Brian Ng

Bo Chen, Ali Bakhshi, Gustavo Batista et al.

An increasing number of artificial intelligence (AI) applications involve the execution of deep neural networks (DNNs) on edge devices. Many practical reasons motivate the need to update the DNN model on the edge device post-deployment, such as refining the model, concept drift, or outright change in the learning task. In this paper, we consider the scenario where retraining can be done on the server side based on a copy of the DNN model, with only the necessary data transmitted to the edge to update the deployed model. However, due to bandwidth constraints, we want to minimise the transmission required to achieve the update. We develop a simple approach based on matrix factorisation to compress the model update -- this differs from compressing the model itself. The key idea is to preserve existing knowledge in the current model and optimise only small additional parameters for the update which can be used to reconstitute the model on the edge. We compared our method to similar techniques used in federated learning; our method usually requires less than half of the update size of existing methods to achieve the same accuracy.

Nigam H. Shah, Nerissa Ambers, Abby Pandya et al.

While large language models (LLMs) can support clinical documentation needs, standalone tools struggle with "workflow friction" from manual data entry. We developed ChatEHR, a system that enables the use of LLMs with the entire patient timeline spanning several years. ChatEHR enables automations - which are static combinations of prompts and data that perform a fixed task - and interactive use in the electronic health record (EHR) via a user interface (UI). The resulting ability to sift through patient medical records for diverse use-cases such as pre-visit chart review, screening for transfer eligibility, monitoring for surgical site infections, and chart abstraction, redefines LLM use as an institutional capability. This system, accessible after user-training, enables continuous monitoring and evaluation of LLM use. In 1.5 years, we built 7 automations and 1075 users have trained to become routine users of the UI, engaging in 23,000 sessions in the first 3 months of launch. For automations, being model-agnostic and accessing multiple types of data was essential for matching specific clinical or administrative tasks with the most appropriate LLM. Benchmark-based evaluations proved insufficient for monitoring and evaluation of the UI, requiring new methods to monitor performance. Generation of summaries was the most frequent task in the UI, with an estimated 0.73 hallucinations and 1.60 inaccuracies per generation. The resulting mix of cost savings, time savings, and revenue growth required a value assessment framework to prioritize work as well as quantify the impact of using LLMs. Initial estimates are $6M savings in the first year of use, without quantifying the benefit of the better care offered. Such a "build-from-within" strategy provides an opportunity for health systems to maintain agency via a vendor-agnostic, internally governed LLM platform.