Nan Liu

Nan Liu, Shuang Li, Yilun Du et al. · mit

Large text-guided diffusion models, such as DALLE-2, are able to generate stunning photorealistic images given natural language descriptions. While such models are highly flexible, they struggle to understand the composition of certain concepts, such as confusing the attributes of different objects or relations between objects. In this paper, we propose an alternative structured approach for compositional generation using diffusion models. An image is generated by composing a set of diffusion models, with each of them modeling a certain component of the image. To do this, we interpret diffusion models as energy-based models in which the data distributions defined by the energy functions may be explicitly combined. The proposed method can generate scenes at test time that are substantially more complex than those seen in training, composing sentence descriptions, object relations, human facial attributes, and even generalizing to new combinations that are rarely seen in the real world. We further illustrate how our approach may be used to compose pre-trained text-guided diffusion models and generate photorealistic images containing all the details described in the input descriptions, including the binding of certain object attributes that have been shown difficult for DALLE-2. These results point to the effectiveness of the proposed method in promoting structured generalization for visual generation. Project page: https://energy-based-model.github.io/Compositional-Visual-Generation-with-Composable-Diffusion-Models/

Nan Liu, Yilun Du, Shuang Li et al. · mit

Text-to-image generative models have enabled high-resolution image synthesis across different domains, but require users to specify the content they wish to generate. In this paper, we consider the inverse problem -- given a collection of different images, can we discover the generative concepts that represent each image? We present an unsupervised approach to discover generative concepts from a collection of images, disentangling different art styles in paintings, objects, and lighting from kitchen scenes, and discovering image classes given ImageNet images. We show how such generative concepts can accurately represent the content of images, be recombined and composed to generate new artistic and hybrid images, and be further used as a representation for downstream classification tasks.

Kabilan Elangovan, Jasmine Chiat Ling Ong, Liyuan Jin et al.

Large Language Models (LLMs) have emerged as a potential solution to assist digital health development with patient education, commonly medication-related enquires. We trained and validated Med-Pal, a medication domain-specific LLM-chatbot fine-tuned with a fine-grained and expert curated dataset from a selection of five light-weighted open-source LLMs of smaller parameter size (7 billion or less) regarding computational constraints and prioritizing operational efficiency. A multi-disciplinary team performed a clinical evaluation of LLMs responses using the SCORE criteria, focusing on safety, accuracy, bias, reproducibility, and ease of understanding. Best performing light-weighted LLM was chosen as Med-Pal for further engineering with guard-railing using adversarial prompting. Med-Pal and existing light-weighted LLMs, including pretrained Biomistral and finetuned Meerkat, were validated on an independent dataset on a broad range of medication-related questions (231 in total), 12 different question types across 14 different medication classes. Mistral-7b emerged as the top performer among selected lightweight LLMs, achieving the highest median score of 14 and 71.9% high-quality responses in accuracy and safety domains, hence chosen as the backbone LLM for Med-Pal. When compared against Biomistral, Med-pal outperformed in generating responses appropriate for patient communication, with significant reductions bias and errors typical of general LLMs. Comparable performance was observed when comparing Med-Pal with Meerkat. Med-Pal showcases the feasibility of developing and employing fine-tuned light-weighted LLMs to enhance digital health communications.

Mingxuan Liu, Siqi Li, Han Yuan et al.

Objective: The proper handling of missing values is critical to delivering reliable estimates and decisions, especially in high-stakes fields such as clinical research. The increasing diversity and complexity of data have led many researchers to develop deep learning (DL)-based imputation techniques. We conducted a systematic review to evaluate the use of these techniques, with a particular focus on data types, aiming to assist healthcare researchers from various disciplines in dealing with missing values. Methods: We searched five databases (MEDLINE, Web of Science, Embase, CINAHL, and Scopus) for articles published prior to August 2021 that applied DL-based models to imputation. We assessed selected publications from four perspectives: health data types, model backbone (i.e., main architecture), imputation strategies, and comparison with non-DL-based methods. Based on data types, we created an evidence map to illustrate the adoption of DL models. Results: We included 64 articles, of which tabular static (26.6%, 17/64) and temporal data (37.5%, 24/64) were the most frequently investigated. We found that model backbone(s) differed among data types as well as the imputation strategy. The "integrated" strategy, that is, the imputation task being solved concurrently with downstream tasks, was popular for tabular temporal (50%, 12/24) and multi-modal data (71.4%, 5/7), but limited for other data types. Moreover, DL-based imputation methods yielded better imputation accuracy in most studies, compared with non-DL-based methods. Conclusion: DL-based imputation models can be customized based on data type, addressing the corresponding missing patterns, and its associated "integrated" strategy can enhance the efficacy of imputation, especially in scenarios where data is complex. Future research may focus on the portability and fairness of DL-based models for healthcare data imputation.

