Xiang Lan

Kai He, Rui Mao, Qika Lin et al.

The utilization of large language models (LLMs) in the Healthcare domain has generated both excitement and concern due to their ability to effectively respond to freetext queries with certain professional knowledge. This survey outlines the capabilities of the currently developed LLMs for Healthcare and explicates their development process, with the aim of providing an overview of the development roadmap from traditional Pretrained Language Models (PLMs) to LLMs. Specifically, we first explore the potential of LLMs to enhance the efficiency and effectiveness of various Healthcare applications highlighting both the strengths and limitations. Secondly, we conduct a comparison between the previous PLMs and the latest LLMs, as well as comparing various LLMs with each other. Then we summarize related Healthcare training data, training methods, optimization strategies, and usage. Finally, the unique concerns associated with deploying LLMs in Healthcare settings are investigated, particularly regarding fairness, accountability, transparency and ethics. Our survey provide a comprehensive investigation from perspectives of both computer science and Healthcare specialty. Besides the discussion about Healthcare concerns, we supports the computer science community by compiling a collection of open source resources, such as accessible datasets, the latest methodologies, code implementations, and evaluation benchmarks in the Github. Summarily, we contend that a significant paradigm shift is underway, transitioning from PLMs to LLMs. This shift encompasses a move from discriminative AI approaches to generative AI approaches, as well as a shift from model-centered methodologies to data-centered methodologies. Also, we determine that the biggest obstacle of using LLMs in Healthcare are fairness, accountability, transparency and ethics.

Yucheng Ruan, Xiang Lan, Jingying Ma et al.

Tabular data, a prevalent data type across various domains, presents unique challenges due to its heterogeneous nature and complex structural relationships. Achieving high predictive performance and robustness in tabular data analysis holds significant promise for numerous applications. Influenced by recent advancements in natural language processing, particularly transformer architectures, new methods for tabular data modeling have emerged. Early techniques concentrated on pre-training transformers from scratch, often encountering scalability issues. Subsequently, methods leveraging pre-trained language models like BERT have been developed, which require less data and yield enhanced performance. The recent advent of large language models, such as GPT and LLaMA, has further revolutionized the field, facilitating more advanced and diverse applications with minimal fine-tuning. Despite the growing interest, a comprehensive survey of language modeling techniques for tabular data remains absent. This paper fills this gap by providing a systematic review of the development of language modeling for tabular data, encompassing: (1) a categorization of different tabular data structures and data types; (2) a review of key datasets used in model training and tasks used for evaluation; (3) a summary of modeling techniques including widely-adopted data processing methods, popular architectures, and training objectives; (4) the evolution from adapting traditional Pre-training/Pre-trained language models to the utilization of large language models; (5) an identification of persistent challenges and potential future research directions in language modeling for tabular data analysis. GitHub page associated with this survey is available at: https://github.com/lanxiang1017/Language-Modeling-on-Tabular-Data-Survey.git.

Jiarui Jin, Haoyu Wang, Xingliang Wu et al.

Electrocardiography (ECG) serves as an indispensable diagnostic tool in clinical practice, yet existing multimodal large language models (MLLMs) remain unreliable for ECG interpretation, often producing plausible but clinically incorrect analyses. To address this, we propose ECG-R1, the first reasoning MLLM designed for reliable ECG interpretation via three innovations. First, we construct the interpretation corpus using \textit{Protocol-Guided Instruction Data Generation}, grounding interpretation in measurable ECG features and monograph-defined quantitative thresholds and diagnostic logic. Second, we present a modality-decoupled architecture with \textit{Interleaved Modality Dropout} to improve robustness and cross-modal consistency when either the ECG signal or ECG image is missing. Third, we present \textit{Reinforcement Learning with ECG Diagnostic Evidence Rewards} to strengthen evidence-grounded ECG interpretation. Additionally, we systematically evaluate the ECG interpretation capabilities of proprietary, open-source, and medical MLLMs, and provide the first quantitative evidence that severe hallucinations are widespread, suggesting that the public should not directly trust these outputs without independent verification. Code and data are publicly available at \href{https://github.com/PKUDigitalHealth/ECG-R1}{here}, and an online platform can be accessed at \href{http://ai.heartvoice.com.cn/ECG-R1/}{here}.

