Cited by 246Artificial Intelligence in Healthcare and EducationMachine Learning in HealthcareTopic Modeling

The DOI matches its Crossref record; 129 of the 129 references it cites were found in a registry or an index; 1 of the 91 sources its claims cite were checked for support.

Large language models in medical and healthcare fields: applications, advances, and challenges

Open access
Wang, Dandan, Zhang, Shiqing·2024·Artificial Intelligence Review

Abstract

Large language models (LLMs) are increasingly recognized for their advanced language capabilities, offering significant assistance in diverse areas like medical communication, patient data optimization, and surgical planning. Our survey meticulously searched for papers with keywords such as “medical,” “clinical,” “healthcare,” and “LLMs” across various databases, including ACM and Google Scholar. It sought to delve into the latest trends and applications of LLMs in healthcare, analyzing 175 relevant publications to support both practitioners and researchers in the field. We have compiled 56 experimental datasets, various evaluation methods and reviewed cutting-edge LLMs across tasks. Our comprehensive analysis of LLMs in healthcare applications, including medical question-answering, dialogue summarization, electronic health record generation, scientific research, medical education, medical product safety monitoring, clinical health reasoning, and clinical decision support. Furthermore, we have identified the challenges, including data security, inaccurate information, fairness and bias, plagiarism, copyrights, and accountability, and the potential solutions, namely de-identification framework, references,counterfactually fair prompting,opening and ending control codes, and establishing normative standards,to address these open issues,respectively. The findings of this survey exert a profound impact on spurring innovation in practical applications and addressing inherent challenges within the academic and medical communities.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This survey reviews large language models in medical and healthcare fields (LLMMs), covering applications, datasets, evaluation methods, model performance, and ethical/safety challenges. It analyzes 175 relevant publications and compiles 56 experimental datasets to guide practitioners and researchers.

Key findings

  • The survey organizes LLMM applications into medical question-answering, medical dialog summarization, EHR/clinical letter/note generation, scientific research, medical education and translation, medical imaging recognition, clinical health reasoning, medical product safety monitoring and disease diagnosis, clinical decision support, and administrative tasks assistance.
  • It reports that GPT-4 with retrieval-augmented generation (GPT4-RAG) achieved 91.4% accuracy in preoperative guidance, 5.1% higher than human-generated answers at 86.3%, with retrieval in about 1 s and generation in 15–20 s versus human physicians’ average 10 min.
  • For clinical question-answering, ChatGPT reached 87% accuracy without options and 97% in multiple-choice settings on the NEJM “Image Challenge”; GPT-4 achieved 96% accuracy in disease classification with chain-of-thought and few-shot prompts.
  • The paper identifies five challenge areas: data security and privacy preservation, incorrect or misleading information, fairness and bias, transparency/explainability/trustworthiness, and plagiarism/copyright/accountability, with proposed solutions such as de-identification frameworks, references, counterfactually fair prompting, opening and ending control codes, and normative standards.

Methods

  • Survey design: searched Google Scholar and multi-source databases including ACM, Springer, Elsevier, arXiv, and medRxiv for papers from January 2022 to January 2024, focusing on models after ChatGPT’s November 2022 launch and parameters exceeding 10^9.
  • Search strategy: combined application domains (“medical,” “clinical,” “healthcare”) with specific LLM names such as ChatGPT, LLaMA, and PaLM; reviewed titles, abstracts, and keywords, excluded papers without specific medical/healthcare LLMs, and included articles from review papers, arriving at 175 papers.
  • Analysis: categorized applications, compiled 56 experimental datasets, summarized evaluation metrics (e.g., ROUGE, BERTScore, BLEU, accuracy, precision, recall, F1-score, MCC, AUM, AKCM, ASRE), and compared state-of-the-art LLMM performance across tasks.

Limitations

  • The paper states that LLMMs face data security and privacy risks, inaccurate or fabricated information, fairness and bias, limited transparency/explainability/trustworthiness, and plagiarism/copyright/accountability concerns.
  • It notes that extensive training of LLMMs is typically based on English-related datasets, causing lack of medical knowledge and poor performance on Chinese tasks such as disease diagnosis, drug recommendation, and clinical decision support.
  • The text also makes evident that the survey is not a systematic review with a formal PRISMA-style protocol, and several sections appear truncated or garbled, limiting reproducibility of the search and synthesis process.

Model-written summary. Check it against the paper before relying on it.

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Registry

Crossref · 10.1007/s10462-024-10921-0

Cites

129 of 129 references verified0 citation errors · 0 not checkable

Statistics

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Verification

Claims the paper makes

85 Not checked yet · 12 Own interpretation · 9 Own result · 6 Own method · 6 No basis given · 1 Partly supported · accuracy not yet measured

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  • Probably not a substantial claim. 33
  • It may state two separate claims as one. 45
  • The quote only partly states this claim. 5
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  • The paper relies on this without support.