Yuzhe Li, Yong Liu, Bo Li et al.

In this paper, we focus our attention on private Empirical Risk Minimization (ERM), which is one of the most commonly used data analysis method. We take the first step towards solving the above problem by theoretically exploring the effect of epsilon (the parameter of differential privacy that determines the strength of privacy guarantee) on utility of the learning model. We trace the change of utility with modification of epsilon and reveal an established relationship between epsilon and utility. We then formalize this relationship and propose a practical approach for estimating the utility under an arbitrary value of epsilon. Both theoretical analysis and experimental results demonstrate high estimation accuracy and broad applicability of our approach in practical applications. As providing algorithms with strong utility guarantees that also give privacy when possible becomes more and more accepted, our approach would have high practical value and may be likely to be adopted by companies and organizations that would like to preserve privacy but are unwilling to compromise on utility.

Siqi Li, Pinyan Liu, Gustavo G. Nascimento et al.

Federated learning (FL) has gained popularity in clinical research in recent years to facilitate privacy-preserving collaboration. Structured data, one of the most prevalent forms of clinical data, has experienced significant growth in volume concurrently, notably with the widespread adoption of electronic health records in clinical practice. This review examines FL applications on structured medical data, identifies contemporary limitations and discusses potential innovations. We searched five databases, SCOPUS, MEDLINE, Web of Science, Embase, and CINAHL, to identify articles that applied FL to structured medical data and reported results following the PRISMA guidelines. Each selected publication was evaluated from three primary perspectives, including data quality, modeling strategies, and FL frameworks. Out of the 1160 papers screened, 34 met the inclusion criteria, with each article consisting of one or more studies that used FL to handle structured clinical/medical data. Of these, 24 utilized data acquired from electronic health records, with clinical predictions and association studies being the most common clinical research tasks that FL was applied to. Only one article exclusively explored the vertical FL setting, while the remaining 33 explored the horizontal FL setting, with only 14 discussing comparisons between single-site (local) and FL (global) analysis. The existing FL applications on structured medical data lack sufficient evaluations of clinically meaningful benefits, particularly when compared to single-site analyses. Therefore, it is crucial for future FL applications to prioritize clinical motivations and develop designs and methodologies that can effectively support and aid clinical practice and research.

Siqi Li, Yilin Ning, Marcus Eng Hock Ong et al.

We propose FedScore, a privacy-preserving federated learning framework for scoring system generation across multiple sites to facilitate cross-institutional collaborations. The FedScore framework includes five modules: federated variable ranking, federated variable transformation, federated score derivation, federated model selection and federated model evaluation. To illustrate usage and assess FedScore's performance, we built a hypothetical global scoring system for mortality prediction within 30 days after a visit to an emergency department using 10 simulated sites divided from a tertiary hospital in Singapore. We employed a pre-existing score generator to construct 10 local scoring systems independently at each site and we also developed a scoring system using centralized data for comparison. We compared the acquired FedScore model's performance with that of other scoring models using the receiver operating characteristic (ROC) analysis. The FedScore model achieved an average area under the curve (AUC) value of 0.763 across all sites, with a standard deviation (SD) of 0.020. We also calculated the average AUC values and SDs for each local model, and the FedScore model showed promising accuracy and stability with a high average AUC value which was closest to the one of the pooled model and SD which was lower than that of most local models. This study demonstrates that FedScore is a privacy-preserving scoring system generator with potentially good generalizability.

Madhurima Panja, Tanujit Chakraborty, Sk Shahid Nadim et al.

Dengue fever is a virulent disease spreading over 100 tropical and subtropical countries in Africa, the Americas, and Asia. This arboviral disease affects around 400 million people globally, severely distressing the healthcare systems. The unavailability of a specific drug and ready-to-use vaccine makes the situation worse. Hence, policymakers must rely on early warning systems to control intervention-related decisions. Forecasts routinely provide critical information for dangerous epidemic events. However, the available forecasting models (e.g., weather-driven mechanistic, statistical time series, and machine learning models) lack a clear understanding of different components to improve prediction accuracy and often provide unstable and unreliable forecasts. This study proposes an ensemble wavelet neural network with exogenous factor(s) (XEWNet) model that can produce reliable estimates for dengue outbreak prediction for three geographical regions, namely San Juan, Iquitos, and Ahmedabad. The proposed XEWNet model is flexible and can easily incorporate exogenous climate variable(s) confirmed by statistical causality tests in its scalable framework. The proposed model is an integrated approach that uses wavelet transformation into an ensemble neural network framework that helps in generating more reliable long-term forecasts. The proposed XEWNet allows complex non-linear relationships between the dengue incidence cases and rainfall; however, mathematically interpretable, fast in execution, and easily comprehensible. The proposal's competitiveness is measured using computational experiments based on various statistical metrics and several statistical comparison tests. In comparison with statistical, machine learning, and deep learning methods, our proposed XEWNet performs better in 75% of the cases for short-term and long-term forecasting of dengue incidence.

