Engineering of Generative Artificial Intelligence and Natural Language Processing Models to Accurately Identify Arrhythmia Recurrence

BACKGROUND: Large language models (LLMs) such as Chat Generative Pre-trained Transformer (ChatGPT) excel at interpreting unstructured data from public sources, yet are limited when responding to queries on private repositories, such as electronic health records (EHRs). We hypothesized that prompt engineering could enhance the accuracy of LLMs for interpreting EHR data without requiring domain knowledge, thus expanding their utility for patients and personalized diagnostics. METHODS: We designed and systematically tested prompt engineering techniques to improve the ability of LLMs to interpret EHRs for nuanced diagnostic questions, referenced to a panel of medical experts. In 490 full-text EHR notes from 125 patients with prior life-threatening heart rhythm disorders, we asked GPT-4-turbo to identify recurrent arrhythmias distinct from prior events and tested 220 563 queries. To provide context, results were compared with rule-based natural language processing and Bidirectional Encoder Representations from Transformer-based language models. Experiments were repeated for 2 additional LLMs. Results were consistent for GPT-3.5-turbo and Jurassic-2 LLMs. CONCLUSIONS: The use of prompt engineering strategies enables LLMs to identify clinical end points from EHRs with an accuracy that surpassed natural language processing and approximated experts, yet without the need for expert knowledge. These approaches could be applied to LLM queries for other domains, to facilitate automated analysis of nuanced data sets with high accuracy by nonexperts.