Xiang Lan, Hanshu Yan, Shenda Hong et al.

Not all positive pairs are beneficial to time series contrastive learning. In this paper, we study two types of bad positive pairs that can impair the quality of time series representation learned through contrastive learning: the noisy positive pair and the faulty positive pair. We observe that, with the presence of noisy positive pairs, the model tends to simply learn the pattern of noise (Noisy Alignment). Meanwhile, when faulty positive pairs arise, the model wastes considerable amount of effort aligning non-representative patterns (Faulty Alignment). To address this problem, we propose a Dynamic Bad Pair Mining (DBPM) algorithm, which reliably identifies and suppresses bad positive pairs in time series contrastive learning. Specifically, DBPM utilizes a memory module to dynamically track the training behavior of each positive pair along training process. This allows us to identify potential bad positive pairs at each epoch based on their historical training behaviors. The identified bad pairs are subsequently down-weighted through a transformation module, thereby mitigating their negative impact on the representation learning process. DBPM is a simple algorithm designed as a lightweight plug-in without learnable parameters to enhance the performance of existing state-of-the-art methods. Through extensive experiments conducted on four large-scale, real-world time series datasets, we demonstrate DBPM's efficacy in mitigating the adverse effects of bad positive pairs.

Yucheng Ruan, Xiang Lan, Daniel J. Tan et al.

Medical tabular data, abundant in Electronic Health Records (EHRs), is a valuable resource for diverse medical tasks such as risk prediction. While deep learning approaches, particularly transformer-based models, have shown remarkable performance in tabular data prediction, there are still problems remaining for existing work to be effectively adapted into medical domain, such as ignoring unstructured free-texts and underutilizing the textual information in structured data. To address these issues, we propose PTransformer, a \underline{P}rompt-based multimodal \underline{Transformer} architecture designed specifically for medical tabular data. This framework consists of two critical components: a tabular cell embedding generator and a tabular transformer. The former efficiently encodes diverse modalities from both structured and unstructured tabular data into a harmonized language semantic space with the help of pre-trained sentence encoder and medical prompts. The latter integrates cell representations to generate patient embeddings for various medical tasks. In comprehensive experiments on two real-world datasets for three medical tasks, PTransformer demonstrated the improvements with 10.9%/11.0% on RMSE/MAE, 0.5%/2.2% on RMSE/MAE, and 1.6%/0.8% on BACC/AUROC compared to state-of-the-art (SOTA) baselines in predictability.

Xiang Lan, Feng Wu, Kai He et al.

While recent multimodal large language models (MLLMs) have advanced automated ECG interpretation, they still face two key limitations: (1) insufficient multimodal synergy between time series signals and visual ECG representations, and (2) limited explainability in linking diagnoses to granular waveform evidence. We introduce GEM, the first MLLM unifying ECG time series, 12-lead ECG images and text for grounded and clinician-aligned ECG interpretation. GEM enables feature-grounded analysis, evidence-driven reasoning, and a clinician-like diagnostic process through three core innovations: a dual-encoder framework extracting complementary time series and image features, cross-modal alignment for effective multimodal understanding, and knowledge-guided instruction generation for generating high-granularity grounding data (ECG-Grounding) linking diagnoses to measurable parameters ($e.g.$, QRS/PR Intervals). Additionally, we propose the Grounded ECG Understanding task, a clinically motivated benchmark designed to comprehensively assess the MLLM's capability in grounded ECG understanding. Experimental results on both existing and our proposed benchmarks show GEM significantly improves predictive performance (CSN $7.4\% \uparrow$), explainability ($22.7\% \uparrow$), and grounding ($24.8\% \uparrow$), making it more suitable for real-world clinical applications. GitHub repository: https://github.com/lanxiang1017/GEM.git

Jingyi Zhang, Tianyi Lin, Huanjin Yao et al.

