{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T17:57:56Z","timestamp":1778003876572,"version":"3.51.4"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"DOI":"10.13039\/501100001349","name":"National Medical Research Council","doi-asserted-by":"publisher","award":["HCSAINV22jul-0002"],"award-info":[{"award-number":["HCSAINV22jul-0002"]}],"id":[{"id":"10.13039\/501100001349","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["npj Digit. Med."],"DOI":"10.1038\/s41746-025-01858-x","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T23:07:45Z","timestamp":1753139265000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Clinical and economic impact of a large language model in perioperative medicine: a randomized crossover trial"],"prefix":"10.1038","volume":"8","author":[{"given":"Yu He","family":"Ke","sequence":"first","affiliation":[]},{"given":"Bernard Soon","family":"Yang Ong","sequence":"additional","affiliation":[]},{"given":"Liyuan","family":"Jin","sequence":"additional","affiliation":[]},{"given":"Jacqueline Xiu Ling","family":"Sim","sequence":"additional","affiliation":[]},{"given":"Chi Ho","family":"Chan","sequence":"additional","affiliation":[]},{"given":"Chai Rick","family":"Soh","sequence":"additional","affiliation":[]},{"given":"Danny Jon Nian","family":"Wong","sequence":"additional","affiliation":[]},{"given":"Nan","family":"Liu","sequence":"additional","affiliation":[]},{"given":"Ban Leong","family":"Sng","sequence":"additional","affiliation":[]},{"given":"Daniel Shu Wei","family":"Ting","sequence":"additional","affiliation":[]},{"given":"Su Qian","family":"Yeo","sequence":"additional","affiliation":[]},{"given":"Marcus Eng Hock","family":"Ong","sequence":"additional","affiliation":[]},{"given":"Hairil Rizal","family":"Abdullah","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2025,7,21]]},"reference":[{"key":"1858_CR1","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1111\/j.1445-2197.2009.05019.x","volume":"79","author":"V Haana","year":"2009","unstructured":"Haana, V., Sethuraman, K., Stephens, L., Rosen, H. & Meara, J. G. Case cancellations on the day of surgery: an investigation in an Australian paediatric hospital. ANZ J. Surg. 79, 636\u2013640 (2009).","journal-title":"ANZ J. Surg."},{"key":"1858_CR2","doi-asserted-by":"crossref","unstructured":"Koushan, M., Wood, L. C. & Greatbanks, R. Evaluating factors associated with the cancellation and delay of elective surgical procedures: a systematic review. Int. J. Qual. Health Care 33, mzab092 (2021).","DOI":"10.1093\/intqhc\/mzab092"},{"key":"1858_CR3","doi-asserted-by":"crossref","unstructured":"Thirunavukarasu, A. J. et al. Large language models in medicine. Nat. Med. 29, 1930\u20131940 (2023).","DOI":"10.1038\/s41591-023-02448-8"},{"key":"1858_CR4","doi-asserted-by":"crossref","unstructured":"Ke, Y. H. et al. Development and testing of retrieval augmented generation in large language models\u2014a case study report. arXiv:https:\/\/arxiv.org\/abs\/2402.01733 (2024).","DOI":"10.2139\/ssrn.4719185"},{"key":"1858_CR5","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1038\/s41746-025-01519-z","volume":"8","author":"YH Ke","year":"2025","unstructured":"Ke, Y. H. et al. Retrieval augmented generation for 10 large language models and its generalizability in assessing medical fitness. NPJ Digit. Med. 8, 187 (2025).","journal-title":"NPJ Digit. Med."},{"key":"1858_CR6","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2023.06.052","author":"DYZ Lim","year":"2023","unstructured":"Lim, D. Y. Z. et al. Large language models in anaesthesiology: use of ChatGPT for American Society of Anesthesiologists physical status classification. Br. J. Anaesth. https:\/\/doi.org\/10.1016\/j.bja.2023.06.052 (2023).","journal-title":"Br. J. Anaesth."},{"key":"1858_CR7","doi-asserted-by":"publisher","first-page":"111582","DOI":"10.1016\/j.jclinane.2024.111582","volume":"98","author":"N Ismaiel","year":"2024","unstructured":"Ismaiel, N. et al. The evaluation of the performance of ChatGPT in the management of labor analgesia. J. Clin. Anesth. 98, 111582 (2024).","journal-title":"J. Clin. Anesth."