Madhurima Panja, Tanujit Chakraborty, Uttam Kumar et al.

Infectious diseases remain among the top contributors to human illness and death worldwide, among which many diseases produce epidemic waves of infection. The unavailability of specific drugs and ready-to-use vaccines to prevent most of these epidemics makes the situation worse. These force public health officials and policymakers to rely on early warning systems generated by reliable and accurate forecasts of epidemics. Accurate forecasts of epidemics can assist stakeholders in tailoring countermeasures, such as vaccination campaigns, staff scheduling, and resource allocation, to the situation at hand, which could translate to reductions in the impact of a disease. Unfortunately, most of these past epidemics exhibit nonlinear and non-stationary characteristics due to their spreading fluctuations based on seasonal-dependent variability and the nature of these epidemics. We analyse a wide variety of epidemic time series datasets using a maximal overlap discrete wavelet transform (MODWT) based autoregressive neural network and call it EWNet model. MODWT techniques effectively characterize non-stationary behavior and seasonal dependencies in the epidemic time series and improve the nonlinear forecasting scheme of the autoregressive neural network in the proposed ensemble wavelet network framework. From a nonlinear time series viewpoint, we explore the asymptotic stationarity of the proposed EWNet model to show the asymptotic behavior of the associated Markov Chain. We also theoretically investigate the effect of learning stability and the choice of hidden neurons in the proposal. From a practical perspective, we compare our proposed EWNet framework with several statistical, machine learning, and deep learning models. Experimental results show that the proposed EWNet is highly competitive compared to the state-of-the-art epidemic forecasting methods.

Mingxuan Liu, Yilin Ning, Salinelat Teixayavong et al.

Artificial intelligence (AI) has demonstrated the ability to extract insights from data, but the issue of fairness remains a concern in high-stakes fields such as healthcare. Despite extensive discussion and efforts in algorithm development, AI fairness and clinical concerns have not been adequately addressed. In this paper, we discuss the misalignment between technical and clinical perspectives of AI fairness, highlight the barriers to AI fairness' translation to healthcare, advocate multidisciplinary collaboration to bridge the knowledge gap, and provide possible solutions to address the clinical concerns pertaining to AI fairness.

Siqi Li, Di Miao, Qiming Wu et al.

Federated learning (FL) has shown promising potential in safeguarding data privacy in healthcare collaborations. While the term "FL" was originally coined by the engineering community, the statistical field has also explored similar privacy-preserving algorithms. Statistical FL algorithms, however, remain considerably less recognized than their engineering counterparts. Our goal was to bridge the gap by presenting the first comprehensive comparison of FL frameworks from both engineering and statistical domains. We evaluated five FL frameworks using both simulated and real-world data. The results indicate that statistical FL algorithms yield less biased point estimates for model coefficients and offer convenient confidence interval estimations. In contrast, engineering-based methods tend to generate more accurate predictions, sometimes surpassing central pooled and statistical FL models. This study underscores the relative strengths and weaknesses of both types of methods, emphasizing the need for increased awareness and their integration in future FL applications.

Mingxuan Liu, Yilin Ning, Han Yuan et al.

Objective: Shapley additive explanations (SHAP) is a popular post-hoc technique for explaining black box models. While the impact of data imbalance on predictive models has been extensively studied, it remains largely unknown with respect to SHAP-based model explanations. This study sought to investigate the effects of data imbalance on SHAP explanations for deep learning models, and to propose a strategy to mitigate these effects. Materials and Methods: We propose to adjust class distributions in the background and explanation data in SHAP when explaining black box models. Our data balancing strategy is to compose background data and explanation data with an equal distribution of classes. To evaluate the effects of data adjustment on model explanation, we propose to use the beeswarm plot as a qualitative tool to identify "abnormal" explanation artifacts, and quantitatively test the consistency between variable importance and prediction power. We demonstrated our proposed approach in an empirical study that predicted inpatient mortality using the Medical Information Mart for Intensive Care (MIMIC-III) data and a multilayer perceptron. Results: Using the data balancing strategy would allow us to reduce the number of the artifacts in the beeswarm plot, thus mitigating the negative effects of data imbalance. Additionally, with the balancing strategy, the top-ranked variables from the corresponding importance ranking demonstrated improved discrimination power. Discussion and Conclusion: Our findings suggest that balanced background and explanation data could help reduce the noise in explanation results induced by skewed data distribution and improve the reliability of variable importance ranking. Furthermore, these balancing procedures improve the potential of SHAP in identifying patients with abnormal characteristics in clinical applications.

