J Ross Mitchell

Sarthak Pati, Ujjwal Baid, Brandon Edwards et al.

Although machine learning (ML) has shown promise in numerous domains, there are concerns about generalizability to out-of-sample data. This is currently addressed by centrally sharing ample, and importantly diverse, data from multiple sites. However, such centralization is challenging to scale (or even not feasible) due to various limitations. Federated ML (FL) provides an alternative to train accurate and generalizable ML models, by only sharing numerical model updates. Here we present findings from the largest FL study to-date, involving data from 71 healthcare institutions across 6 continents, to generate an automatic tumor boundary detector for the rare disease of glioblastoma, utilizing the largest dataset of such patients ever used in the literature (25,256 MRI scans from 6,314 patients). We demonstrate a 33% improvement over a publicly trained model to delineate the surgically targetable tumor, and 23% improvement over the tumor's entire extent. We anticipate our study to: 1) enable more studies in healthcare informed by large and diverse data, ensuring meaningful results for rare diseases and underrepresented populations, 2) facilitate further quantitative analyses for glioblastoma via performance optimization of our consensus model for eventual public release, and 3) demonstrate the effectiveness of FL at such scale and task complexity as a paradigm shift for multi-site collaborations, alleviating the need for data sharing.

Samridhi Vaid, Mike Weldon, Jesse Dunn et al.

Commercial AI scribes cost \$99-600 per physician per month, operate as opaque systems, and do not return data to institutional infrastructure, limiting organizational control over data governance, quality improvement, and clinical workflows. We developed Berta, an open-source modular scribe platform for AI-enabled clinical documentation, and deployed a customized implementation within Alberta Health Services (AHS) integrated with their existing Snowflake AI Data Cloud infrastructure. The system combines automatic speech recognition with large language models while retaining all clinical data within the secure AHS environment. During eight months (November 2024 to July 2025), 198 emergency physicians used the system in 105 urban and rural facilities, generating 22148 clinical sessions and more than 2800 hours of audio. The use grew from 680 to 5530 monthly sessions. Operating costs averaged less than \$30 per physician per month, a 70-95% reduction compared to commercial alternatives. AHS has since approved expansion to 850 physicians. This is the first provincial-scale deployment of an AI scribe integrated with existing health system infrastructure. By releasing Berta as open source, we provide a reproducible, cost-effective alternative that health systems can adapt to their own secure environments, supporting data sovereignty and informed evaluation of AI documentation technology.

Mohammad Tavakoli, Alireza Salemi, Carrie Ye et al.

Evaluating the abilities of large language models (LLMs) for tasks that require long-term memory and thus long-context reasoning, for example in conversational settings, is hampered by the existing benchmarks, which often lack narrative coherence, cover narrow domains, and only test simple recall-oriented tasks. This paper introduces a comprehensive solution to these challenges. First, we present a novel framework for automatically generating long (up to 10M tokens), coherent, and topically diverse conversations, accompanied by probing questions targeting a wide range of memory abilities. From this, we construct BEAM, a new benchmark comprising 100 conversations and 2,000 validated questions. Second, to enhance model performance, we propose LIGHT-a framework inspired by human cognition that equips LLMs with three complementary memory systems: a long-term episodic memory, a short-term working memory, and a scratchpad for accumulating salient facts. Our experiments on BEAM reveal that even LLMs with 1M token context windows (with and without retrieval-augmentation) struggle as dialogues lengthen. In contrast, LIGHT consistently improves performance across various models, achieving an average improvement of 3.5%-12.69% over the strongest baselines, depending on the backbone LLM. An ablation study further confirms the contribution of each memory component.