},{"key":"1858_CR8","doi-asserted-by":"publisher","first-page":"111475","DOI":"10.1016\/j.jclinane.2024.111475","volume":"96","author":"E\u0130 Turan","year":"2024","unstructured":"Turan, E. \u0130, Baydemir, A. E., \u00d6zcan, F. G. & \u015eahin, A. S. Evaluating the accuracy of ChatGPT-4 in predicting ASA scores: A prospective multicentric study ChatGPT-4 in ASA score prediction. J. Clin. Anesth. 96, 111475 (2024).","journal-title":"J. Clin. Anesth."},{"key":"1858_CR9","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-019-0935-4","volume":"19","author":"X Yang","year":"2019","unstructured":"Yang, X. et al. A study of deep learning methods for de-identification of clinical notes in cross-institute settings. BMC Med. Inform. Decis. Mak. 19, 232 (2019).","journal-title":"BMC Med. Inform. Decis. Mak."},{"key":"1858_CR10","doi-asserted-by":"publisher","first-page":"e186040","DOI":"10.1001\/jamanetworkopen.2018.6040","volume":"1","author":"L Na","year":"2018","unstructured":"Na, L. et al. Feasibility of reidentifying individuals in large national physical activity data sets from which protected health information has been removed with use of machine learning. JAMA Netw. Open 1, e186040 (2018).","journal-title":"JAMA Netw. Open"},{"key":"1858_CR11","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/j.medj.2023.02.008","volume":"4","author":"RS Goodman","year":"2023","unstructured":"Goodman, R. S. et al. On the cusp: considering the impact of artificial intelligence language models in healthcare. Med4, 139\u2013140 (2023).","journal-title":"Med"},{"key":"1858_CR12","unstructured":"Government of Singapore. Pair Website https:\/\/www.tech.gov.sg\/products-and-services\/for-government-agencies\/productivity-and-marketing\/pair."},{"key":"1858_CR13","unstructured":"Government of Singapore. Health Sciences Authority Website https:\/\/www.hsa.gov.sg\/medical-devices\/."},{"key":"1858_CR14","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1038\/s41586-023-06291-2","volume":"620","author":"K Singhal","year":"2023","unstructured":"Singhal, K. et al. Large language models encode clinical knowledge. Nature 620, 172\u2013180 (2023).","journal-title":"Nature"},{"key":"1858_CR15","doi-asserted-by":"publisher","first-page":"928","DOI":"10.1001\/jamasurg.2024.1621","volume":"159","author":"P Chung","year":"2024","unstructured":"Chung, P. et al. Large language model capabilities in perioperative risk prediction and prognostication. JAMA Surg. 159, 928\u2013937 (2024).","journal-title":"JAMA Surg."},{"key":"1858_CR16","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2024.10.042","author":"JJ Woo","year":"2024","unstructured":"Woo, J. J. et al. Custom Large Language Models improve accuracy: Comparing Retrieval Augmented Generation and Artificial Intelligence agents to non-custom models for evidence-based medicine. Arthroscopy https:\/\/doi.org\/10.1016\/j.arthro.2024.10.042 (2024).","journal-title":"Arthroscopy"},{"key":"1858_CR17","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1038\/s41746-024-01315-1","volume":"7","author":"E Klang","year":"2024","unstructured":"Klang, E. et al. A strategy for cost-effective large language model use at health system-scale. NPJ Digit. Med. 7, 320 (2024).","journal-title":"NPJ Digit. Med."},{"key":"1858_CR18","doi-asserted-by":"crossref","unstructured":"Li, Z., Li, C., Zhang, M., Mei, Q. & Bendersky, M. Retrieval Augmented Generation or long-context LLMs? A comprehensive study and hybrid approach. arXiv:https:\/\/arxiv.org\/abs\/2407.16833 (2024).","DOI":"10.18653\/v1\/2024.emnlp-industry.66"},{"key":"1858_CR19","doi-asserted-by":"publisher","first-page":"100220","DOI":"10.1016\/j.joitmc.2024.100220","volume":"10","author":"YJ Kim","year":"2024","unstructured":"Kim, Y. J., Choi, J. H. & Fotso, G. M. N. Medical professionals\u2019 adoption of AI-based medical devices: UTAUT model with trust mediation. J. Open Innov. 10, 100220 (2024).","journal-title":"J. Open Innov."