Yilin Ning, Salinelat Teixayavong, Yuqing Shang et al.

The widespread use of ChatGPT and other emerging technology powered by generative artificial intelligence (GenAI) has drawn much attention to potential ethical issues, especially in high-stakes applications such as healthcare, but ethical discussions are yet to translate into operationalisable solutions. Furthermore, ongoing ethical discussions often neglect other types of GenAI that have been used to synthesise data (e.g., images) for research and practical purposes, which resolved some ethical issues and exposed others. We conduct a scoping review of ethical discussions on GenAI in healthcare to comprehensively analyse gaps in the current research, and further propose to reduce the gaps by developing a checklist for comprehensive assessment and transparent documentation of ethical discussions in GenAI research. The checklist can be readily integrated into the current peer review and publication system to enhance GenAI research, and may be used for ethics-related disclosures for GenAI-powered products, healthcare applications of such products and beyond.

Yilin Ning, Victor Volovici, Marcus Eng Hock Ong et al.

A prediction model is most useful if it generalizes beyond the development data with external validations, but to what extent should it generalize remains unclear. In practice, prediction models are externally validated using data from very different settings, including populations from other health systems or countries, with predictably poor results. This may not be a fair reflection of the performance of the model which was designed for a specific target population or setting, and may be stretching the expected model generalizability. To address this, we suggest to externally validate a model using new data from the target population to ensure clear implications of validation performance on model reliability, whereas model generalizability to broader settings should be carefully investigated during model development instead of explored post-hoc. Based on this perspective, we propose a roadmap that facilitates the development and application of reliable, fair, and trustworthy artificial intelligence prediction models.

Siqi Li, Xin Li, Kunyu Yu et al.

Clinical and biomedical research in low-resource settings often faces significant challenges due to the need for high-quality data with sufficient sample sizes to construct effective models. These constraints hinder robust model training and prompt researchers to seek methods for leveraging existing knowledge from related studies to support new research efforts. Transfer learning (TL), a machine learning technique, emerges as a powerful solution by utilizing knowledge from pre-trained models to enhance the performance of new models, offering promise across various healthcare domains. Despite its conceptual origins in the 1990s, the application of TL in medical research has remained limited, especially beyond image analysis. In our review of TL applications in structured clinical and biomedical data, we screened 3,515 papers, with 55 meeting the inclusion criteria. Among these, only 2% (one out of 55) utilized external studies, and 7% (four out of 55) addressed scenarios involving multi-site collaborations with privacy constraints. To achieve actionable TL with structured medical data while addressing regional disparities, inequality, and privacy constraints in healthcare research, we advocate for the careful identification of appropriate source data and models, the selection of suitable TL frameworks, and the validation of TL models with proper baselines.

Yilin Ning, Mingxuan Liu, Nan Liu

Current practice in interpretable machine learning often focuses on explaining the final model trained from data, e.g., by using the Shapley additive explanations (SHAP) method. The recently developed Shapley variable importance cloud (ShapleyVIC) extends the current practice to a group of "nearly optimal models" to provide comprehensive and robust variable importance assessments, with estimated uncertainty intervals for a more complete understanding of variable contributions to predictions. ShapleyVIC was initially developed for applications with traditional regression models, and the benefits of ShapleyVIC inference have been demonstrated in real-life prediction tasks using the logistic regression model. However, as a model-agnostic approach, ShapleyVIC application is not limited to such scenarios. In this work, we extend ShapleyVIC implementation for machine learning models to enable wider applications, and propose it as a useful complement to the current SHAP analysis to enable more trustworthy applications of these black-box models.

Han Yuan, Chuan Hong, Nguyen Tuan Anh Tran et al.

