Karthik Natarajan

Betina Idnay, Zihan Xu, William G. Adams et al.

This study reports a comprehensive environmental scan of the generative AI (GenAI) infrastructure in the national network for clinical and translational science across 36 institutions supported by the Clinical and Translational Science Award (CTSA) Program led by the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) at the United States. With the rapid advancement of GenAI technologies, including large language models (LLMs), healthcare institutions face unprecedented opportunities and challenges. This research explores the current status of GenAI integration, focusing on stakeholder roles, governance structures, and ethical considerations by administering a survey among leaders of health institutions (i.e., representing academic medical centers and health systems) to assess the institutional readiness and approach towards GenAI adoption. Key findings indicate a diverse range of institutional strategies, with most organizations in the experimental phase of GenAI deployment. The study highlights significant variations in governance models, with a strong preference for centralized decision-making but notable gaps in workforce training and ethical oversight. Moreover, the results underscore the need for a more coordinated approach to GenAI governance, emphasizing collaboration among senior leaders, clinicians, information technology staff, and researchers. Our analysis also reveals concerns regarding GenAI bias, data security, and stakeholder trust, which must be addressed to ensure the ethical and effective implementation of GenAI technologies. This study offers valuable insights into the challenges and opportunities of GenAI integration in healthcare, providing a roadmap for institutions aiming to leverage GenAI for improved quality of care and operational efficiency.

Bahar Taşkesen, Soroosh Shafieezadeh-Abadeh, Daniel Kuhn et al.

We study the computational complexity of the optimal transport problem that evaluates the Wasserstein distance between the distributions of two K-dimensional discrete random vectors. The best known algorithms for this problem run in polynomial time in the maximum of the number of atoms of the two distributions. However, if the components of either random vector are independent, then this number can be exponential in K even though the size of the problem description scales linearly with K. We prove that the described optimal transport problem is #P-hard even if all components of the first random vector are independent uniform Bernoulli random variables, while the second random vector has merely two atoms, and even if only approximate solutions are sought. We also develop a dynamic programming-type algorithm that approximates the Wasserstein distance in pseudo-polynomial time when the components of the first random vector follow arbitrary independent discrete distributions, and we identify special problem instances that can be solved exactly in strongly polynomial time.

Arjun Ramachandra, Karthik Natarajan

In this paper, we introduce the notion of a ``pairwise independent correlation gap'' for set functions with random elements. The pairwise independent correlation gap is defined as the ratio of the maximum expected value of a set function with arbitrary dependence among the elements with fixed marginal probabilities to the maximum expected value with pairwise independent elements with the same marginal probabilities. We show that for any nonnegative monotone submodular set function defined on $n$ elements, this ratio is upper bounded by $4/3$ in the following two cases: (a) $n = 3$ for all marginal probabilities and (b) all $n$ for small marginal probabilities (and similarly large marginal probabilities). This differs from the bound on the ``correlation gap'' which holds with mutual independence and showcases the fundamental difference between pairwise independence and mutual independence. We discuss the implication of the results with two examples and end the paper with a conjecture.

Chao Pang, Xinzhuo Jiang, Nishanth Parameshwar Pavinkurve et al.

Synthetic Electronic Health Records (EHR) have emerged as a pivotal tool in advancing healthcare applications and machine learning models, particularly for researchers without direct access to healthcare data. Although existing methods, like rule-based approaches and generative adversarial networks (GANs), generate synthetic data that resembles real-world EHR data, these methods often use a tabular format, disregarding temporal dependencies in patient histories and limiting data replication. Recently, there has been a growing interest in leveraging Generative Pre-trained Transformers (GPT) for EHR data. This enables applications like disease progression analysis, population estimation, counterfactual reasoning, and synthetic data generation. In this work, we focus on synthetic data generation and demonstrate the capability of training a GPT model using a particular patient representation derived from CEHR-BERT, enabling us to generate patient sequences that can be seamlessly converted to the Observational Medical Outcomes Partnership (OMOP) data format.

Chao Pang, Jiheum Park, Xinzhuo Jiang et al.

