Rahul Thapa

Michael Wornow, Rahul Thapa, Ethan Steinberg et al. · stanford

While the general machine learning (ML) community has benefited from public datasets, tasks, and models, the progress of ML in healthcare has been hampered by a lack of such shared assets. The success of foundation models creates new challenges for healthcare ML by requiring access to shared pretrained models to validate performance benefits. We help address these challenges through three contributions. First, we publish a new dataset, EHRSHOT, which contains deidentified structured data from the electronic health records (EHRs) of 6,739 patients from Stanford Medicine. Unlike MIMIC-III/IV and other popular EHR datasets, EHRSHOT is longitudinal and not restricted to ICU/ED patients. Second, we publish the weights of CLMBR-T-base, a 141M parameter clinical foundation model pretrained on the structured EHR data of 2.57M patients. We are one of the first to fully release such a model for coded EHR data; in contrast, most prior models released for clinical data (e.g. GatorTron, ClinicalBERT) only work with unstructured text and cannot process the rich, structured data within an EHR. We provide an end-to-end pipeline for the community to validate and build upon its performance. Third, we define 15 few-shot clinical prediction tasks, enabling evaluation of foundation models on benefits such as sample efficiency and task adaptation. Our model and dataset are available via a research data use agreement from our website: https://ehrshot.stanford.edu. Code to reproduce our results are available at our Github repo: https://github.com/som-shahlab/ehrshot-benchmark

Scott L. Fleming, Alejandro Lozano, William J. Haberkorn et al. · stanford

The ability of large language models (LLMs) to follow natural language instructions with human-level fluency suggests many opportunities in healthcare to reduce administrative burden and improve quality of care. However, evaluating LLMs on realistic text generation tasks for healthcare remains challenging. Existing question answering datasets for electronic health record (EHR) data fail to capture the complexity of information needs and documentation burdens experienced by clinicians. To address these challenges, we introduce MedAlign, a benchmark dataset of 983 natural language instructions for EHR data. MedAlign is curated by 15 clinicians (7 specialities), includes clinician-written reference responses for 303 instructions, and provides 276 longitudinal EHRs for grounding instruction-response pairs. We used MedAlign to evaluate 6 general domain LLMs, having clinicians rank the accuracy and quality of each LLM response. We found high error rates, ranging from 35% (GPT-4) to 68% (MPT-7B-Instruct), and an 8.3% drop in accuracy moving from 32k to 2k context lengths for GPT-4. Finally, we report correlations between clinician rankings and automated natural language generation metrics as a way to rank LLMs without human review. We make MedAlign available under a research data use agreement to enable LLM evaluations on tasks aligned with clinician needs and preferences.

Michael Wornow, Yizhe Xu, Rahul Thapa et al. · stanford

The successes of foundation models such as ChatGPT and AlphaFold have spurred significant interest in building similar models for electronic medical records (EMRs) to improve patient care and hospital operations. However, recent hype has obscured critical gaps in our understanding of these models' capabilities. We review over 80 foundation models trained on non-imaging EMR data (i.e. clinical text and/or structured data) and create a taxonomy delineating their architectures, training data, and potential use cases. We find that most models are trained on small, narrowly-scoped clinical datasets (e.g. MIMIC-III) or broad, public biomedical corpora (e.g. PubMed) and are evaluated on tasks that do not provide meaningful insights on their usefulness to health systems. In light of these findings, we propose an improved evaluation framework for measuring the benefits of clinical foundation models that is more closely grounded to metrics that matter in healthcare.

Debadutta Dash, Rahul Thapa, Juan M. Banda et al.

