医疗信息技术的三代发展：从数字记录到可计算护理流程
Three Generations of Healthcare IT: From the Digital Record to the Computable Care Process
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中文总结 AI 辅助
本文按系统可计算信息单元划分医疗IT，提出以患者临床意图为对象的计算层，将ACR形式化为该层原子对象，其与FHIR等互补，为可计算临床意图研究提供可复用构建块。
中文摘要 AI 辅助
目标：医疗信息技术通常按其采用的技术进行组织，而本文则按系统可计算的信息单元对其进行组织，并描述了一个以患者特定临床意图为对象的计算层。方法：本文给出了计算层的标准，推导了三个层级（记录、临床状态以及本文提出的意图层），并将可操作临床记录（ACR）形式化为第三层的原子对象。讨论：该框架区分了规定、观察和意图流程；现有标准在意图结构化后会对其进行表示，但无法从自然交流中恢复意图，而本文所定位的正是这一能力。ACR与FHIR工作流资源、指南及流程挖掘互为补充；一项配套可行性研究表明，其在一个狭窄子问题上具有可处理性。结论：可计算临床意图是一个连贯的研究方向；ACR及其就绪度阶梯、可执行正确性评估框架是可复用的构建块，可供后续研究用于扩展、评估或证伪。
英文摘要
Objective. Healthcare IT is usually organized by the technologies it adopts. We instead organize it by the unit of information a system makes computable, and describe a computational layer whose object is patient-specific clinical intent. Approach. We give criteria for a computational layer, derive three (record, clinical state, and a proposed layer of intent), and formalize the Actionable Clinical Record (ACR) as the atomic object of the third layer. Discussion. The framework distinguishes prescribed, observed, and intended process; existing standards represent intent once it is structured but do not recover it from natural communication, the capability we localize. The ACR is complementary to FHIR workflow resources, guidelines, and process mining; a companion feasibility study illustrates tractability for one narrow subproblem. Conclusion. Computable clinical intent is a coherent research direction; the ACR, its readiness ladder, and an executable-correctness evaluation framework are reusable constructs for subsequent work to extend, evaluate, or falsify.
