Duncan C. McElfresh

Duncan McElfresh, Sujay Khandagale, Jonathan Valverde et al.

While other areas of machine learning have seen more and more automation, designing a high-performing recommender system still requires a high level of human effort. Furthermore, recent work has shown that modern recommender system algorithms do not always improve over well-tuned baselines. A natural follow-up question is, "how do we choose the right algorithm for a new dataset and performance metric?" In this work, we start by giving the first large-scale study of recommender system approaches by comparing 18 algorithms and 100 sets of hyperparameters across 85 datasets and 315 metrics. We find that the best algorithms and hyperparameters are highly dependent on the dataset and performance metric, however, there are also strong correlations between the performance of each algorithm and various meta-features of the datasets. Motivated by these findings, we create RecZilla, a meta-learning approach to recommender systems that uses a model to predict the best algorithm and hyperparameters for new, unseen datasets. By using far more meta-training data than prior work, RecZilla is able to substantially reduce the level of human involvement when faced with a new recommender system application. We not only release our code and pretrained RecZilla models, but also all of our raw experimental results, so that practitioners can train a RecZilla model for their desired performance metric: https://github.com/naszilla/reczilla.

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.

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.

Duncan McElfresh, Sujay Khandagale, Jonathan Valverde et al.

Tabular data is one of the most commonly used types of data in machine learning. Despite recent advances in neural nets (NNs) for tabular data, there is still an active discussion on whether or not NNs generally outperform gradient-boosted decision trees (GBDTs) on tabular data, with several recent works arguing either that GBDTs consistently outperform NNs on tabular data, or vice versa. In this work, we take a step back and question the importance of this debate. To this end, we conduct the largest tabular data analysis to date, comparing 19 algorithms across 176 datasets, and we find that the 'NN vs. GBDT' debate is overemphasized: for a surprisingly high number of datasets, either the performance difference between GBDTs and NNs is negligible, or light hyperparameter tuning on a GBDT is more important than choosing between NNs and GBDTs. A remarkable exception is the recently-proposed prior-data fitted network, TabPFN: although it is effectively limited to training sets of size 3000, we find that it outperforms all other algorithms on average, even when randomly sampling 3000 training datapoints. Next, we analyze dozens of metafeatures to determine what properties of a dataset make NNs or GBDTs better-suited to perform well. For example, we find that GBDTs are much better than NNs at handling skewed or heavy-tailed feature distributions and other forms of dataset irregularities. Our insights act as a guide for practitioners to determine which techniques may work best on their dataset. Finally, with the goal of accelerating tabular data research, we release the TabZilla Benchmark Suite: a collection of the 36 'hardest' of the datasets we study. Our benchmark suite, codebase, and all raw results are available at https://github.com/naszilla/tabzilla.

Duncan C McElfresh, Christian Kroer, Sergey Pupyrev et al.

Global demand for donated blood far exceeds supply, and unmet need is greatest in low- and middle-income countries; experts suggest that large-scale coordination is necessary to alleviate demand. Using the Facebook Blood Donation tool, we conduct the first large-scale algorithmic matching of blood donors with donation opportunities. While measuring actual donation rates remains a challenge, we measure donor action (e.g., making a donation appointment) as a proxy for actual donation. We develop automated policies for matching donors with donation opportunities, based on an online matching model. We provide theoretical guarantees for these policies, both regarding the number of expected donations and the equitable treatment of blood recipients. In simulations, a simple matching strategy increases the number of donations by 5-10%; a pilot experiment with real donors shows a 5% relative increase in donor action rate (from 3.7% to 3.9%). When scaled to the global Blood Donation tool user base, this corresponds to an increase of around one hundred thousand users taking action toward donation. Further, observing donor action on a social network can shed light onto donor behavior and response to incentives. Our initial findings align with several observations made in the medical and social science literature regarding donor behavior.

Duncan C McElfresh, Lok Chan, Kenzie Doyle et al.

