Cited by 213Artificial Intelligence in Healthcare and EducationArtificial Intelligence in HealthcareAI in Service Interactions

The DOI matches its Crossref record; 134 of the 143 references it cites were found in a registry or an index; 1 of the 58 sources its claims cite were checked for support.

Foundation metrics for evaluating effectiveness of healthcare conversations powered by generative AI

Open access

Abstract

Generative Artificial Intelligence is set to revolutionize healthcare delivery by transforming traditional patient care into a more personalized, efficient, and proactive process. Chatbots, serving as interactive conversational models, will probably drive this patient-centered transformation in healthcare. Through the provision of various services, including diagnosis, personalized lifestyle recommendations, dynamic scheduling of follow-ups, and mental health support, the objective is to substantially augment patient health outcomes, all the while mitigating the workload burden on healthcare providers. The life-critical nature of healthcare applications necessitates establishing a unified and comprehensive set of evaluation metrics for conversational models. Existing evaluation metrics proposed for various generic large language models (LLMs) demonstrate a lack of comprehension regarding medical and health concepts and their significance in promoting patients’ well-being. Moreover, these metrics neglect pivotal user-centered aspects, including trust-building, ethics, personalization, empathy, user comprehension, and emotional support. The purpose of this paper is to explore state-of-the-art LLM-based evaluation metrics that are specifically applicable to the assessment of interactive conversational models in healthcare. Subsequently, we present a comprehensive set of evaluation metrics designed to thoroughly assess the performance of healthcare chatbots from an end-user perspective. These metrics encompass an evaluation of language processing abilities, impact on real-world clinical tasks, and effectiveness in user-interactive conversations. Finally, we engage in a discussion concerning the challenges associated with defining and implementing these metrics, with particular emphasis on confounding factors such as the target audience, evaluation methods, and prompt techniques involved in the evaluation process.

Overview

AI snapshot

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TL;DR

This perspective paper argues that existing LLM evaluation metrics are inadequate for healthcare chatbots because they miss medical semantics and user-centered concerns such as trust, empathy, ethics, personalization, and hallucination. It proposes a comprehensive set of foundation metrics grouped into accuracy, trustworthiness, empathy, and performance, along with an evaluation framework and discussion of implementation challenges.

Key findings

  • Existing intrinsic metrics such as BLEU and ROUGE rely on surface-form similarity and fail to capture medical concepts, semantics, context, and human-centered aspects; the paper illustrates this with two semantically similar health sentences that scored only 0.39 BLEU and 0.13 ROUGE on a 0–1 scale.
  • Existing extrinsic and multi-metric evaluations remain incomplete for healthcare chatbots, often neglecting empathy, reasoning, up-to-dateness, hallucinations, personalization, relevance, and latency.
  • The paper proposes four user-centered metric groups—accuracy, trustworthiness, empathy, and performance—with submetrics such as groundedness, privacy, bias, emotional support, health literacy, fairness, personalization, memory efficiency, FLOP, token limit, and number of parameters.
  • It identifies three confounding variables for evaluation—user type, domain type, and task type—and presents a framework with models, environment, interface, interacting users, and leaderboard components.

Methods

  • Narrative review and position paper: reviews intrinsic and extrinsic evaluation metrics for LLMs, including general-purpose, health-specific, and multi-metric approaches.
  • Synthesizes a proposed set of healthcare chatbot metrics from the literature, categorizes them into four groups, and maps each metric to healthcare problems and existing benchmarks in Table 2.
  • No empirical data collection, model training, or experimental evaluation is reported; the paper proposes an evaluation framework and discusses challenges and future implementation.

Limitations

  • The paper states that future work is needed to implement the proposed evaluation framework, conduct extensive metric assessment using benchmarks and case studies, and establish unified benchmarks tailored to healthcare chatbots.
  • It discusses challenges including metric associations and correlations, selection of evaluation methods, subjectivity and need for diverse expert annotators, and effects of prompt techniques and model parameters.
  • Evident from the text: the proposed metrics and framework are not empirically validated in this paper, and no sample, dataset, or model evaluation results are reported beyond the illustrative BLEU/ROUGE example.

