Farhad Abtahi

Abdolamir Karbalaie, Fernando Seoane, Farhad Abtahi

Ambient AI "scribe" systems promise to reduce clinical documentation burden, but automatic speech recognition (ASR) errors can remain unnoticed without careful review, and high-quality human reference transcripts are often unavailable for calibrating uncertainty. We investigate whether cross-model disagreement among heterogeneous ASR systems can act as a reference-free uncertainty signal to prioritize human verification in medical transcription workflows. Using 50 publicly available medical education audio clips (8 h 14 min), we transcribed each clip with eight ASR systems spanning commercial APIs and open-source engines. We aligned multi-model outputs, built consensus pseudo-references, and quantified token-level agreement using a majority-strength metric; we further characterized disagreements by type (content vs. punctuation/formatting) and assessed per-model agreement via leave-one-model-out (jackknife) consensus scoring. Inter-model reliability was low (ICC[2,1] = 0.131), indicating heterogeneous failure modes across systems. Across 76,398 evaluated token positions, 72.1% showed near-unanimous agreement (7-8 models), while 2.5% fell into high-risk bands (0-3 models), with high-risk mass varying from 0.7% to 11.4% across accent groups. Low-agreement regions were enriched for content disagreements, with the content fraction increasing from 53.9% to 73.9% across quintiles of high-risk mass. These results suggest that cross-model disagreement provides a sparse, localizable signal that can surface potentially unreliable transcript spans without human-verified references, enabling targeted review; clinical accuracy of flagged regions remains to be established.

Farhad Abtahi, Abdolamir Karbalaie, Eduardo Illueca-Fernandez et al.

Metacognition, the ability to monitor and regulate one's own reasoning, remains under-evaluated in AI benchmarking. We introduce MEDLEY-BENCH, a benchmark of behavioural metacognition that separates independent reasoning, private self-revision, and socially influenced revision under genuine inter-model disagreement. The benchmark evaluates 35 models from 12 families on 130 ambiguous instances across five domains and reports two complementary scores: the Medley Metacognition Score (MMS), a tier-based aggregate of reflective updating, social robustness, and epistemic articulation, and the Medley Ability Score (MAS), derived from four metacognitive sub-abilities. Results show a robust evaluation/control dissociation: evaluation ability increases with model size within families, whereas control does not. In a follow-up progressive adversarial analysis of 11 models, we observed two behavioural profiles, i.e., models that revise primarily in response to argument quality and models that track consensus statistics. Under within-model relative profiling (ipsative scoring), evaluation was the weakest relative ability in all 35 models, indicating a systematic knowing/doing gap. Smaller and cheaper models often matched or outperformed larger counterparts, suggesting that metacognitive competence is not simply a function of scale. These findings position MEDLEY-BENCH as a tool for measuring belief revision under social pressure and suggest that future training should reward calibrated, proportional updating rather than output quality alone.

Fardin Afdideh, Mehdi Astaraki, Fernando Seoane et al.

Machine learning systems deployed in medical devices require governance frameworks that ensure safety while enabling continuous improvement. Regulatory bodies including the FDA and European Union have introduced mechanisms such as the Predetermined Change Control Plan (PCCP) and Post-Market Surveillance (PMS) to manage iterative model updates without repeated submissions. This paper presents AI/ML Evaluation and Governance Infrastructure for Safety (AEGIS), a governance framework applicable to any healthcare AI system. AEGIS comprises three modules, i.e., dataset assimilation and retraining, model monitoring, and conditional decision, that operationalize FDA PCCP and EU AI Act Article 43(4) provisions. We implement a four-category deployment decision taxonomy (APPROVE, CONDITIONAL APPROVAL, CLINICAL REVIEW, REJECT) with an independent PMS ALARM signal, enabling detection of the critical state in which no deployable model exists while the released model is simultaneously at risk. To illustrate how AEGIS can be instantiated across heterogeneous clinical contexts, we provide two examples: sepsis prediction from electronic health records and brain tumor segmentation from medical imaging. Both cases use identical governance architecture, differing only in configuration. Across 11 simulated iterations on the sepsis example, AEGIS yielded 8 APPROVE, 1 CONDITIONAL APPROVAL, 1 CLINICAL REVIEW, and 1 REJECT decision, exercising all four categories. ALARM signals were co-issued at iterations 8 and 10, including the critical state where no deployable model exists and the released model is simultaneously failing. AEGIS detected drift before observable performance degradation. These results demonstrate that AEGIS translates regulatory change-control concepts into executable governance procedures, supporting safe continuous learning for adaptive medical AI across diverse clinical applications.

