David Page

Jihye Choi, Nils Palumbo, Prasad Chalasani et al.

In the era of Large Language Models (LLMs), given their remarkable text understanding and generation abilities, there is an unprecedented opportunity to develop new, LLM-based methods for trustworthy medical knowledge synthesis, extraction and summarization. This paper focuses on the problem of Pharmacovigilance (PhV), where the significance and challenges lie in identifying Adverse Drug Events (ADEs) from diverse text sources, such as medical literature, clinical notes, and drug labels. Unfortunately, this task is hindered by factors including variations in the terminologies of drugs and outcomes, and ADE descriptions often being buried in large amounts of narrative text. We present MALADE, the first effective collaborative multi-agent system powered by LLM with Retrieval Augmented Generation for ADE extraction from drug label data. This technique involves augmenting a query to an LLM with relevant information extracted from text resources, and instructing the LLM to compose a response consistent with the augmented data. MALADE is a general LLM-agnostic architecture, and its unique capabilities are: (1) leveraging a variety of external sources, such as medical literature, drug labels, and FDA tools (e.g., OpenFDA drug information API), (2) extracting drug-outcome association in a structured format along with the strength of the association, and (3) providing explanations for established associations. Instantiated with GPT-4 Turbo or GPT-4o, and FDA drug label data, MALADE demonstrates its efficacy with an Area Under ROC Curve of 0.90 against the OMOP Ground Truth table of ADEs. Our implementation leverages the Langroid multi-agent LLM framework and can be found at https://github.com/jihyechoi77/malade.

Tatsuki Koga, Kamalika Chaudhuri, David Page

Patient privacy is a major barrier to healthcare AI. For confidentiality reasons, most patient data remains in silo in separate hospitals, preventing the design of data-driven healthcare AI systems that need large volumes of patient data to make effective decisions. A solution to this is collective learning across multiple sites through federated learning with differential privacy. However, literature in this space typically focuses on differentially private statistical estimation and machine learning, which is different from the causal inference-related problems that arise in healthcare. In this work, we take a fresh look at federated learning with a focus on causal inference; specifically, we look at estimating the average treatment effect (ATE), an important task in causal inference for healthcare applications, and provide a federated analytics approach to enable ATE estimation across multiple sites along with differential privacy (DP) guarantees at each site. The main challenge comes from site heterogeneity -- different sites have different sample sizes and privacy budgets. We address this through a class of per-site estimation algorithms that reports the ATE estimate and its variance as a quality measure, and an aggregation algorithm on the server side that minimizes the overall variance of the final ATE estimate. Our experiments on real and synthetic data show that our method reliably aggregates private statistics across sites and provides better privacy-utility tradeoff under site heterogeneity than baselines.

Boyao Li, Alexander J. Thomson, Houssam Nassif et al.

Deep neural networks (DNNs) lack the precise semantics and definitive probabilistic interpretation of probabilistic graphical models (PGMs). In this paper, we propose an innovative solution by constructing infinite tree-structured PGMs that correspond exactly to neural networks. Our research reveals that DNNs, during forward propagation, indeed perform approximations of PGM inference that are precise in this alternative PGM structure. Not only does our research complement existing studies that describe neural networks as kernel machines or infinite-sized Gaussian processes, it also elucidates a more direct approximation that DNNs make to exact inference in PGMs. Potential benefits include improved pedagogy and interpretation of DNNs, and algorithms that can merge the strengths of PGMs and DNNs.

Alex Taylor, Ross Kleiman, Scott Hebbring et al.

Accurate estimation of healthcare costs is crucial for healthcare systems to plan and effectively negotiate with insurance companies regarding the coverage of patient-care costs. Greater accuracy in estimating healthcare costs would provide mutual benefit for both health systems and the insurers that support these systems by better aligning payment models with patient-care costs. This study presents the results of a generalizable machine learning approach to predicting medical events built from 40 years of data from >860,000 patients pertaining to >6,700 prescription medications, courtesy of Marshfield Clinic in Wisconsin. It was found that models built using this approach performed well when compared to similar studies predicting physician prescriptions of individual medications. In addition to providing a comprehensive predictive model for all drugs in a large healthcare system, the approach taken in this research benefits from potential applicability to a wide variety of other medical events.

Irene Giacomelli, Somesh Jha, Ross Kleiman et al.

We study the problem of privacy-preserving machine learning (PPML) for ensemble methods, focusing our effort on random forests. In collaborative analysis, PPML attempts to solve the conflict between the need for data sharing and privacy. This is especially important in privacy sensitive applications such as learning predictive models for clinical decision support from EHR data from different clinics, where each clinic has a responsibility for its patients' privacy. We propose a new approach for ensemble methods: each entity learns a model, from its own data, and then when a client asks the prediction for a new private instance, the answers from all the locally trained models are used to compute the prediction in such a way that no extra information is revealed. We implement this approach for random forests and we demonstrate its high efficiency and potential accuracy benefit via experiments on real-world datasets, including actual EHR data.

Jesse Davis, Vitor Santos Costa, Peggy Peissig et al.

Learning from electronic medical records (EMR) is challenging due to their relational nature and the uncertain dependence between a patient's past and future health status. Statistical relational learning is a natural fit for analyzing EMRs but is less adept at handling their inherent latent structure, such as connections between related medications or diseases. One way to capture the latent structure is via a relational clustering of objects. We propose a novel approach that, instead of pre-clustering the objects, performs a demand-driven clustering during learning. We evaluate our algorithm on three real-world tasks where the goal is to use EMRs to predict whether a patient will have an adverse reaction to a medication. We find that our approach is more accurate than performing no clustering, pre-clustering, and using expert-constructed medical heterarchies.

Kendrick Boyd, Vitor Santos Costa, Jesse Davis et al.

Precision-recall (PR) curves and the areas under them are widely used to summarize machine learning results, especially for data sets exhibiting class skew. They are often used analogously to ROC curves and the area under ROC curves. It is known that PR curves vary as class skew changes. What was not recognized before this paper is that there is a region of PR space that is completely unachievable, and the size of this region depends only on the skew. This paper precisely characterizes the size of that region and discusses its implications for empirical evaluation methodology in machine learning.