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Integrity signals

Registry

Crossref · 10.1038/s41746-024-01074-z

Cites

134 of 134 references verified0 citation errors · 0 not checkable

Statistics

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Figures

Fig. 1 An overview of the metrics proposed in the literature. a Existing intrinsic metrics which are categorized into general LLM metrics and Dialog metrics. b Existing extrinsic metrics for both general domain and healthcare-specific evaluations are presented.
Fig. 1 An overview of the metrics proposed in the literature. a Existing intrinsic metrics which are categorized into general LLM metrics and Dialog metrics. b Existing extrinsic metrics for both general domain and healthcare-specific evaluations are presented.CC BY · PubMed Central
Fig. 2 A broad overview of the evaluation process and the role of metrics. Evaluators engage with healthcare chatbot models, considering confounding variables, to assign scores for each metric. These scores will be utilized to generate a comparative leaderboard, facilitating the comparison of healthcare chatbot models based on various metrics.
Fig. 2 A broad overview of the evaluation process and the role of metrics. Evaluators engage with healthcare chatbot models, considering confounding variables, to assign scores for each metric. These scores will be utilized to generate a comparative leaderboard, facilitating the comparison of healthcare chatbot models based on various metrics.CC BY · PubMed Central
Fig. 3 Overview of the four healthcare evaluation metric groups. Accuracy metrics are scored based on domain and task types, trustworthiness metrics are evaluated according to the user type, empathy metrics consider patients needs in evaluation (among the user type), and performance metrics are evaluated based on the three confounding variables. The metrics identify the listed problems of healthcare chatbots. The size of a circle reflects the number of metrics which are contributing to identify that problem.
Fig. 3 Overview of the four healthcare evaluation metric groups. Accuracy metrics are scored based on domain and task types, trustworthiness metrics are evaluated according to the user type, empathy metrics consider patients needs in evaluation (among the user type), and performance metrics are evaluated based on the three confounding variables. The metrics identify the listed problems of healthcare chatbots. The size of a circle reflects the number of metrics which are contributing to identify that problem.CC BY · PubMed Central
Fig. 4 An illustrative high-level representation of an evaluation framework containing five main components: models, environment, interface, interacting users, and leaderboard.
Fig. 4 An illustrative high-level representation of an evaluation framework containing five main components: models, environment, interface, interacting users, and leaderboard.CC BY · PubMed Central

Verification

Claims the paper makes

32 Own interpretation · 24 Not checked yet · 6 No basis given · 1 Supported · 1 Own method

Verify all 57 references — free account

Show all 19 claims

  • Probably not a substantial claim. 41
  • It may state two separate claims as one. 11
45 of 45
  • The paper relies on this without support.

    Healthcare applications are life-critical.

    “Due to the life-critical nature of healthcare applications, using conversational models necessitates establishing a unified and comprehensive set of foundation metrics1 that enable a meticulous evaluation of the models’ performance, capabilities, identification of potential errors, and implementation of effective feedback mechanisms.”
  • The paper relies on this without support.

    Emotional bonds play a vital role in physician–patient communications.

    “Emotional bonds play a vital role in physician–patient communications, but they are often ignored during the development and evaluation of chatbots.”
  • The paper relies on this without support.

    In the healthcare domain, safety and currentness of information are paramount.

    “In particular, in the healthcare domain, where safety and currentness of information are paramount, hallucinations pose a significant concern.”
  • The paper relies on this without support.

    There is scarcity of data and information across various medical domains and categories.

    “In the context of healthcare, the significance of the generalization metric becomes pronounced due to the scarcity of data and information across various medical domains and categories.”
  • The paper relies on this without support.

    Human inquiries may not precisely align with their underlying issues or intent.

    “In healthcare chatbots, where human inquiries may not precisely align with their underlying issues or intent, robustness assumes paramount importance.”
  • The paper relies on this without support.

    The desired level of interpretability for a generated text may vary between a patient and a nurse.

    “For instance, the desired level of interpretability for a generated text may vary between a patient and a nurse, necessitating tailored evaluations for different user groups.”
  • The paper relies on this without support.

    Empathy plays a crucial role in building trust between users and chatbots.

    “Empathy also plays a crucial role in building trust between users and chatbots.”
  • The paper relies on this without support.

    Unempathetic responses can erode trust and credibility in the system.

    “Unempathetic responses can erode trust and credibility in the system, as users may feel unheard, misunderstood, or invalidated.”
  • The paper relies on this without support.

    Low latency ensures prompt and efficient communication, enabling users to obtain timely responses.

    “Low latency ensures prompt and efficient communication, enabling users to obtain timely responses.”
  • The paper relies on this without support.

    Performance metrics may remain invariant concerning the three confounding variables (user type, domain type, and task type).

    “It is important to note that performance metrics may remain invariant concerning the three confounding variables (user type, domain type, and task type).”
10 of 10

