面向醫療保健的 HIPAA 合規 LLM 微調

{
  "instruction": "Generate a clinical note from the following encounter summary.",
  "input": "45M, presenting with chest pain x 2 days, radiating to left arm. Hx HTN, DM2. BP 158/92, HR 88, SpO2 98%. ECG: normal sinus rhythm. Troponin: negative x2.",
  "output": "CHIEF COMPLAINT: Chest pain for 2 days.\n\nHPI: 45-year-old male presents with chest pain of 2 days duration, radiating to the left arm. Patient has a history of hypertension and type 2 diabetes mellitus.\n\nVITALS: BP 158/92 mmHg, HR 88 bpm, SpO2 98% on room air.\n\nDIAGNOSTICS: ECG shows normal sinus rhythm. Troponin negative on two serial measurements.\n\nASSESSMENT: Chest pain, likely non-cardiac given negative troponin and normal ECG. Differential includes musculoskeletal, GERD, anxiety."
}

{
  "instruction": "Suggest ICD-10 codes for the following clinical note excerpt.",
  "input": "Patient presents with acute exacerbation of chronic obstructive pulmonary disease. Chest X-ray shows hyperinflation without infiltrate. Started on nebulized albuterol and oral prednisone taper.",
  "output": "J44.1 - Chronic obstructive pulmonary disease with acute exacerbation\nJ44.9 - Chronic obstructive pulmonary disease, unspecified (secondary)\nZ87.01 - Personal history of pneumonia (if documented)"
}

{
  "instruction": "Classify the following patient complaint by triage urgency: EMERGENT, URGENT, SEMI-URGENT, NON-URGENT.",
  "input": "72F, sudden onset severe headache described as 'worst headache of my life', neck stiffness, photophobia. No trauma history.",
  "output": "EMERGENT\nRationale: Sudden onset severe headache with neck stiffness and photophobia in elderly patient. High suspicion for subarachnoid hemorrhage. Requires immediate CT head and lumbar puncture if CT negative."
}

{
  "instruction": "Generate a discharge summary from the following hospitalization data.",
  "input": "Admission: acute cholecystitis. LOS: 3 days. Procedure: laparoscopic cholecystectomy day 2. Complications: none. Discharge meds: acetaminophen 500mg PRN, omeprazole 20mg daily. Follow-up: surgeon 2 weeks.",
  "output": "DISCHARGE SUMMARY\n\nAdmitting Diagnosis: Acute cholecystitis\nProcedure: Laparoscopic cholecystectomy\nHospital Course: Patient admitted with acute cholecystitis confirmed by ultrasound. Managed initially with IV antibiotics and NPO. Underwent uncomplicated laparoscopic cholecystectomy on hospital day 2. Tolerated regular diet post-operatively. Pain well controlled.\nDischarge Medications: Acetaminophen 500mg by mouth every 6 hours as needed for pain. Omeprazole 20mg by mouth daily.\nFollow-up: Surgical clinic in 2 weeks.\nDischarge Condition: Stable, ambulatory."
}

{
  "instruction": "Rewrite the following clinical information in plain language for the patient.",
  "input": "Labs show HbA1c of 8.2%, indicating suboptimal glycemic control. Recommend titrating metformin to 1000mg BID and adding SGLT2 inhibitor.",
  "output": "Your blood sugar test (called HbA1c) came back at 8.2%. This is higher than our target of below 7%, which means your blood sugar has been running too high over the past few months. We are going to increase your metformin dose to 1000mg twice a day and add a new medication that helps your kidneys remove extra sugar from your blood. This combination should help bring your levels down."
}

┌─────────────────────────────────────────────────────┐
│                 醫院網路（隔離）                       │
│                                                      │
│  ┌──────────┐    ┌───────────────┐    ┌──────────┐  │
│  │   EHR    │───→│ 去識別化管道   │───→│  訓練    │  │
│  │ (Epic/   │    │（NER + 手動   │    │  伺服器  │  │
│  │  Cerner) │    │  審查）       │    │（GPU）   │  │
│  └──────────┘    └───────────────┘    └────┬─────┘  │
│                                            │         │
│                                     ┌──────▼──────┐  │
│                                     │  驗證        │  │
│                                     │（評估套件）  │  │
│                                     └──────┬──────┘  │
│                                            │         │
│  ┌──────────┐    ┌───────────────┐  ┌──────▼──────┐  │
│  │  臨床    │←───│   API 閘道    │←─│  推理       │  │
│  │  用戶    │    │  (nginx/Kong) │  │  伺服器     │  │
│  └──────────┘    └───────────────┘  └─────────────┘  │
└─────────────────────────────────────────────────────┘