Electronic Health Records (EHRs) provide a rich, longitudinal view of patient health and hold significant potential for advancing clinical decision support, risk prediction, and data-driven healthcare research. However, most artificial intelligence (AI) models for EHRs are designed for narrow, single-purpose tasks, limiting their generalizability and utility in real-world settings. Here, we present CEHR-XGPT, a general-purpose foundation model for EHR data that unifies three essential capabilities - feature representation, zero-shot prediction, and synthetic data generation - within a single architecture. To support temporal reasoning over clinical sequences, CEHR-XGPT incorporates a novel time-token-based learning framework that explicitly encodes patients' dynamic timelines into the model structure. CEHR-XGPT demonstrates strong performance across all three tasks and generalizes effectively to external datasets through vocabulary expansion and fine-tuning. Its versatility enables rapid model development, cohort discovery, and patient outcome forecasting without the need for task-specific retraining.

Chao Pang, Vincent Jeanselme, Young Sang Choi et al.

Foundation models hold significant promise in healthcare, given their capacity to extract meaningful representations independent of downstream tasks. This property has enabled state-of-the-art performance across several clinical applications trained on structured electronic health record (EHR) data, even in settings with limited labeled data, a prevalent challenge in healthcare. However, there is little consensus on these models' potential for clinical utility due to the lack of desiderata of comprehensive and meaningful tasks and sufficiently diverse evaluations to characterize the benefit over conventional supervised learning. To address this gap, we propose a suite of clinically meaningful tasks spanning patient outcomes, early prediction of acute and chronic conditions, including desiderata for robust evaluations. We evaluate state-of-the-art foundation models on EHR data consisting of 5 million patients from Columbia University Irving Medical Center (CUMC), a large urban academic medical center in New York City, across 14 clinically relevant tasks. We measure overall accuracy, calibration, and subpopulation performance to surface tradeoffs based on the choice of pre-training, tokenization, and data representation strategies. Our study aims to advance the empirical evaluation of structured EHR foundation models and guide the development of future healthcare foundation models.

Chao Pang, Xinzhuo Jiang, Krishna S Kalluri et al.

Embedding algorithms are increasingly used to represent clinical concepts in healthcare for improving machine learning tasks such as clinical phenotyping and disease prediction. Recent studies have adapted state-of-the-art bidirectional encoder representations from transformers (BERT) architecture to structured electronic health records (EHR) data for the generation of contextualized concept embeddings, yet do not fully incorporate temporal data across multiple clinical domains. Therefore we developed a new BERT adaptation, CEHR-BERT, to incorporate temporal information using a hybrid approach by augmenting the input to BERT using artificial time tokens, incorporating time, age, and concept embeddings, and introducing a new second learning objective for visit type. CEHR-BERT was trained on a subset of Columbia University Irving Medical Center-York Presbyterian Hospital's clinical data, which includes 2.4M patients, spanning over three decades, and tested using 4-fold cross-validation on the following prediction tasks: hospitalization, death, new heart failure (HF) diagnosis, and HF readmission. Our experiments show that CEHR-BERT outperformed existing state-of-the-art clinical BERT adaptations and baseline models across all 4 prediction tasks in both ROC-AUC and PR-AUC. CEHR-BERT also demonstrated strong transfer learning capability, as our model trained on only 5% of data outperformed comparison models trained on the entire data set. Ablation studies to better understand the contribution of each time component showed incremental gains with every element, suggesting that CEHR-BERT's incorporation of artificial time tokens, time and age embeddings with concept embeddings, and the addition of the second learning objective represents a promising approach for future BERT-based clinical embeddings.

Louis Chen, Divya Padmanabhan, Chee Chin Lim et al.

We propose a distributionally robust model for the influence maximization problem. Unlike the classic independent cascade model \citep{kempe2003maximizing}, this model's diffusion process is adversarially adapted to the choice of seed set. Hence, instead of optimizing under the assumption that all influence relationships in the network are independent, we seek a seed set whose expected influence under the worst correlation, i.e. the "worst-case, expected influence", is maximized. We show that this worst-case influence can be efficiently computed, and though the optimization is NP-hard, a ($1 - 1/e$) approximation guarantee holds. We also analyze the structure to the adversary's choice of diffusion process, and contrast with established models. Beyond the key computational advantages, we also highlight the extent to which the independence assumption may cost optimality, and provide insights from numerical experiments comparing the adversarial and independent cascade model.