    Advanced LLMs do not perform well in Chinese medical question-answering systems because most LLMs are trained on English corpora.

    “However, since most LLMs are trained and learned from English corpora, advanced LLMs do not perform well in Chinese medical question-answering systems.”
  • The paper relies on this without support.

    GPT-4 exhibits superior problem-solving capabilities and an expansive knowledge base compared to ChatGPT.

    “In comparison to ChatGPT, GPT-4 exhibits superior problem-solving capabilities and an expansive knowledge base.”
  • The paper relies on this without support.

    Models such as ChatGPT and GPT-4 can serve as virtual educational companions in rehabilitation.

    “Models such as ChatGPT and GPT-4 can serve as virtual educational companions in rehabilitation.”
  • The paper relies on this without support.

    The LLMs have been trained to recognize and analyze medical images, including x-rays, MRI, and ultrasound.

    “The LLMs have been trained to recognize and analyze medical images, including x-rays, magnetic resonance imaging (MRI), and ultrasound.”
  • The paper relies on this without support.

    These models can interpret features and structures within images, assisting physicians in accurately and rapidly identifying abnormalities, diagnosing diseases, and injuries.

    “These models can interpret features and structures within images, assisting physicians in accurately and rapidly identifying abnormalities, diagnosing diseases, and injuries.”
  • The paper relies on this without support.

    The integration of LLMs can enhance radiologists' interpretive skills, facilitate communication between physicians and patients, and streamline workflow in clinical settings, particularly in hospitals.

    “The integration of LLMs can enhance radiologists' interpretive skills, facilitate communication between physicians and patients, and streamline workflow in clinical settings, particularly in hospitals.”
  • The paper relies on this without support.

    For medical device manufacturers, LLMs can serve as a valuable tool for analyzing user feedback and technical documents, providing insights that inform device development.

    “For medical device manufacturers, LLMs can serve as a valuable tool for analyzing user feedback and technical documents, providing insights that inform device development.”
  • The paper relies on this without support.

    For health insurance companies and providers, LLMs can process and analyze large datasets to identify potential fraud patterns and anomalies, offering tools for insurers to prevent fraud.

    “For health insurance companies and providers, LLMs can process and analyze large datasets to identify potential fraud patterns and anomalies, offering tools for insurers to prevent fraud.”
  • The paper relies on this without support.

    LLMs can address policyholders' queries, provide personalized recommendations to enhance customer experience, and ensure delivery of accurate and valuable information.

    “Additionally, LLMs can address policyholders' queries, provide personalized recommendations to enhance customer experience, and ensure the delivery of accurate and valuable information.”
  • The paper relies on this without support.

    For regulatory bodies, LLMs can strengthen the regulatory review process and assist in detailed scrutiny of medical product submissions.

    “For regulatory bodies, LLMs can strengthen the regulatory review process and assist in the detailed scrutiny of medical product submissions.”
  • The paper relies on this without support.

    Public health authorities can utilize the analytical capabilities of these models to analyze health data, identify disease trends and patterns, and significantly enhance disease surveillance, informing disease control and prevention strategies.

    “Public health authorities can utilize the analytical capabilities of these models to analyze health data, identify disease trends and patterns, and significantly enhance disease surveillance, informing disease control and prevention strategies.”
  • The paper relies on this without support.

    Due to the constrained scope and diversity of clinical trials for novel pharmaceuticals, comprehensive pre-market safety and efficacy assessments are often unattainable.

    “Due to the constrained scope and diversity of clinical trials for novel pharmaceuticals, comprehensive pre-market safety and efficacy assessments are often unattainable.”
  • The paper relies on this without support.

    Virtual mental health assistants are not suitable for use as diagnostic tools because they lack the ability to adhere to essential safety constraints and the professional clinical process knowledge required for accurate diagnosis.

    “However, these assistants are not suitable for use as diagnostic tools because they lack the ability to adhere to essential safety constraints and the professional clinical process knowledge required for accurate diagnosis.”
  • The paper relies on this without support.

    Despite growing interest among scholars and medical professionals in leveraging LLMs in healthcare, the examination and appraisal of their practical application and safety in clinical contexts remain limited.

    “Despite growing interest among scholars and medical professionals in leveraging LLMs in healthcare, the examination and appraisal of their practical application and safety in clinical contexts remain limited.”
  • The paper relies on this without support.

    There is currently a scarcity of data employing large-scale electronic health records (EHR) to assess the performance of LLMs and their utility in providing clinical diagnostic assistance to patients.

    “Despite the exemplary performance of ChatGPT and GPT-4 models in various medical tasks, there is currently a scarcity of data employing large-scale electronic health records (EHR) to assess the performance of LLMs and their utility in providing clinical diagnostic assistance to patients.”
  • The paper relies on this without support.