Despite growing interest in using large language models (LLMs) in healthcare, current explorations do not assess the real-world utility and safety of LLMs in clinical settings. Our objective was to determine whether two LLMs can serve information needs submitted by physicians as questions to an informatics consultation service in a safe and concordant manner. Sixty six questions from an informatics consult service were submitted to GPT-3.5 and GPT-4 via simple prompts. 12 physicians assessed the LLM responses' possibility of patient harm and concordance with existing reports from an informatics consultation service. Physician assessments were summarized based on majority vote. For no questions did a majority of physicians deem either LLM response as harmful. For GPT-3.5, responses to 8 questions were concordant with the informatics consult report, 20 discordant, and 9 were unable to be assessed. There were 29 responses with no majority on "Agree", "Disagree", and "Unable to assess". For GPT-4, responses to 13 questions were concordant, 15 discordant, and 3 were unable to be assessed. There were 35 responses with no majority. Responses from both LLMs were largely devoid of overt harm, but less than 20% of the responses agreed with an answer from an informatics consultation service, responses contained hallucinated references, and physicians were divided on what constitutes harm. These results suggest that while general purpose LLMs are able to provide safe and credible responses, they often do not meet the specific information need of a given question. A definitive evaluation of the usefulness of LLMs in healthcare settings will likely require additional research on prompt engineering, calibration, and custom-tailoring of general purpose models.

Haotian Ye, Haowei Lin, Jingyi Tang et al.

Language models are increasingly used in scientific discovery to generate hypotheses, propose candidate solutions, implement systems, and iteratively refine them. At the core of these trial-and-error loops lies evaluation: the process of obtaining feedback on candidate solutions via verifiers, simulators, or task-specific scoring functions. While prior work has highlighted the importance of evaluation, it has not explicitly formulated the problem of how evaluation-driven discovery loops can be scaled up in a principled and effective manner to push the boundaries of scientific discovery, a problem this paper seeks to address. We introduce Simple Test-time Evaluation-driven Scaling (SimpleTES), a general framework that strategically combines parallel exploration, feedback-driven refinement, and local selection, revealing substantial gains unlocked by scaling evaluation-driven discovery loops along the right dimensions. Across 21 scientific problems spanning six domains, SimpleTES discovers state-of-the-art solutions using gpt-oss models, consistently outperforming both frontier-model baselines and sophisticated optimization pipelines. Particularly, we sped up the widely used LASSO algorithm by over 2x, designed quantum circuit routing policies that reduce gate overhead by 24.5%, and discovered new Erdos minimum overlap constructions that surpass the best-known results. Beyond novel discoveries, SimpleTES produces trajectory-level histories that naturally supervise feedback-driven learning. When post-trained on successful trajectories, models not only improve efficiency on seen problems but also generalize to unseen problems, discovering solutions that base models fail to uncover. Together, our results establish effective evaluation-driven loop scaling as a central axis for advancing LLM-driven scientific discovery, and provide a simple yet practical framework for realizing these gains.

Conor K. Corbin, Rob Maclay, Aakash Acharya et al.

Machine learning (ML) applications in healthcare are extensively researched, but successful translations to the bedside are scant. Healthcare institutions are establishing frameworks to govern and promote the implementation of accurate, actionable and reliable models that integrate with clinical workflow. Such governance frameworks require an accompanying technical framework to deploy models in a resource efficient manner. Here we present DEPLOYR, a technical framework for enabling real-time deployment and monitoring of researcher created clinical ML models into a widely used electronic medical record (EMR) system. We discuss core functionality and design decisions, including mechanisms to trigger inference based on actions within EMR software, modules that collect real-time data to make inferences, mechanisms that close-the-loop by displaying inferences back to end-users within their workflow, monitoring modules that track performance of deployed models over time, silent deployment capabilities, and mechanisms to prospectively evaluate a deployed model's impact. We demonstrate the use of DEPLOYR by silently deploying and prospectively evaluating twelve ML models triggered by clinician button-clicks in Stanford Health Care's production instance of Epic. Our study highlights the need and feasibility for such silent deployment, because prospectively measured performance varies from retrospective estimates. By describing DEPLOYR, we aim to inform ML deployment best practices and help bridge the model implementation gap.

Jenish Maharjan, Anurag Garikipati, Navan Preet Singh et al.