In this work, we aim to develop effective data synthesis techniques that autonomously synthesize multimodal training data for enhancing MLLMs in solving complex real-world tasks. To this end, we propose Collective Adversarial Data Synthesis (CADS), a novel and general approach to synthesize high-quality, diverse and challenging multimodal data for MLLMs. The core idea of CADS is to leverage collective intelligence to ensure high-quality and diverse generation, while exploring adversarial learning to synthesize challenging samples for effectively driving model improvement. Specifically, CADS operates with two cyclic phases, i.e., Collective Adversarial Data Generation (CAD-Generate) and Collective Adversarial Data Judgment (CAD-Judge). CAD-Generate leverages collective knowledge to jointly generate new and diverse multimodal data, while CAD-Judge collaboratively assesses the quality of synthesized data. In addition, CADS introduces an Adversarial Context Optimization mechanism to optimize the generation context to encourage challenging and high-value data generation. With CADS, we construct MMSynthetic-20K and train our model R1-SyntheticVL, which demonstrates superior performance on various benchmarks.

Jiarui Jin, Haoyu Wang, Xiang Lan et al.

Recent unified models such as GPT-5 have achieved encouraging progress on vision-language tasks. However, these unified models typically fail to correctly understand ECG signals and provide accurate medical diagnoses, nor can they correctly generate ECG signals. To address these limitations, we propose UniECG, the first unified model for ECG capable of concurrently performing evidence-based ECG interpretation and text-conditioned ECG generation tasks. Through a decoupled two-stage training approach, the model first learns evidence-based interpretation skills (ECG-to-Text), and then injects ECG generation capabilities (Text-to-ECG) via latent space alignment. UniECG can autonomously choose to interpret or generate an ECG based on user input, significantly extending the capability boundaries of current ECG models. Our code and checkpoints will be made publicly available at https://github.com/PKUDigitalHealth/UniECG upon acceptance.

Fan Ma, Qier An, Peng Chen et al.

Learning transferable representations for electroencephalography (EEG) remains challenging because EEG signals are inherently multi-channel and non-stationary. Channels observed at the same time provide coupled measurements of neural activity, while the relevant temporal dynamics vary across contexts. This structure is poorly matched by architectures that apply uniform computation across time or route each channel patch independently. To this end, we propose TRACE, an autoregressive EEG pre-training framework that predicts future EEG patches from causal context while performing temporally adaptive and cross-channel coherent computation. At each temporal step, TRACE derives an expert routing decision from the causal cross-channel history and applies it jointly to all channels at that step. This preserves instantaneous cross-channel coherence while allowing different temporal regimes to activate different computation. Since routing is defined over the available channel set and causal temporal context, TRACE is compatible with heterogeneous pre-training across corpora with different channel counts, montages, sequence lengths, and recording domains. Across eight downstream EEG benchmarks, TRACE is evaluated in both settings: when downstream domains are seen only as unlabeled pre-training data and when downstream datasets are completely unseen during pre-training. It obtains the best results on several benchmarks while remaining competitive on motor imagery and clinical event classification tasks, with ablations supporting the importance of cross-channel temporal routing.

Fan Ma, Yuntian Liu, Xiang Lan et al.

Evidence derived from large-scale real-world data (RWD) is increasingly informing regulatory evaluation and healthcare decision-making. Administrative claims provide population-scale, longitudinal records of healthcare utilization, expenditure, and detailed coding of diagnoses, procedures, and medications, yet their potential as a substrate for healthcare foundation models remains largely unexplored. Here we present ReClaim, a generative transformer trained from scratch on 43.8 billion medical events from more than 200 million enrollees in the MarketScan claims data spanning 2008-2022. ReClaim models longitudinal trajectories across diagnoses, procedures, medications, and expenditure, and was scaled to 140 million, 700 million, and 1.7 billion parameters. Across over 1,000 disease-onset prediction tasks, ReClaim achieved a mean AUC of 75.6%, substantially outperforming disease-specific LightGBM (66.3%) and the transformer-based Delphi model (69.4%), with the largest gains for rare diseases. These advantages held across retrospective and prospective evaluations and in external validation on two independent datasets. Performance improved monotonically with scale, and post-training added 13.8 percentage points over pre-training alone. Beyond disease prediction, ReClaim captured financial outcomes and improved real-world evidence (RWE) analyses: for healthcare expenditure forecasting it increased explained variance from 0.28 to 0.37 relative to LightGBM, and in a target trial emulation it reduced systematic bias by 72% on average relative to Delphi. Together, these results establish administrative claims as a scalable substrate for healthcare foundation models and show that learned representations generalize across time periods and data sources, supporting disease surveillance, expenditure forecasting, and RWE generation.

