Luis R. Soenksen

Kimberly Villalobos Carballo, Liangyuan Na, Yu Ma et al.

Tabular medical records remain the most readily available data format for applying machine learning in healthcare. However, traditional data preprocessing ignores valuable contextual information in tables and requires substantial manual cleaning and harmonisation, creating a bottleneck for model development. We introduce TabText, a preprocessing and feature extraction method that leverages contextual information and streamlines the curation of tabular medical data. This method converts tables into contextual language and applies pretrained large language models (LLMs) to generate task-independent numerical representations. These fixed embeddings are then used as input for various predictive tasks. TabText was evaluated on nine inpatient flow prediction tasks (e.g., ICU admission, discharge, mortality) using electronic medical records across six hospitals from a US health system, and on nine publicly available datasets from the UCI Machine Learning Repository, covering tasks such as cancer diagnosis, recurrence, and survival. TabText models trained on unprocessed data from a single hospital (572,964 patient-days, Jan 2018-Dec 2020) achieved accurate performance (AUC 0.75-0.94) when tested prospectively on 265,917 patient-days from Jan 2021-Apr 2022, and generalised well to five additional hospitals not used for training. When augmenting preprocessed tabular records with these contextual embeddings, out-of-sample AUC improved by up to 4 additive percentage points in challenging tasks such as ICU transfer and breast cancer recurrence, while providing little to no benefit for already high-performing tasks. Findings were consistent across both private and public datasets.

Xuhai Xu, Haoyu Hu, Haoran Zhang et al.

Artificial intelligence (AI) is increasingly permeating healthcare, from physician assistants to consumer applications. Since AI algorithm's opacity challenges human interaction, explainable AI (XAI) addresses this by providing AI decision-making insight, but evidence suggests XAI can paradoxically induce over-reliance or bias. We present results from two large-scale experiments (623 lay people; 153 primary care physicians, PCPs) combining a fairness-based diagnosis AI model and different XAI explanations to examine how XAI assistance, particularly multimodal large language models (LLMs), influences diagnostic performance. AI assistance balanced across skin tones improved accuracy and reduced diagnostic disparities. However, LLM explanations yielded divergent effects: lay users showed higher automation bias - accuracy boosted when AI was correct, reduced when AI erred - while experienced PCPs remained resilient, benefiting irrespective of AI accuracy. Presenting AI suggestions first also led to worse outcomes when the AI was incorrect for both groups. These findings highlight XAI's varying impact based on expertise and timing, underscoring LLMs as a "double-edged sword" in medical AI and informing future human-AI collaborative system design.

Luis R. Soenksen, Yu Ma, Cynthia Zeng et al.

Artificial intelligence (AI) systems hold great promise to improve healthcare over the next decades. Specifically, AI systems leveraging multiple data sources and input modalities are poised to become a viable method to deliver more accurate results and deployable pipelines across a wide range of applications. In this work, we propose and evaluate a unified Holistic AI in Medicine (HAIM) framework to facilitate the generation and testing of AI systems that leverage multimodal inputs. Our approach uses generalizable data pre-processing and machine learning modeling stages that can be readily adapted for research and deployment in healthcare environments. We evaluate our HAIM framework by training and characterizing 14,324 independent models based on HAIM-MIMIC-MM, a multimodal clinical database (N=34,537 samples) containing 7,279 unique hospitalizations and 6,485 patients, spanning all possible input combinations of 4 data modalities (i.e., tabular, time-series, text, and images), 11 unique data sources and 12 predictive tasks. We show that this framework can consistently and robustly produce models that outperform similar single-source approaches across various healthcare demonstrations (by 6-33%), including 10 distinct chest pathology diagnoses, along with length-of-stay and 48-hour mortality predictions. We also quantify the contribution of each modality and data source using Shapley values, which demonstrates the heterogeneity in data modality importance and the necessity of multimodal inputs across different healthcare-relevant tasks. The generalizable properties and flexibility of our Holistic AI in Medicine (HAIM) framework could offer a promising pathway for future multimodal predictive systems in clinical and operational healthcare settings.