LLMs have become increasingly capable at accomplishing a range of specialized-tasks and can be utilized to expand equitable access to medical knowledge. Most medical LLMs have involved extensive fine-tuning, leveraging specialized medical data and significant, thus costly, amounts of computational power. Many of the top performing LLMs are proprietary and their access is limited to very few research groups. However, open-source (OS) models represent a key area of growth for medical LLMs due to significant improvements in performance and an inherent ability to provide the transparency and compliance required in healthcare. We present OpenMedLM, a prompting platform which delivers state-of-the-art (SOTA) performance for OS LLMs on medical benchmarks. We evaluated a range of OS foundation LLMs (7B-70B) on four medical benchmarks (MedQA, MedMCQA, PubMedQA, MMLU medical-subset). We employed a series of prompting strategies, including zero-shot, few-shot, chain-of-thought (random selection and kNN selection), and ensemble/self-consistency voting. We found that OpenMedLM delivers OS SOTA results on three common medical LLM benchmarks, surpassing the previous best performing OS models that leveraged computationally costly extensive fine-tuning. The model delivers a 72.6% accuracy on the MedQA benchmark, outperforming the previous SOTA by 2.4%, and achieves 81.7% accuracy on the MMLU medical-subset, establishing itself as the first OS LLM to surpass 80% accuracy on this benchmark. Our results highlight medical-specific emergent properties in OS LLMs which have not yet been documented to date elsewhere, and showcase the benefits of further leveraging prompt engineering to improve the performance of accessible LLMs for medical applications.

Pan Lu, Bowen Chen, Sheng Liu et al. · stanford

Solving complex reasoning tasks may involve visual understanding, domain knowledge retrieval, numerical calculation, and multi-step reasoning. Existing methods augment large language models (LLMs) with external tools but are restricted to specialized domains, limited tool types, or require additional training data. In this paper, we introduce OctoTools, a training-free, user-friendly, and easily extensible open-source agentic framework designed to tackle complex reasoning across diverse domains. OctoTools introduces standardized tool cards to encapsulate tool functionality, a planner for both high-level and low-level planning, and an executor to carry out tool usage. We validate OctoTools' generality across 16 diverse tasks (including MathVista, MMLU-Pro, MedQA, and GAIA-Text), achieving substantial average accuracy gains of 9.3% over GPT-4o. Furthermore, OctoTools outperforms AutoGen, GPT-Functions and LangChain by up to 10.6% when given the same set of tools. Through comprehensive analysis and ablations, OctoTools demonstrates advantages in task planning, effective tool usage, and multi-step problem solving.

William Lehn-Schiøler, Magnus Ruud Kjær, Phillip Hempel et al.

Sleep foundation models have recently demonstrated strong performance on in-domain polysomnography tasks, including sleep staging, apnea detection, and disease risk prediction. In this work, we investigate whether sleep biosignals can serve as an effective pretraining distribution for learning representations that transfer beyond sleep to adjacent domains. Following sleep foundation models, we perform sleep-only multimodal contrastive pretraining (with a leave-one-out objective) and evaluate transfer to non-sleep EEG and ECG, two well-benchmarked biosignal modalities with heterogeneous datasets and clinically meaningful downstream tasks. Across eight downstream tasks spanning multiple EEG and ECG datasets, sleep pretraining consistently improves performance relative to training from scratch. Moreover, on several tasks, we achieve performance competitive with or surpassing prior specialized state-of-the-art and foundation models.

William Lehn-Schiøler, Magnus Ruud Kjær, Rahul Thapa et al.

EEG foundation models achieve state-of-the-art clinical performance, yet the internal computations driving their predictions remain opaque: a barrier to clinical trust. We apply TopK Sparse Autoencoders (SAEs) across three architecturally distinct EEG transformers: SleepFM, REVE, and LaBraM to extract sparse feature dictionaries from their embeddings. By grounding these features in a clinical taxonomy (abnormality, age, sex, and medication), we benchmark monosemanticity and entanglement across architectures. A single hyperparameter procedure, driven by an intrinsic dictionary health audit, transfers robustly across all three architectures. Via concept steering, we introduce a "target vs. off-target" probe area metric to quantify steering selectivity and reveal three operational regimes: selectively steerable, encoded but entangled, and non-encoded. This framework exposes critical representational failures: "wrecking-ball" interventions that collapse global model performance, and clinical entanglements, such as age-pathology confounding, where it is impossible to suppress one concept without corrupting the other. Finally, a spectral decoder maps these interventions back to the amplitude spectrum, translating latent manipulations into physiologically interpretable frequency signatures, such as pathological slow-wave suppression and $α$-band restoration.

