Anna Lin

Snigdha Pandya, Rohan Nagale, Kenji Sahay et al.

Large language models (LLMs) often generate fluent but factually incorrect statements despite having access to relevant evidence, a failure mode rooted in how they allocate attention between contextual and parametric knowledge. Understanding and steering this internal behavior is key both for trustworthy deployment and for scientific interpretability of model mechanisms. We introduce COMPASS (Context-Modulated PID Attention Steering System), a lightweight, interpretable control framework that embeds a model-based feedback loop directly within decoding. COMPASS quantifies context reliance via a transparent metric, the Context Reliance Score (CRS), which serves as an online probe of how attention heads ground generation in evidence. Using this interpretable signal, a PID controller dynamically modulates attention heads to maintain factual consistency without retraining or multi-pass decoding. Across benchmarks (HotpotQA, XSum, HaluEval, RAGTruth), COMPASS consistently reduces contextual hallucination rates (2.8 to 5.8 percent absolute) while revealing how distinct attention heads contribute to evidence alignment. These results highlight feedback-driven interpretability as a pathway toward scientific understanding of LLM behavior.

Faith Wavinya Mutinda, Spandana Makeneni, Anna Lin et al.

Introduction: Semantic search, which retrieves documents based on conceptual similarity rather than keyword matching, offers substantial advantages for retrieval of clinical information. However, deploying semantic search across entire health systems, comprising hundreds of millions of clinical notes, presents formidable engineering, cost, and governance challenges that have prevented adoption. Methods: We deployed a semantic search system at a large children's hospital indexing 166 million clinical notes (484 million vectors) from 1.68 million patients. The system uses instruction-tuned qwen3-embedding-0.6B embeddings, stores vectors in a managed database with storage-optimized indexing, maintains full-text metadata in a low-latency key-value store, and operates within a HIPAA-compliant governance framework. We evaluated the system through three experiments: optimization of embedding model and chunking strategy using a physician-authored benchmark dataset, characterization of full-scale performance (cost, latency, retrieval quality), and clinical utility assessment via comparison of chart abstraction efficiency across three tasks. Results: The system delivers sub-second query latency (median 237 ms single-user, 451 ms 20-user concurrency) with monthly costs of approximately USD 4,000. Qwen3 embeddings with 300-token chunk size achieved 94.6% accuracy on a clinical question-answering benchmark. In clinical utility evaluation across three abstraction tasks, semantic search reduced time-to-completion by 24 to 89% compared to clinician-performed chart review while maintaining comparable inter-rater agreement. Conclusion: Health-system-scale semantic search is both technically and operationally feasible. The system provides infrastructure supporting interactive search, cohort generation, and downstream LLM-powered clinical applications without requiring specialized informatics expertise.