AI systems are often used to make or contribute to important decisions in a growing range of applications, including criminal justice, hiring, and medicine. Since these decisions impact human lives, it is important that the AI systems act in ways which align with human values. Techniques for preference modeling and social choice help researchers learn and aggregate peoples' preferences, which are used to guide AI behavior; thus, it is imperative that these learned preferences are accurate. These techniques often assume that people are willing to express strict preferences over alternatives; which is not true in practice. People are often indecisive, and especially so when their decision has moral implications. The philosophy and psychology literature shows that indecision is a measurable and nuanced behavior -- and that there are several different reasons people are indecisive. This complicates the task of both learning and aggregating preferences, since most of the relevant literature makes restrictive assumptions on the meaning of indecision. We begin to close this gap by formalizing several mathematical \emph{indecision} models based on theories from philosophy, psychology, and economics; these models can be used to describe (indecisive) agent decisions, both when they are allowed to express indecision and when they are not. We test these models using data collected from an online survey where participants choose how to (hypothetically) allocate organs to patients waiting for a transplant.

Duncan C McElfresh, Michael Curry, Tuomas Sandholm et al.

In barter exchanges, participants swap goods with one another without exchanging money; exchanges are often facilitated by a central clearinghouse, with the goal of maximizing the aggregate quality (or number) of swaps. Barter exchanges are subject to many forms of uncertainty--in participant preferences, the feasibility and quality of various swaps, and so on. Our work is motivated by kidney exchange, a real-world barter market in which patients in need of a kidney transplant swap their willing living donors, in order to find a better match. Modern exchanges include 2- and 3-way swaps, making the kidney exchange clearing problem NP-hard. Planned transplants often fail for a variety of reasons--if the donor organ is refused by the recipient's medical team, or if the donor and recipient are found to be medically incompatible. Due to 2- and 3-way swaps, failed transplants can "cascade" through an exchange; one US-based exchange estimated that about 85% of planned transplants failed in 2019. Many optimization-based approaches have been designed to avoid these failures; however most exchanges cannot implement these methods due to legal and policy constraints. Instead we consider a setting where exchanges can query the preferences of certain donors and recipients--asking whether they would accept a particular transplant. We characterize this as a two-stage decision problem, in which the exchange program (a) queries a small number of transplants before committing to a matching, and (b) constructs a matching according to fixed policy. We show that selecting these edges is a challenging combinatorial problem, which is non-monotonic and non-submodular, in addition to being NP-hard. We propose both a greedy heuristic and a Monte Carlo tree search, which outperforms previous approaches, using experiments on both synthetic data and real kidney exchange data from the United Network for Organ Sharing.

Hoda Bidkhori, John P Dickerson, Duncan C McElfresh et al.

Motivated by kidney exchange, we study a stochastic cycle and chain packing problem, where we aim to identify structures in a directed graph to maximize the expectation of matched edge weights. All edges are subject to failure, and the failures can have nonidentical probabilities. To the best of our knowledge, the state-of-the-art approaches are only tractable when failure probabilities are identical. We formulate a relevant non-convex optimization problem and propose a tractable mixed-integer linear programming reformulation to solve it. In addition, we propose a model that integrates both risks and the expected utilities of the matching by incorporating conditional value at risk (CVaR) into the objective function, providing a robust formulation for this problem. Subsequently, we propose a sample-average-approximation (SAA) based approach to solve this problem. We test our approaches on data from the United Network for Organ Sharing (UNOS) and compare against state-of-the-art approaches. Our model provides better performance with the same running time as a leading deterministic approach (PICEF). Our CVaR extensions with an SAA-based method improves the $α\times 100\%$ ($0<α\leqslant 1$) worst-case performance substantially compared to existing models.

Phebe Vayanos, Yingxiao Ye, Duncan McElfresh et al.