Farhad Abtahi, Fernando Seoane, Iván Pau et al.

Healthcare AI systems face major vulnerabilities to data poisoning that current defenses and regulations cannot adequately address. We analyzed eight attack scenarios in four categories: architectural attacks on convolutional neural networks, large language models, and reinforcement learning agents; infrastructure attacks exploiting federated learning and medical documentation systems; critical resource allocation attacks affecting organ transplantation and crisis triage; and supply chain attacks targeting commercial foundation models. Our findings indicate that attackers with access to only 100-500 samples can compromise healthcare AI regardless of dataset size, often achieving over 60 percent success, with detection taking an estimated 6 to 12 months or sometimes not occurring at all. The distributed nature of healthcare infrastructure creates many entry points where insiders with routine access can launch attacks with limited technical skill. Privacy laws such as HIPAA and GDPR can unintentionally shield attackers by restricting the analyses needed for detection. Supply chain weaknesses allow a single compromised vendor to poison models across 50 to 200 institutions. The Medical Scribe Sybil scenario shows how coordinated fake patient visits can poison data through legitimate clinical workflows without requiring a system breach. Current regulations lack mandatory adversarial robustness testing, and federated learning can worsen risks by obscuring attribution. We recommend multilayer defenses including required adversarial testing, ensemble-based detection, privacy-preserving security mechanisms, and international coordination on AI security standards. We also question whether opaque black-box models are suitable for high-stakes clinical decisions, suggesting a shift toward interpretable systems with verifiable safety guarantees.

Farhad Abtahi, Mehdi Astaraki, Fernando Seoane

Bias in medical artificial intelligence is conventionally viewed as a defect requiring elimination. However, human reasoning inherently incorporates biases shaped by education, culture, and experience, suggesting their presence may be inevitable and potentially valuable. We propose MEDLEY (Medical Ensemble Diagnostic system with Leveraged diversitY), a conceptual framework that orchestrates multiple AI models while preserving their diverse outputs rather than collapsing them into a consensus. Unlike traditional approaches that suppress disagreement, MEDLEY documents model-specific biases as potential strengths and treats hallucinations as provisional hypotheses for clinician verification. A proof-of-concept demonstrator was developed using over 30 large language models, creating a minimum viable product that preserved both consensus and minority views in synthetic cases, making diagnostic uncertainty and latent biases transparent for clinical oversight. While not yet a validated clinical tool, the demonstration illustrates how structured diversity can enhance medical reasoning under clinician supervision. By reframing AI imperfection as a resource, MEDLEY offers a paradigm shift that opens new regulatory, ethical, and innovation pathways for developing trustworthy medical AI systems.

Eduardo Illueca-Fernandez, Kaile Chen, Fernando Seoane et al.

Process mining has emerged as a powerful analytical technique for understanding complex healthcare workflows. However, its application faces significant barriers, including technical complexity, a lack of standardized approaches, and limited access to practical training resources. We introduce HealthProcessAI, a GenAI framework designed to simplify process mining applications in healthcare and epidemiology by providing a comprehensive wrapper around existing Python (PM4PY) and R (bupaR) libraries. To address unfamiliarity and improve accessibility, the framework integrates multiple Large Language Models (LLMs) for automated process map interpretation and report generation, helping translate technical analyses into outputs that diverse users can readily understand. We validated the framework using sepsis progression data as a proof-of-concept example and compared the outputs of five state-of-the-art LLM models through the OpenRouter platform. To test its functionality, the framework successfully processed sepsis data across four proof-of-concept scenarios, demonstrating robust technical performance and its capability to generate reports through automated LLM analysis. LLM evaluation using five independent LLMs as automated evaluators revealed distinct model strengths: Claude Sonnet-4 and Gemini 2.5-Pro achieved the highest consistency scores (3.79/4.0 and 3.65/4.0) when evaluated by automated LLM assessors. By integrating multiple Large Language Models (LLMs) for automated interpretation and report generation, the framework addresses widespread unfamiliarity with process mining outputs, making them more accessible to clinicians, data scientists, and researchers. This structured analytics and AI-driven interpretation combination represents a novel methodological advance in translating complex process mining results into potentially actionable insights for healthcare applications.