Jihai Zhang, Xiang Lan, Xiaoye Qu et al.

Self-Supervised Contrastive Learning has proven effective in deriving high-quality representations from unlabeled data. However, a major challenge that hinders both unimodal and multimodal contrastive learning is feature suppression, a phenomenon where the trained model captures only a limited portion of the information from the input data while overlooking other potentially valuable content. This issue often leads to indistinguishable representations for visually similar but semantically different inputs, adversely affecting downstream task performance, particularly those requiring rigorous semantic comprehension. To address this challenge, we propose a novel model-agnostic Multistage Contrastive Learning (MCL) framework. Unlike standard contrastive learning which inherently captures one single biased feature distribution, MCL progressively learns previously unlearned features through feature-aware negative sampling at each stage, where the negative samples of an anchor are exclusively selected from the cluster it was assigned to in preceding stages. Meanwhile, MCL preserves the previously well-learned features by cross-stage representation integration, integrating features across all stages to form final representations. Our comprehensive evaluation demonstrates MCL's effectiveness and superiority across both unimodal and multimodal contrastive learning, spanning a range of model architectures from ResNet to Vision Transformers (ViT). Remarkably, in tasks where the original CLIP model has shown limitations, MCL dramatically enhances performance, with improvements up to threefold on specific attributes in the recently proposed MMVP benchmark.

Xingshuo Han, Xuanye Zhang, Xiang Lan et al.

By using a control variate to calibrate the local gradient of each client, Scaffold has been widely known as a powerful solution to mitigate the impact of data heterogeneity in Federated Learning. Although Scaffold achieves significant performance improvements, we show that this superiority is at the cost of increased security vulnerabilities. Specifically, this paper presents BadSFL, the first backdoor attack targeting Scaffold, which turns benign clients into accomplices to amplify the attack effect. The core idea of BadSFL is to uniquely tamper with the control variate to subtly steer benign clients' local gradient updates towards the attacker's poisoned direction, effectively turning them into unwitting accomplices and significantly enhancing the backdoor persistence. Additionally, BadSFL leverages a GAN-enhanced poisoning strategy to enrich the attacker's dataset, maintaining high accuracy on both benign and backdoored samples while remaining stealthy. Extensive experiments demonstrate that BadSFL achieves superior attack durability, maintaining effectiveness for over 60 global rounds, lasting up to three times longer than existing baselines even after ceasing malicious model injections.

Yucheng Ruan, Xiang Lan, Daniel J. Tan et al.

Background Predicting mortality and resource utilization from electronic health records (EHRs) is challenging yet crucial for optimizing patient outcomes and managing costs in intensive care unit (ICU). Existing approaches predominantly focus on structured EHRs, often ignoring the valuable clinical insights in free-text notes. Additionally, the potential of textual information within structured data is not fully leveraged. This study aimed to introduce and assess a deep learning framework using natural language processing techniques that integrates multimodal EHRs to predict mortality and resource utilization in critical care settings. Methods Utilizing two real-world EHR datasets, we developed and evaluated our model on three clinical tasks with leading existing methods. We also performed an ablation study on three key components in our framework: medical prompts, free-texts, and pre-trained sentence encoder. Furthermore, we assessed the model's robustness against the corruption in structured EHRs. Results Our experiments on two real-world datasets across three clinical tasks showed that our proposed model improved performance metrics by 1.6\%/0.8\% on BACC/AUROC for mortality prediction, 0.5%/2.2% on RMSE/MAE for LOS prediction, 10.9%/11.0% on RMSE/MAE for surgical duration estimation compared to the best existing methods. It consistently demonstrated superior performance compared to other baselines across three tasks at different corruption rates. Conclusions The proposed framework is an effective and accurate deep learning approach for predicting mortality and resource utilization in critical care. The study also highlights the success of using prompt learning with a transformer encoder in analyzing multimodal EHRs. Importantly, the model showed strong resilience to data corruption within structured data, especially at high corruption levels.