We study the problem of eliciting the preferences of a decision-maker through a moderate number of pairwise comparison queries to make them a high quality recommendation for a specific problem. We are motivated by applications in high stakes domains, such as when choosing a policy for allocating scarce resources to satisfy basic needs (e.g., kidneys for transplantation or housing for those experiencing homelessness) where a consequential recommendation needs to be made from the (partially) elicited preferences. We model uncertainty in the preferences as being set based and} investigate two settings: a) an offline elicitation setting, where all queries are made at once, and b) an online elicitation setting, where queries are selected sequentially over time in an adaptive fashion. We propose robust optimization formulations of these problems which integrate the preference elicitation and recommendation phases with aim to either maximize worst-case utility or minimize worst-case regret, and study their complexity. For the offline case, where active preference elicitation takes the form of a two and half stage robust optimization problem with decision-dependent information discovery, we provide an equivalent reformulation in the form of a mixed-binary linear program which we solve via column-and-constraint generation. For the online setting, where active preference learning takes the form of a multi-stage robust optimization problem with decision-dependent information discovery, we propose a conservative solution approach. Numerical studies on synthetic data demonstrate that our methods outperform state-of-the art approaches from the literature in terms of worst-case rank, regret, and utility. We showcase how our methodology can be used to assist a homeless services agency in choosing a policy for allocating scarce housing resources of different types to people experiencing homelessness.

Lok Chan, Kenzie Doyle, Duncan McElfresh et al.

Given AI's growing role in modeling and improving decision-making, how and when to present users with feedback is an urgent topic to address. We empirically examined the effect of feedback from false AI on moral decision-making about donor kidney allocation. We found some evidence that judgments about whether a patient should receive a kidney can be influenced by feedback about participants' own decision-making perceived to be given by AI, even if the feedback is entirely random. We also discovered different effects between assessments presented as being from human experts and assessments presented as being from AI.

Debjani Saha, Candice Schumann, Duncan C. McElfresh et al.

Bias in machine learning has manifested injustice in several areas, such as medicine, hiring, and criminal justice. In response, computer scientists have developed myriad definitions of fairness to correct this bias in fielded algorithms. While some definitions are based on established legal and ethical norms, others are largely mathematical. It is unclear whether the general public agrees with these fairness definitions, and perhaps more importantly, whether they understand these definitions. We take initial steps toward bridging this gap between ML researchers and the public, by addressing the question: does a lay audience understand a basic definition of ML fairness? We develop a metric to measure comprehension of three such definitions--demographic parity, equal opportunity, and equalized odds. We evaluate this metric using an online survey, and investigate the relationship between comprehension and sentiment, demographics, and the definition itself.

Duncan C McElfresh, Hoda Bidkhori, John P Dickerson

In barter exchanges, participants directly trade their endowed goods in a constrained economic setting without money. Transactions in barter exchanges are often facilitated via a central clearinghouse that must match participants even in the face of uncertainty---over participants, existence and quality of potential trades, and so on. Leveraging robust combinatorial optimization techniques, we address uncertainty in kidney exchange, a real-world barter market where patients swap (in)compatible paired donors. We provide two scalable robust methods to handle two distinct types of uncertainty in kidney exchange---over the quality and the existence of a potential match. The latter case directly addresses a weakness in all stochastic-optimization-based methods to the kidney exchange clearing problem, which all necessarily require explicit estimates of the probability of a transaction existing---a still-unsolved problem in this nascent market. We also propose a novel, scalable kidney exchange formulation that eliminates the need for an exponential-time constraint generation process in competing formulations, maintains provable optimality, and serves as a subsolver for our robust approach. For each type of uncertainty we demonstrate the benefits of robustness on real data from a large, fielded kidney exchange in the United States. We conclude by drawing parallels between robustness and notions of fairness in the kidney exchange setting.

Duncan C. McElfresh, John P. Dickerson

Balancing fairness and efficiency in resource allocation is a classical economic and computational problem. The price of fairness measures the worst-case loss of economic efficiency when using an inefficient but fair allocation rule; for indivisible goods in many settings, this price is unacceptably high. One such setting is kidney exchange, where needy patients swap willing but incompatible kidney donors. In this work, we close an open problem regarding the theoretical price of fairness in modern kidney exchanges. We then propose a general hybrid fairness rule that balances a strict lexicographic preference ordering over classes of agents, and a utilitarian objective that maximizes economic efficiency. We develop a utility function for this rule that favors disadvantaged groups lexicographically; but if cost to overall efficiency becomes too high, it switches to a utilitarian objective. This rule has only one parameter which is proportional to a bound on the price of fairness, and can be adjusted by policymakers. We apply this rule to real data from a large kidney exchange and show that our hybrid rule produces more reliable outcomes than other fairness rules.