Upholding the Maxim of Relevance during Patient-Centered Activities

摘要

This paper addresses "kinds and focuses of relevance" that a language-generating clinical decision-support system should adhere to during activities in which a health care provider's attention is on his or her patient and not on a computer screen. During such "patient-centered" activities, utterances generated by a computer system intrude on patient management. They must be thus seen by HCPs as having immediate clinical relevance, or, like the continual ringing of ICU monitors, they will be ignored. This paper describes how plan recognition and plan evaluation can be used to achieve clinical relevance. The work is being done in the context of the TraumAID project, whose overall goal is to improve delivery of quality trauma care during the initial definitive phase of patient management. Given an early pilot study that showed that physicians using TraumAID disliked the continuous presentation of its entire management plan, we decided to explore how TraumAID could restrict commentary to only those situations in which a comment could make a clinically significant difference to patient management. We took advantage of the fact that actions that involve resources that need to be brought to the trauma bay or that can only be done elsewhere must be ordered. Since orders can be rescinded, comments pointing out problems with an order can potentially make a clinically significant difference to patient management. The contributions of this paper are (1) pointing out additional constraints on language generation raised by the desire to convey information to listeners attending to something other than an computer terminal, and (2) pointing out some features of plan inference and evaluation raised by multiple goal planning in a complex domain.