Deyun Zhang, Xiang Lan, Shijia Geng et al.

Electrocardiogram (ECG) plays a foundational role in modern cardiovascular care, enabling non-invasive diagnosis of arrhythmias, myocardial ischemia, and conduction disorders. While machine learning has achieved expert-level performance in ECG interpretation, the development of clinically deployable multimodal AI systems remains constrained, primarily due to the lack of publicly available datasets that simultaneously incorporate raw signals, diagnostic images, and interpretation text. Most existing ECG datasets provide only single-modality data or, at most, dual modalities, making it difficult to build models that can understand and integrate diverse ECG information in real-world settings. To address this gap, we introduce MEETI (MIMIC-IV-Ext ECG-Text-Image), the first large-scale ECG dataset that synchronizes raw waveform data, high-resolution plotted images, and detailed textual interpretations generated by large language models. In addition, MEETI includes beat-level quantitative ECG parameters extracted from each lead, offering structured parameters that support fine-grained analysis and model interpretability. Each MEETI record is aligned across four components: (1) the raw ECG waveform, (2) the corresponding plotted image, (3) extracted feature parameters, and (4) detailed interpretation text. This alignment is achieved using consistent, unique identifiers. This unified structure supports transformer-based multimodal learning and supports fine-grained, interpretable reasoning about cardiac health. By bridging the gap between traditional signal analysis, image-based interpretation, and language-driven understanding, MEETI established a robust foundation for the next generation of explainable, multimodal cardiovascular AI. It offers the research community a comprehensive benchmark for developing and evaluating ECG-based AI systems.

Xiang Lan, Dianwen Ng, Shenda Hong et al.

Learning information-rich and generalizable representations effectively from unlabeled multivariate cardiac signals to identify abnormal heart rhythms (cardiac arrhythmias) is valuable in real-world clinical settings but often challenging due to its complex temporal dynamics. Cardiac arrhythmias can vary significantly in temporal patterns even for the same patient ($i.e.$, intra subject difference). Meanwhile, the same type of cardiac arrhythmia can show different temporal patterns among different patients due to different cardiac structures ($i.e.$, inter subject difference). In this paper, we address the challenges by proposing an Intra-inter Subject self-supervised Learning (ISL) model that is customized for multivariate cardiac signals. Our proposed ISL model integrates medical knowledge into self-supervision to effectively learn from intra-inter subject differences. In intra subject self-supervision, ISL model first extracts heartbeat-level features from each subject using a channel-wise attentional CNN-RNN encoder. Then a stationarity test module is employed to capture the temporal dependencies between heartbeats. In inter subject self-supervision, we design a set of data augmentations according to the clinical characteristics of cardiac signals and perform contrastive learning among subjects to learn distinctive representations for various types of patients. Extensive experiments on three real-world datasets were conducted. In a semi-supervised transfer learning scenario, our pre-trained ISL model leads about 10% improvement over supervised training when only 1% labeled data is available, suggesting strong generalizability and robustness of the model.

Zhaowei Zhu, Xiang Lan, Tingting Zhao et al.

Cardiovascular disease is a major threat to health and one of the primary causes of death globally. The 12-lead ECG is a cheap and commonly accessible tool to identify cardiac abnormalities. Early and accurate diagnosis will allow early treatment and intervention to prevent severe complications of cardiovascular disease. In the PhysioNet/Computing in Cardiology Challenge 2020, our objective is to develop an algorithm that automatically identifies 27 ECG abnormalities from 12-lead ECG recordings.