可计算的信息单元进行分类，提出一个以患者特异性临床意图为对象的计算层。我们给出计算层的标准，推导出三类：病历、临床状态，以及提出的意图层，并将可行动临床记录（ACR）形式化为第三层的原子对象。该框架区分了处方、观察与意图过程；现有标准虽可表示结构化意图，但无法从自然语言交流中恢复意图，这一能力正是本文定位的核心。ACR与FHIR工作流资源、指南及流程挖掘互补，一项配套可行性研究展示了在某一具体子问题上的可实现性。结论指出，可计算临床意图是一个连贯的研究方向；ACR、其成熟度阶梯及可执行正确性评估框架，是后续研究可复用的构造工具，用于扩展、评估或证伪。
原文摘要 · Abstract (English)
Objective. Healthcare IT is usually organized by the technologies it adopts. We instead organize it by the unit of information a system makes computable, and describe a computational layer whose object is patient-specific clinical intent. Approach. We give criteria for a computational layer, derive three (record, clinical state, and a proposed layer of intent), and formalize the Actionable Clinical Record (ACR) as the atomic object of the third layer. Discussion. The framework distinguishes prescribed, observed, and intended process; existing standards represent intent once it is structured but do not recover it from natural communication, the capability we localize. The ACR is complementary to FHIR workflow resources, guidelines, and process mining; a companion feasibility study illustrates tractability for one narrow subproblem. Conclusion. Computable clinical intent is a coherent research direction; the ACR, its readiness ladder, and an executable-correctness evaluation framework are reusable constructs for subsequent work to extend, evaluate, or falsify.
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