Pneumothorax is a medical emergency caused by abnormal accumulation of air in the pleural space - the potential space between the lungs and chest wall. On 2D chest radiographs, pneumothorax occurs within the thoracic cavity and outside of the mediastinum and we refer to this area as "lung+ space". While deep learning (DL) has increasingly been utilized to segment pneumothorax lesions in chest radiographs, many existing DL models employ an end-to-end approach. These models directly map chest radiographs to clinician-annotated lesion areas, often neglecting the vital domain knowledge that pneumothorax is inherently location-sensitive. We propose a novel approach that incorporates the lung+ space as a constraint during DL model training for pneumothorax segmentation on 2D chest radiographs. To circumvent the need for additional annotations and to prevent potential label leakage on the target task, our method utilizes external datasets and an auxiliary task of lung segmentation. This approach generates a specific constraint of lung+ space for each chest radiograph. Furthermore, we have incorporated a discriminator to eliminate unreliable constraints caused by the domain shift between the auxiliary and target datasets. Our results demonstrated significant improvements, with average performance gains of 4.6%, 3.6%, and 3.3% regarding Intersection over Union (IoU), Dice Similarity Coefficient (DSC), and Hausdorff Distance (HD). Our research underscores the significance of incorporating medical domain knowledge about the location-specific nature of pneumothorax to enhance DL-based lesion segmentation.

Mingxuan Liu, Yuhe Ke, Wentao Zhu et al.

The integration of large language models (LLMs) into healthcare holds promise to enhance clinical decision-making, yet their susceptibility to biases remains a critical concern. Gender has long influenced physician behaviors and patient outcomes, raising concerns that LLMs assuming human-like roles, such as clinicians or medical educators, may replicate or amplify gender-related biases. Using case studies from the New England Journal of Medicine Challenge (NEJM), we assigned genders (female, male, or unspecified) to multiple open-source and proprietary LLMs. We evaluated their response consistency across LLM-gender assignments regarding both LLM-based diagnosis and models' judgments on the clinical relevance or necessity of patient gender. In our findings, diagnoses were relatively consistent across LLM genders for most models. However, for patient gender's relevance and necessity in LLM-based diagnosis, all models demonstrated substantial inconsistency across LLM genders, particularly for relevance judgements. Some models even displayed a systematic female-male disparity in their interpretation of patient gender. These findings present an underexplored bias that could undermine the reliability of LLMs in clinical practice, underscoring the need for routine checks of identity-assignment consistency when interacting with LLMs to ensure reliable and equitable AI-supported clinical care.

Qiming Wu, Siqi Li, Doudou Zhou et al.

Ensuring fairness is critical when applying artificial intelligence to high-stakes domains such as healthcare, where predictive models trained on imbalanced and demographically skewed data risk exacerbating existing disparities. Federated learning (FL) enables privacy-preserving collaboration across institutions, but remains vulnerable to both algorithmic bias and subgroup imbalance - particularly when multiple sensitive attributes intersect. We propose FedIDA (Fed erated Learning for Imbalance and D isparity A wareness), a framework-agnostic method that combines fairness-aware regularization with group-conditional oversampling. FedIDA supports multiple sensitive attributes and heterogeneous data distributions without altering the convergence behavior of the underlying FL algorithm. We provide theoretical analysis establishing fairness improvement bounds using Lipschitz continuity and concentration inequalities, and show that FedIDA reduces the variance of fairness metrics across test sets. Empirical results on both benchmark and real-world clinical datasets confirm that FedIDA consistently improves fairness while maintaining competitive predictive performance, demonstrating its effectiveness for equitable and privacy-preserving modeling in healthcare. The source code is available on GitHub.

Feng Xie, Jun Zhou, Jin Wee Lee et al.

The demand for emergency department (ED) services is increasing across the globe, particularly during the current COVID-19 pandemic. Clinical triage and risk assessment have become increasingly challenging due to the shortage of medical resources and the strain on hospital infrastructure caused by the pandemic. As a result of the widespread use of electronic health records (EHRs), we now have access to a vast amount of clinical data, which allows us to develop predictive models and decision support systems to address these challenges. To date, however, there are no widely accepted benchmark ED triage prediction models based on large-scale public EHR data. An open-source benchmarking platform would streamline research workflows by eliminating cumbersome data preprocessing, and facilitate comparisons among different studies and methodologies. In this paper, based on the Medical Information Mart for Intensive Care IV Emergency Department (MIMIC-IV-ED) database, we developed a publicly available benchmark suite for ED triage predictive models and created a benchmark dataset that contains over 400,000 ED visits from 2011 to 2019. We introduced three ED-based outcomes (hospitalization, critical outcomes, and 72-hour ED reattendance) and implemented a variety of popular methodologies, ranging from machine learning methods to clinical scoring systems. We evaluated and compared the performance of these methods against benchmark tasks. Our codes are open-source, allowing anyone with MIMIC-IV-ED data access to perform the same steps in data processing, benchmark model building, and experiments. This study provides future researchers with insights, suggestions, and protocols for managing raw data and developing risk triaging tools for emergency care.