},{"key":"1858_CR20","doi-asserted-by":"publisher","first-page":"205","DOI":"10.2147\/MDER.S43369","volume":"7","author":"J Bergsland","year":"2014","unstructured":"Bergsland, J., Elle, O. J. & Fosse, E. Barriers to medical device innovation. Med. Devices 7, 205\u2013209 (2014).","journal-title":"Med. Devices"},{"key":"1858_CR21","doi-asserted-by":"publisher","first-page":"100330","DOI":"10.1016\/j.smhl.2022.100330","volume":"26","author":"S Renukappa","year":"2022","unstructured":"Renukappa, S., Mudiyi, P., Suresh, S., Abdalla, W. & Subbarao, C. Evaluation of challenges for adoption of smart healthcare strategies. Smart Health 26, 100330 (2022).","journal-title":"Smart Health"},{"key":"1858_CR22","doi-asserted-by":"publisher","DOI":"10.2196\/51580","volume":"25","author":"K Giannakopoulos","year":"2023","unstructured":"Giannakopoulos, K., Kavadella, A., Aaqel Salim, A., Stamatopoulos, V. & Kaklamanos, E. G. Evaluation of the performance of generative AI large language models ChatGPT, Google Bard, and Microsoft Bing Chat in supporting evidence-based dentistry: comparative mixed methods study. J. Med. Internet Res. 25, e51580 (2023).","journal-title":"J. Med. Internet Res."},{"key":"1858_CR23","doi-asserted-by":"publisher","first-page":"1491","DOI":"10.3390\/diagnostics14141491","volume":"14","author":"SA Haider","year":"2024","unstructured":"Haider, S. A. et al. Evaluating large language model (LLM) performance on established breast classification systems. Diagnostics14, 1491 (2024).","journal-title":"Diagnostics"},{"key":"1858_CR24","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1177\/0310057X221114900","volume":"51","author":"XL Sim","year":"2023","unstructured":"Sim, X. L. et al. Transforming the perioperative medicine care model: the Singapore experience. Anaesth. Intensive Care 51, 96\u2013106 (2023).","journal-title":"Anaesth. Intensive Care"},{"key":"1858_CR25","unstructured":"Xiao, G. et al. DuoAttention: efficient long-context LLM inference with retrieval and Streaming Heads. ArXiv: https:\/\/arxiv.org\/abs\/2410.10819 (2024)."},{"key":"1858_CR26","unstructured":"Peng, H. et al. When does in-context learning fall short and why? A study on specification-heavy tasks. arXiv:https:\/\/arxiv.org\/abs\/2311.08993 (2023)."},{"key":"1858_CR27","unstructured":"Anthropic PBC. Anthropic Website. https:\/\/www.anthropic.com\/."},{"key":"1858_CR28","doi-asserted-by":"crossref","unstructured":"Godbole, A., George, J. G. & Shandilya, S. Leveraging long-context Large Language Models for multi-document understanding and summarization in enterprise applications. arXiv:https:\/\/arxiv.org\/abs\/2409.18454 (2024).","DOI":"10.20944\/preprints202409.1734.v1"},{"key":"1858_CR29","doi-asserted-by":"publisher","DOI":"10.2196\/50638","volume":"25","author":"B Mesk\u00f3","year":"2023","unstructured":"Mesk\u00f3, B. Prompt engineering as an important emerging skill for medical professionals: tutorial. J. Med. Internet Res. 25, e50638 (2023).","journal-title":"J. Med. Internet Res."},{"key":"1858_CR30","doi-asserted-by":"publisher","first-page":"319","DOI":"10.2307\/249008","volume":"13","author":"FD Davis","year":"1989","unstructured":"Davis, F. D. Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Q 13, 319 (1989).","journal-title":"MIS Q"},{"key":"1858_CR31","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.jval.2021.10.008","volume":"25","author":"D Husereau","year":"2022","unstructured":"Husereau, D. et al. Consolidated health economic evaluation reporting standards (cheers) 2022 explanation and elaboration: a report of the ISPOR CHEERS II Good Practices Task Force. Value Health 25, 10\u201331 (2022).","journal-title":"Value Health"}],"container-title":["npj Digital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-01858-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-01858-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-01858-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T17:03:51Z","timestamp":1757264631000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41746-025-01858-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,21]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1858"],"URL":"https:\/\/doi.org\/10.1038\/s41746-025-01858-x","relation":{},"ISSN":["2398-6352"],"issn-type":[{"value":"2398-6352","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,21]]},"assertion":[{"value":"27 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"462"}}