Alison Callahan, Duncan McElfresh, Juan M. Banda et al.

The impact of using artificial intelligence (AI) to guide patient care or operational processes is an interplay of the AI model's output, the decision-making protocol based on that output, and the capacity of the stakeholders involved to take the necessary subsequent action. Estimating the effects of this interplay before deployment, and studying it in real time afterwards, are essential to bridge the chasm between AI model development and achievable benefit. To accomplish this, the Data Science team at Stanford Health Care has developed a Testing and Evaluation (T&E) mechanism to identify fair, useful and reliable AI models (FURM) by conducting an ethical review to identify potential value mismatches, simulations to estimate usefulness, financial projections to assess sustainability, as well as analyses to determine IT feasibility, design a deployment strategy, and recommend a prospective monitoring and evaluation plan. We report on FURM assessments done to evaluate six AI guided solutions for potential adoption, spanning clinical and operational settings, each with the potential to impact from several dozen to tens of thousands of patients each year. We describe the assessment process, summarize the six assessments, and share our framework to enable others to conduct similar assessments. Of the six solutions we assessed, two have moved into a planning and implementation phase. Our novel contributions - usefulness estimates by simulation, financial projections to quantify sustainability, and a process to do ethical assessments - as well as their underlying methods and open source tools, are available for other healthcare systems to conduct actionable evaluations of candidate AI solutions.

Andrew Li, Rahul Thapa, Rahul Chalamala et al.

Vision-Language Models (VLMs) excel at understanding single images, aided by high-quality instruction datasets. However, multi-image reasoning remains underexplored in the open-source community due to two key challenges: (1) scaling datasets with correlated images and complex reasoning instructions is resource-intensive, and (2) robust evaluation benchmarks for multi-image tasks are lacking. To address this, we introduce SMiR, a synthetic data-generation pipeline for multi-image reasoning, along with a high-quality dataset generated using this pipeline. SMiR efficiently extracts correlated images via multimodal embeddings, integrates visual and descriptive information, and leverages open-source LLMs to generate quality instructions. Using this approach, we produce 160K synthetic training samples, offering a cost-effective alternative to closed-source solutions. Additionally, we present SMiR-Bench, a multi-image reasoning benchmark comprising 200 diverse examples across seven complex reasoning tasks. SMiR-Bench is multi-turn and employs a VLM judge to evaluate free-form responses, providing a comprehensive assessment of model expressiveness and reasoning capability across modalities. We demonstrate the effectiveness of SMiR by fine-tuning open-source VLMs and evaluating them on SMiR-Bench.

Magnus Ruud Kjaer, Rahul Thapa, Gauri Ganjoo et al.

Polysomnography (PSG), the gold standard test for sleep analysis, generates vast amounts of multimodal clinical data, presenting an opportunity to leverage self-supervised representation learning (SSRL) for pre-training foundation models to enhance sleep analysis. However, progress in sleep foundation models is hindered by two key limitations: (1) the lack of a shared dataset and benchmark with diverse tasks for training and evaluation, and (2) the absence of a systematic evaluation of SSRL approaches across sleep-related tasks. To address these gaps, we introduce Stanford Sleep Bench, a large-scale PSG dataset comprising 17,467 recordings totaling over 163,000 hours from a major sleep clinic, including 13 clinical disease prediction tasks alongside canonical sleep-related tasks such as sleep staging, apnea diagnosis, and age estimation. We systematically evaluate SSRL pre-training methods on Stanford Sleep Bench, assessing downstream performance across four tasks: sleep staging, apnea diagnosis, age estimation, and disease and mortality prediction. Our results show that multiple pretraining methods achieve comparable performance for sleep staging, apnea diagnosis, and age estimation. However, for mortality and disease prediction, contrastive learning significantly outperforms other approaches while also converging faster during pretraining. To facilitate reproducibility and advance sleep research, we will release Stanford Sleep Bench along with pretrained model weights, training pipelines, and evaluation code.

