Tasks as needs: reframing the paradigm of clinical natural language processing research for real-world decision support.
Tasks as needs: reframing the paradigm of clinical natural language processing research for real-world decision support.
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DOI：
10.1093/jamia/ocac121
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发表时间：
2022-09-12
影响因子：
6.4
通讯作者：
Verspoor, Karin
中科院分区：
文献类型：
--
作者：
Lederman, Asher;Lederman, Reeva;Verspoor, Karin
关键词：
电子医疗记录越来越多地用于在医院和其他临床环境中存储患者信息。临床自然语言处理（cNLP）系统也相应地激增，其目的是使用这些记录中的文本数据来改善临床决策，而不仅仅是手动临床医生搜索和临床判断。然而，这些系统提供了边际实际效用，很少部署到医疗保健环境，导致技术和结构改进的建议。在本文中，我们认为，这反映了违反弗里德曼的“生物医学信息学的基本定理”，并且在cNLP领域必须发生更深层次的认识论变化，作为与任何技术或结构改进并行的一步。我们建议研究人员从设计独立于临床需求的cNLP系统（cNLP任务本身就是目的-“任务作为决策”）转向直接由临床医生在现实决策环境中的需求指导的系统-“任务作为需求”。案例研究示例说明了开发旨在更直接支持临床需求的cNLP系统的潜在好处。
Electronic medical records are increasingly used to store patient information in hospitals and other clinical settings. There has been a corresponding proliferation of clinical natural language processing (cNLP) systems aimed at using text data in these records to improve clinical decision-making, in comparison to manual clinician search and clinical judgment alone. However, these systems have delivered marginal practical utility and are rarely deployed into healthcare settings, leading to proposals for technical and structural improvements. In this paper, we argue that this reflects a violation of Friedman’s “Fundamental Theorem of Biomedical Informatics,” and that a deeper epistemological change must occur in the cNLP field, as a parallel step alongside any technical or structural improvements. We propose that researchers shift away from designing cNLP systems independent of clinical needs, in which cNLP tasks are ends in themselves—“tasks as decisions”—and toward systems that are directly guided by the needs of clinicians in realistic decision-making contexts—“tasks as needs.” A case study example illustrates the potential benefits of developing cNLP systems that are designed to more directly support clinical needs.
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