YuHe Ke, Liyuan Jin, Kabilan Elangovan et al.

Purpose: Large Language Models (LLMs) hold significant promise for medical applications. Retrieval Augmented Generation (RAG) emerges as a promising approach for customizing domain knowledge in LLMs. This case study presents the development and evaluation of an LLM-RAG pipeline tailored for healthcare, focusing specifically on preoperative medicine. Methods: We developed an LLM-RAG model using 35 preoperative guidelines and tested it against human-generated responses, with a total of 1260 responses evaluated. The RAG process involved converting clinical documents into text using Python-based frameworks like LangChain and Llamaindex, and processing these texts into chunks for embedding and retrieval. Vector storage techniques and selected embedding models to optimize data retrieval, using Pinecone for vector storage with a dimensionality of 1536 and cosine similarity for loss metrics. Human-generated answers, provided by junior doctors, were used as a comparison. Results: The LLM-RAG model generated answers within an average of 15-20 seconds, significantly faster than the 10 minutes typically required by humans. Among the basic LLMs, GPT4.0 exhibited the best accuracy of 80.1%. This accuracy was further increased to 91.4% when the model was enhanced with RAG. Compared to the human-generated instructions, which had an accuracy of 86.3%, the performance of the GPT4.0 RAG model demonstrated non-inferiority (p=0.610). Conclusions: In this case study, we demonstrated a LLM-RAG model for healthcare implementation. The pipeline shows the advantages of grounded knowledge, upgradability, and scalability as important aspects of healthcare LLM deployment.

Ting Fang Tan, Kabilan Elangovan, Liyuan Jin et al.

Purpose: To assess the alignment of GPT-4-based evaluation to human clinician experts, for the evaluation of responses to ophthalmology-related patient queries generated by fine-tuned LLM chatbots. Methods: 400 ophthalmology questions and paired answers were created by ophthalmologists to represent commonly asked patient questions, divided into fine-tuning (368; 92%), and testing (40; 8%). We find-tuned 5 different LLMs, including LLAMA2-7b, LLAMA2-7b-Chat, LLAMA2-13b, and LLAMA2-13b-Chat. For the testing dataset, additional 8 glaucoma QnA pairs were included. 200 responses to the testing dataset were generated by 5 fine-tuned LLMs for evaluation. A customized clinical evaluation rubric was used to guide GPT-4 evaluation, grounded on clinical accuracy, relevance, patient safety, and ease of understanding. GPT-4 evaluation was then compared against ranking by 5 clinicians for clinical alignment. Results: Among all fine-tuned LLMs, GPT-3.5 scored the highest (87.1%), followed by LLAMA2-13b (80.9%), LLAMA2-13b-chat (75.5%), LLAMA2-7b-Chat (70%) and LLAMA2-7b (68.8%) based on the GPT-4 evaluation. GPT-4 evaluation demonstrated significant agreement with human clinician rankings, with Spearman and Kendall Tau correlation coefficients of 0.90 and 0.80 respectively; while correlation based on Cohen Kappa was more modest at 0.50. Notably, qualitative analysis and the glaucoma sub-analysis revealed clinical inaccuracies in the LLM-generated responses, which were appropriately identified by the GPT-4 evaluation. Conclusion: The notable clinical alignment of GPT-4 evaluation highlighted its potential to streamline the clinical evaluation of LLM chatbot responses to healthcare-related queries. By complementing the existing clinician-dependent manual grading, this efficient and automated evaluation could assist the validation of future developments in LLM applications for healthcare.

Ziwen Wang, Jin Wee Lee, Tanujit Chakraborty et al.