Rahul Thapa, Kezhen Chen, Ian Covert et al.

Recent advances in vision-language models (VLMs) have demonstrated the advantages of processing images at higher resolutions and utilizing multi-crop features to preserve native resolution details. However, despite these improvements, existing vision transformers (ViTs) still struggle to capture fine-grained details from less prominent objects, charts, and embedded text, limiting their effectiveness in certain tasks. In this paper, we extend recent high-resolution and multi-crop techniques by not only preserving the native resolution, but zooming in beyond it and extracting features from a large number of image sub-crops. This enhancement allows our model to better capture fine-grained details, overcoming the limitations of current ViTs. To manage the increased token count and computational complexity, we demonstrate that a simple mean-pooling aggregation over tokens is effective. Our model, Dragonfly, achieves competitive performance on general-domain tasks such as ScienceQA and AI2D, and excels in tasks requiring fine-grained image understanding, including TextVQA and ChartQA. Among models in the 7-8B parameter range, Dragonfly consistently ranks at the top across ten general-domain benchmarks, achieving the highest or second-highest scores in most cases, outperforming models that are significantly larger or trained on larger datasets. Our biomedical model, Dragonfly-Med, sets new benchmarks on several medical tasks, achieving 91.6% accuracy on SLAKE (compared to 84.8% for Med-Gemini), a 67.1% token F1 score on Path-VQA (compared to 62.7% for Med-PaLM M), and state-of-the-art results across the majority of image captioning tasks. Overall, our work highlights the persistent challenge of engineering visual representations with fixed-resolution ViTs, and proposes a simple yet effective solution to address this issue and boost performance in both general and specialized domains.

Dongning Ma, Rahul Thapa, Xun Jiao

Modern drug discovery is often time-consuming, complex and cost-ineffective due to the large volume of molecular data and complicated molecular properties. Recently, machine learning algorithms have shown promising results in virtual screening of automated drug discovery by predicting molecular properties. While emerging learning methods such as graph neural networks and recurrent neural networks exhibit high accuracy, they are also notoriously computation-intensive and memory-intensive with operations such as feature embeddings or deep convolutions. In this paper, we propose a viable alternative to existing learning methods by presenting MoleHD, a method based on brain-inspired hyperdimensional computing (HDC) for molecular property prediction. We develop HDC encoders to project SMILES representation of a molecule into high-dimensional vectors that are used for HDC training and inference. We perform an extensive evaluation using 29 classification tasks from 3 widely-used molecule datasets (Clintox, BBBP, SIDER) under three splits methods (random, scaffold, and stratified). By an comprehensive comparison with 8 existing learning models including SOTA graph/recurrent neural networks, we show that MoleHD is able to achieve highest ROC-AUC score on random and scaffold splits on average across 3 datasets and achieve second-highest on stratified split. Importantly, MoleHD achieves such performance with significantly reduced computing cost and training efforts. To the best of our knowledge, this is the first HDC-based method for drug discovery. The promising results presented in this paper can potentially lead to a novel path in drug discovery research.

Rahul Thapa, Dongning Ma, Xun Jiao

Inspired by the way human brain works, the emerging hyperdimensional computing (HDC) is getting more and more attention. HDC is an emerging computing scheme based on the working mechanism of brain that computes with deep and abstract patterns of neural activity instead of actual numbers. Compared with traditional ML algorithms such as DNN, HDC is more memory-centric, granting it advantages such as relatively smaller model size, less computation cost, and one-shot learning, making it a promising candidate in low-cost computing platforms. However, the robustness of HDC models have not been systematically studied. In this paper, we systematically expose the unexpected or incorrect behaviors of HDC models by developing HDXplore, a blackbox differential testing-based framework. We leverage multiple HDC models with similar functionality as cross-referencing oracles to avoid manual checking or labeling the original input. We also propose different perturbation mechanisms in HDXplore. HDXplore automatically finds thousands of incorrect corner case behaviors of the HDC model. We propose two retraining mechanisms and using the corner cases generated by HDXplore to retrain the HDC model, we can improve the model accuracy by up to 9%.