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Citations

Cites

Show all 143 references

Research works printed but not linked: 18

  1. Resnik, P. et al. Using intrinsic and extrinsic metrics to evaluate accuracy and facilitation in computer-assisted coding. In Perspectives in Health Information Management Computer Assisted Coding Conference Proceedings (The American Health Information Management Association (AHIMA), 2006).
  2. Zhang*, T., Kishore*, V., Wu*, F., Weinberger, K. Q. & Artzi, Y. Bertscore: evaluating text generation with bert. In International Conference on Learning Representations. (International Conference on Learning Representations (ICLR), 2020).
  3. Napoles, C., Van Durme, B. & Callison-Burch, C. Evaluating sentence compression: Pitfalls and suggested remedies. In Proceedings of the Workshop on Monolingual Text-To-Text Generation, 91–97 (Association for Computational Linguistics, 2011). https://aclanthology.org/volumes/W11-16/.
  4. Zhou, C. et al. Lima: Less is more for alignment. Advances in Neural Information Processing Systems 36 (Neural Information Processing Systems Foundation, Inc. (NeurIPS), 2024).
  5. Devlin, J., Chang, M.-W., Lee, K. & Toutanova, K. BERT: pre-training of deep bidirectional transformers for language understanding. In Proceedings of the 2019 Conference of the North American Chapter of the Association for Computational Linguistics: Human Language Technologies, Volume 1 (Long and Short Papers), 4171–4186 (Association for Computational Linguistics, Minneapolis, 2019).
  6. Hoffmann, J. et al. An empirical analysis of compute-optimal large language model training. In Advances in Neural Information Processing Systems (eds Oh, A. H. et al.) (Neural Information Processing Systems Foundation, Inc. (NeurIPS), 2022).
  7. Text REtrieval Conference (TREC) Home Page — trec.nist.gov. https://trec.nist.gov/. [Accessed 28-07-2023]
  8. Ge, Y. et al. Openagi: When llm meets domain experts. Advances in Neural Information Processing Systems 36 (Neural Information Processing Systems Foundation, Inc. (NeurIPS), 2024).
  9. Wei, J. et al. Finetuned language models are zero-shot learners. In International Conference on Learning Representations (ICLR, 2022).
  10. Radford, A. et al. Language models are unsupervised multitask learners. OpenAI Blog 1, 9 (2019).
  11. Zhang, K. et al. BiomedGPT: a unified and generalist biomedical generative pre-trained transformer for vision, language, and multimodal tasks. Preprint at https://arxiv.org/abs/2305.17100 (2023). · arXiv
  12. Banerjee, S. & Lavie, A. Meteor: an automatic metric for mt evaluation with improved correlation with human judgments. In Proceedings of the ACL Workshop on Intrinsic and Extrinsic Evaluation Measures for Machine Translation and/or Summarization, 65–72 (Association for Computational Linguistics, 2005).
  13. Peng, Y.-S., Tang, K.-F., Lin, H.-T. & Chang, E. Refuel: exploring sparse features in deep reinforcement learning for fast disease diagnosis. Adv. Neural Inf. Process. Syst. 31, (2018).
  14. Hermann, K. M. et al. Teaching machines to read and comprehend. In Proceedings of the 28th International Conference on Neural Information Processing Systems - Volume 1, NIPS’15, 1693–1701 (MIT Press, Cambridge, 2015).
  15. Aryan, A., Nain, A. K., McMahon, A., Meyer, L. A. & Sahota, H. S. The costly dilemma: are large language models the pay-day loans of machine learning? https://abiaryan.com/assets/EMNLP%20Submission_Non-Anon.pdf. (2023).
  16. Yuan, L. et al. Revisiting out-of-distribution robustness in nlp: Benchmarks, analysis, and LLMs evaluations. Advances in Neural Information Processing Systems 36 (Neural Information Processing Systems Foundation, Inc. (NeurIPS), 2024).
  17. Hendrycks, D. et al. Measuring coding challenge competence with APPS. In Thirty-fifth Conference on Neural Information Processing Systems Datasets and Benchmarks Track (Round 2) (Neural Information Processing Systems Foundation, Inc. (NeurIPS), 2021).
  18. Maas, A. et al. Learning word vectors for sentiment analysis. In Proceedings of the 49th Annual Meeting of the Association for Computational Linguistics: Human Language Technologies, 142–150 (Association for Computational Linguistics, 2011).

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Metadata

Authors
Abbasian, M., Khatibi, E., Azimi, I., Oniani, D., Shakeri Hossein Abad, Z., Thieme, A., Sriram, R., Yang, Z., Wang, Y., Lin, B., Gevaert, O., Li, L.-J., Jain, R., & Rahmani, A. M.
Affiliations
  • University of California, Irvine (US)
  • University of Pittsburgh (US)
  • Stanford University (US)
  • National Institute of Standards and Technology (US)
Corresponding author
  • Abbasian, Mahyar
  • Khatibi, Elahe
Venue
npj Digital Medicine
Published
2024-03-29
Volume
7
Issue
1
Pages
82-82
ISSN
2398-6352 (ISSN-L)
OpenAlex
W4393335480
Cited by
213
References
143
Citations by year
2026: 92 · 2025: 83 · 2024: 38
FWCI
4.81
Type
journal article
Language
en
Open access
Locations
  • npj Digital Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • arXiv (Cornell University) (submittedVersion, cc-by)
  • eScholarship (California Digital Library) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • arXiv (Cornell University) (cc-by)
Funders
National Institute of Standards and Technology
Topics
  • Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
  • Health Sciences › Health Professions › Health Information Management › Artificial Intelligence in Healthcare
  • Social Sciences › Business, Management and Accounting › Marketing › AI in Service Interactions
Keywords
generative AI in healthcare, healthcare chatbots, evaluation metrics, large language models, chatbots, patient-centered care, user trust, empathy, emotional support, personalized health recommendations, confounding factors

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