Survival analysis is essential for studying time-to-event outcomes and providing a dynamic understanding of the probability of an event occurring over time. Various survival analysis techniques, from traditional statistical models to state-of-the-art machine learning algorithms, support healthcare intervention and policy decisions. However, there remains ongoing discussion about their comparative performance. We conducted a comparative study of several survival analysis methods, including Cox proportional hazards (CoxPH), stepwise CoxPH, elastic net penalized Cox model, Random Survival Forests (RSF), Gradient Boosting machine (GBM) learning, AutoScore-Survival, DeepSurv, time-dependent Cox model based on neural network (CoxTime), and DeepHit survival neural network. We applied the concordance index (C-index) for model goodness-of-fit, and integral Brier scores (IBS) for calibration, and considered the model interpretability. As a case study, we performed a retrospective analysis of patients admitted through the emergency department of a tertiary hospital from 2017 to 2019, predicting 90-day all-cause mortality based on patient demographics, clinicopathological features, and historical data. The results of the C-index indicate that deep learning achieved comparable performance, with DeepSurv producing the best discrimination (DeepSurv: 0.893; CoxTime: 0.892; DeepHit: 0.891). The calibration of DeepSurv (IBS: 0.041) performed the best, followed by RSF (IBS: 0.042) and GBM (IBS: 0.0421), all using the full variables. Moreover, AutoScore-Survival, using a minimal variable subset, is easy to interpret, and can achieve good discrimination and calibration (C-index: 0.867; IBS: 0.044). While all models were satisfactory, DeepSurv exhibited the best discrimination and calibration. In addition, AutoScore-Survival offers a more parsimonious model and excellent interpretability.

Jasmine Chiat Ling Ong, Yilin Ning, Mingxuan Liu et al.

The integration of generative AI (GenAI) and large language models (LLMs) in healthcare presents both unprecedented opportunities and challenges, necessitating innovative regulatory approaches. GenAI and LLMs offer broad applications, from automating clinical workflows to personalizing diagnostics. However, the non-deterministic outputs, broad functionalities and complex integration of GenAI and LLMs challenge existing medical device regulatory frameworks, including the total product life cycle (TPLC) approach. Here we discuss the constraints of the TPLC approach to GenAI and LLM-based medical device regulation, and advocate for global collaboration in regulatory science research. This serves as the foundation for developing innovative approaches including adaptive policies and regulatory sandboxes, to test and refine governance in real-world settings. International harmonization, as seen with the International Medical Device Regulators Forum, is essential to manage implications of LLM on global health, including risks of widening health inequities driven by inherent model biases. By engaging multidisciplinary expertise, prioritizing iterative, data-driven approaches, and focusing on the needs of diverse populations, global regulatory science research enables the responsible and equitable advancement of LLM innovations in healthcare.

Rui Yang, Jiayi Tong, Haoyuan Wang et al.

Background. Systematic reviews in comparative effectiveness research require timely evidence synthesis. Preprints accelerate knowledge dissemination but vary in quality, posing challenges for systematic reviews. Methods. We propose AutoConfidence (automated confidence assessment), an advanced framework for predicting preprint publication, which reduces reliance on manual curation and expands the range of predictors, including three key advancements: (1) automated data extraction using natural language processing techniques, (2) semantic embeddings of titles and abstracts, and (3) large language model (LLM)-driven evaluation scores. Additionally, we employed two prediction models: a random forest classifier for binary outcome and a survival cure model that predicts both binary outcome and publication risk over time. Results. The random forest classifier achieved AUROC 0.692 with LLM-driven scores, improving to 0.733 with semantic embeddings and 0.747 with article usage metrics. The survival cure model reached AUROC 0.716 with LLM-driven scores, improving to 0.731 with semantic embeddings. For publication risk prediction, it achieved a concordance index of 0.658, increasing to 0.667 with semantic embeddings. Conclusion. Our study advances the framework for preprint publication prediction through automated data extraction and multiple feature integration. By combining semantic embeddings with LLM-driven evaluations, AutoConfidence enhances predictive performance while reducing manual annotation burden. The framework has the potential to facilitate incorporation of preprint articles during the appraisal phase of systematic reviews, supporting researchers in more effective utilization of preprint resources.

Yu He Ke, Liyuan Jin, Kabilan Elangovan et al.

Large Language Models (LLMs) show potential for medical applications but often lack specialized clinical knowledge. Retrieval Augmented Generation (RAG) allows customization with domain-specific information, making it suitable for healthcare. This study evaluates the accuracy, consistency, and safety of RAG models in determining fitness for surgery and providing preoperative instructions. We developed LLM-RAG models using 35 local and 23 international preoperative guidelines and tested them against human-generated responses. A total of 3,682 responses were evaluated. Clinical documents were processed using Llamaindex, and 10 LLMs, including GPT3.5, GPT4, and Claude-3, were assessed. Fourteen clinical scenarios were analyzed, focusing on seven aspects of preoperative instructions. Established guidelines and expert judgment were used to determine correct responses, with human-generated answers serving as comparisons. The LLM-RAG models generated responses within 20 seconds, significantly faster than clinicians (10 minutes). The GPT4 LLM-RAG model achieved the highest accuracy (96.4% vs. 86.6%, p=0.016), with no hallucinations and producing correct instructions comparable to clinicians. Results were consistent across both local and international guidelines. This study demonstrates the potential of LLM-RAG models for preoperative healthcare tasks, highlighting their efficiency, scalability, and reliability.

