Mauro Giuffrè

Lingfei Qian, Mauro Giuffre, Yan Wang et al.

Clinical decision-making increasingly relies on timely and context-aware access to patient information within Electronic Health Records (EHRs), yet most existing natural language question-answering (QA) systems are evaluated solely on benchmark datasets, limiting their practical relevance. To overcome this limitation, we introduce EHRNavigator, a multi-agent framework that harnesses AI agents to perform patient-level question answering across heterogeneous and multimodal EHR data. We assessed its performance using both public benchmark and institutional datasets under realistic hospital conditions characterized by diverse schemas, temporal reasoning demands, and multimodal evidence integration. Through quantitative evaluation and clinician-validated chart review, EHRNavigator demonstrated strong generalization, achieving 86% accuracy on real-world cases while maintaining clinically acceptable response times. Overall, these findings confirm that EHRNavigator effectively bridges the gap between benchmark evaluation and clinical deployment, offering a robust, adaptive, and efficient solution for real-world EHR question answering.

Colleen Chan, Kisung You, Sunny Chung et al.

Applications of large language models (LLMs) like ChatGPT have potential to enhance clinical decision support through conversational interfaces. However, challenges of human-algorithmic interaction and clinician trust are poorly understood. GutGPT, a LLM for gastrointestinal (GI) bleeding risk prediction and management guidance, was deployed in clinical simulation scenarios alongside the electronic health record (EHR) with emergency medicine physicians, internal medicine physicians, and medical students to evaluate its effect on physician acceptance and trust in AI clinical decision support systems (AI-CDSS). GutGPT provides risk predictions from a validated machine learning model and evidence-based answers by querying extracted clinical guidelines. Participants were randomized to GutGPT and an interactive dashboard, or the interactive dashboard and a search engine. Surveys and educational assessments taken before and after measured technology acceptance and content mastery. Preliminary results showed mixed effects on acceptance after using GutGPT compared to the dashboard or search engine but appeared to improve content mastery based on simulation performance. Overall, this study demonstrates LLMs like GutGPT could enhance effective AI-CDSS if implemented optimally and paired with interactive interfaces.

Zhen Chen, Yihang Fu, Gabriel Madera et al.

Multi-modal large language models (MLLMs) have shown promise in advancing healthcare. However, most existing models remain confined to single-image understanding, which greatly limits their applicability in clinical workflows. In practice, medical diagnosis and progression often require synthesizing information across multiple images from different modalities or time points. The development of medical MLLMs capable of such multi-image understanding has been hindered by the lack of large-scale, high-quality annotated training data. To address this limitation, we propose a novel framework that leverages license-permissive compound images in biomedical literature, as a rich yet underutilized data source for multi-image analysis. Specifically, we design a five-stage, context-aware instruction generation paradigm underpinned by a divide-and-conquer strategy. By decomposing multi-image analysis into manageable sub-tasks, this paradigm empowers MLLMs to move beyond single-panel analysis and provide a composite understanding by learning the complex spatial, temporal, and cross-modal relationships inherent in these compound figures. By parsing over 237,000 compound figures and their contextual text for instruction generation, we develop M3LLM, a medical multi-image multi-modal large language model. For benchmarking, we construct PMC-MI-Bench for composite understanding, manually validated by medical experts. Extensive experiments show that M3LLM significantly outperforms both general-purpose and specialized medical MLLMs across multi-image, single-image, text-only, and multi-choice scenarios. Notably, M3LLM exhibits strong generalization to longitudinal chest X-ray analysis using the MIMIC dataset. This work establishes a scalable and efficient paradigm for developing medical MLLMs capable of composite reasoning, bridging the gap between biomedical literature and real-world clinical applications.

Ryan Chen, Youngmin Ko, Zeyu Zhang et al.

We introduce LAMP (Linear Attribution Mapping Probe), a method that shines light onto a black-box language model's decision surface and studies how reliably a model maps its stated reasons to its predictions through a locally linear model approximating the decision surface. LAMP treats the model's own self-reported explanations as a coordinate system and fits a locally linear surrogate that links those weights to the model's output. By doing so, it reveals which stated factors steer the model's decisions, and by how much. We apply LAMP to three tasks: sentiment analysis, controversial-topic detection, and safety-prompt auditing. Across these tasks, LAMP reveals that many LLMs exhibit locally linear decision landscapes. In addition, these surfaces correlate with human judgments on explanation quality and, on a clinical case-file data set, aligns with expert assessments. Since LAMP operates without requiring access to model gradients, logits, or internal activations, it serves as a practical and lightweight framework for auditing proprietary language models, and enabling assessment of whether a model behaves consistently with the explanations it provides.