    The extensive training of LLMMs is typically based on English-related datasets, resulting in a lack of medical knowledge, which can lead to poor performance in tasks such as disease diagnosis, drug recommendation, and clinical decision support.

    “However, the extensive training of LLMMs is typically based on English-related datasets, resulting in a lack of medical knowledge, which can lead to poor performance in tasks such as disease diagnosis, drug recommendation, and clinical decision support.”
  • The paper relies on this without support.

    Existing medical datasets based on English corpora present challenges for conducting accurate experimental analyses of LLMMs on Chinese tasks.

    “Existing medical datasets based on English corpora present challenges for conducting accurate experimental analyses of LLMMs on Chinese tasks.”
  • The paper relies on this without support.

    Medical reports may inadvertently reveal private and demographic details of patient records.

    “Medical reports may inadvertently reveal private and demographic details of patient records.”
  • The paper relies on this without support.

    The training data of LLMs typically comes from institutions in high-income, English-speaking countries, which may severely limit the representativeness of viewpoints from other regions of the world.

    “The training data of LLMs typically comes from institutions in high-income, English-speaking countries, which may severely limit the representativeness of viewpoints from other regions of the world.”
  • The paper relies on this without support.

    The discrepancy between the model's output and the diagnoses of seasoned medical professionals can engender structural bias and inequitable treatment.

    “The discrepancy between the model's output and the diagnoses of seasoned medical professionals can engender structural bias and inequitable treatment.”
  • The paper relies on this without support.

    LLMs suffer from a lack of transparency, hindering their efficiency in assisting humans with complex tasks.

    “Despite their impressive potential in performing various simple tasks, LLMs suffer from a lack of transparency, hindering their efficiency in assisting humans with complex tasks.”
  • The paper relies on this without support.

    A significant challenge for healthcare practitioners is the absence of guidelines for assessing whether LLM outputs align with social norms and regulations.

    “A significant challenge for healthcare practitioners is the absence of guidelines for assessing whether LLM outputs align with social norms and regulations.”
  • The paper relies on this without support.

    As LLMs become more advanced, they are increasingly susceptible to generating harmful or inappropriate content, such as hallucinations, spam, sexist, and racist hate speech.

    “As LLMs become more advanced, they are increasingly susceptible to generating harmful or inappropriate content, such as hallucinations, spam, sexist, and racist hate speech.”
  • The paper relies on this without support.

    These models may also produce responses that sound plausible yet are incorrect or absurd.

    “These models may also produce responses that sound plausible yet are incorrect or absurd.”
  • The paper relies on this without support.

    The Health Insurance Portability and Accountability Act (HIPAA) mandates patient confidentiality and privacy, stipulating that medical records must be sanitized of sensitive information before dissemination.

    “The Health Insurance Portability and Accountability Act (HIPAA) mandates patient confidentiality and privacy, stipulating that medical records must be sanitized of sensitive information before dissemination.”
  • The paper relies on this without support.

    While rule-based and machine learning-based deidentification methods have been extensively implemented in practice, they remain limited in their versatility and effectiveness across diverse scenarios.

    “While rule-based and machine learning-based deidentification methods have been extensively implemented in practice, they remain limited in their versatility and effectiveness across diverse scenarios.”
  • The paper relies on this without support.

    Recent research has revealed a strong correlation between job opportunities and male job seekers, a correlation between negative emotions and the black race, and a correlation between positive emotions and the Asian race.

    “Recent research has revealed a strong correlation between job opportunities and male job seekers, a correlation between negative emotions and the black race, and a correlation between positive emotions and the Asian race.”
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Citations

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Metadata

Authors
Wang, D., & Zhang, S.
Affiliations
Taizhou University (CN)
Corresponding author
Zhang, Shiqing
Venue
Artificial Intelligence Review
Published
2024-09-20
Volume
57
Issue
11
ISSN
  • 0269-2821 (ISSN-L)
  • 1573-7462
OpenAlex
W4402692877
Cited by
246
References
122
Citations by year
2026: 124 · 2025: 119 · 2024: 3
FWCI
23.05
Type
journal article
Language
en
Open access
Locations
Artificial Intelligence Review (publishedVersion, cc-by-nc-nd)
Funders
  • Natural Science Foundation of Zhejiang Province (LQ24F020014)
  • The Project of Zhejiang Province's Educational Science Planning (2024SCG176)
  • National Natural Science Foundation of China (62276180)
Topics
  • Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
  • Physical Sciences › Computer Science › Artificial Intelligence › Machine Learning in Healthcare
  • Physical Sciences › Computer Science › Artificial Intelligence › Topic Modeling
Keywords
large language models, medical applications, medical question answering, medical education, clinical decision support, clinical reasoning, data security, algorithmic bias, de-identification, accountability

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