As EMRs start incorporating Artificial Intelligence (AI) capabilities, clinical providers might benefit from understanding the concept of ‘Prompt Engineering”. What is AI prompt engineering? It is the art of structuring your command line prompt to improve and fine-tune the output from AI software such as Bard, ChatGPT, Midjourney, etc. The idea of this post is to show how AI could help medical providers reduce charting/documentation time in various ways. Such prompts will most likely be incorporated in EMR buttons & so we won’t have to remember them, but if an EMR offers the option to custom-build prompts to individualize output, this could be a useful skill to learn.
Here’s an example of using ChatGPT for automated documentation in clinical medicine. I tried tweaking command prompts on the free online ChatGPT software to automatically generate an ‘Impression & Assessment’ part of a H & P note, using the History of Presenting Illness (HPI) section. Enter the following or similar command onto the ChatGPT command prompt line, followed by a sample HPI of your own:
You have two tasks to complete.
Task 1: You are an experienced physician. Using least possible words, generate a shortest possible high-level summary as a single paragraph. Use medical acronyms. Get creative with use of least possible characters . Does not need to be grammatical correct but preserve meaning and sequence of medical events. Preserve chronology. Skip negative review of systems. and absent symptoms. Please preserve dates. Label Task 1 as ‘Impression’
Task 2: Forget Task 1. Extract ICD-11 medical conditions from this medical note and create a multi-line numbered list using least possible words in the descending order of medical acuity including significant and critical symptoms first. Include ICD name for any abnormal labs if present in the note. Do not include medications. Do not include procedures. Get creative and derive diagnoses that you can infer from the given information. Also add chronic conditions and medical history at the end of the list. Do not add any brackets or annotations. Convert all listed conditions to shortest ICD-11 diagnosis without including ICD-11 code. Remove All ICD-11 codes. Go back to top of list and Delete all brackets and content in brackets. Label Task 2 as ‘Assessment’
“copy-paste your history and physical here”
The output list may not be always complete or perfect but gives a pretty good starting point. Depending on the output you can try changing the prompt structure to keep fine-tuning your output/ Here are some online History & Physical samples to try. Here’s a short one I tried :
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