Mingxuan Liu, Yilin Ning, Yuhe Ke et al.

The escalating integration of machine learning in high-stakes fields such as healthcare raises substantial concerns about model fairness. We propose an interpretable framework - Fairness-Aware Interpretable Modeling (FAIM), to improve model fairness without compromising performance, featuring an interactive interface to identify a "fairer" model from a set of high-performing models and promoting the integration of data-driven evidence and clinical expertise to enhance contextualized fairness. We demonstrated FAIM's value in reducing sex and race biases by predicting hospital admission with two real-world databases, MIMIC-IV-ED and SGH-ED. We show that for both datasets, FAIM models not only exhibited satisfactory discriminatory performance but also significantly mitigated biases as measured by well-established fairness metrics, outperforming commonly used bias-mitigation methods. Our approach demonstrates the feasibility of improving fairness without sacrificing performance and provides an a modeling mode that invites domain experts to engage, fostering a multidisciplinary effort toward tailored AI fairness.

Siqi Li, Yuqing Shang, Ziwen Wang et al.

Survival analysis serves as a fundamental component in numerous healthcare applications, where the determination of the time to specific events (such as the onset of a certain disease or death) for patients is crucial for clinical decision-making. Scoring systems are widely used for swift and efficient risk prediction. However, existing methods for constructing survival scores presume that data originates from a single source, posing privacy challenges in collaborations with multiple data owners. We propose a novel framework for building federated scoring systems for multi-site survival outcomes, ensuring both privacy and communication efficiency. We applied our approach to sites with heterogeneous survival data originating from emergency departments in Singapore and the United States. Additionally, we independently developed local scores at each site. In testing datasets from each participant site, our proposed federated scoring system consistently outperformed all local models, evidenced by higher integrated area under the receiver operating characteristic curve (iAUC) values, with a maximum improvement of 11.6%. Additionally, the federated score's time-dependent AUC(t) values showed advantages over local scores, exhibiting narrower confidence intervals (CIs) across most time points. The model developed through our proposed method exhibits effective performance on each local site, signifying noteworthy implications for healthcare research. Sites participating in our proposed federated scoring model training gained benefits by acquiring survival models with enhanced prediction accuracy and efficiency. This study demonstrates the effectiveness of our privacy-preserving federated survival score generation framework and its applicability to real-world heterogeneous survival data.

Mengying Yan, Ziye Tian, Siqi Li et al.

Clinical decision support tools built on electronic health records often experience performance drift due to temporal population shifts, particularly when changes in the clinical environment initially affect only a subset of patients, resulting in a transition to mixed populations. Such case-mix changes commonly arise following system-level operational updates or the emergence of new diseases, such as COVID-19. We propose TRACER (Transfer Learning-based Real-time Adaptation for Clinical Evolving Risk), a framework that identifies encounter-level transition membership and adapts predictive models using transfer learning without full retraining. In simulation studies, TRACER outperformed static models trained on historical or contemporary data. In a real-world application predicting hospital admission following emergency department visits across the COVID-19 transition, TRACER improved both discrimination and calibration. TRACER provides a scalable approach for maintaining robust predictive performance under evolving and heterogeneous clinical conditions.

Mingxuan Liu, Yilin Ning, Haoyuan Wang et al.

As machine learning models become increasingly integrated into healthcare, structural inequities and social biases embedded in clinical data can be perpetuated or even amplified by data-driven models. In survival analysis, censoring and time dynamics can further add complexity to fair model development. Additionally, algorithmic fairness approaches often overlook disparities in cross-group rankings, e.g., high-risk Black patients may be ranked below lower-risk White patients who do not experience the event of mortality. Such misranking can reinforce biological essentialism and undermine equitable care. We propose a Fairness-Aware Survival Modeling (FASM), designed to mitigate algorithmic bias regarding both intra-group and cross-group risk rankings over time. Using breast cancer prognosis as a representative case and applying FASM to SEER breast cancer data, we show that FASM substantially improves fairness while preserving discrimination performance comparable to fairness-unaware survival models. Time-stratified evaluations show that FASM maintains stable fairness over a 10-year horizon, with the greatest improvements observed during the mid-term of follow-up. Our approach enables the development of survival models that prioritize both accuracy and equity in clinical decision-making, advancing fairness as a core principle in clinical care.

Wangxuan Fan, Ching Wang, Siqi Li et al.

For many real-world applications, understanding feature-outcome relationships is as crucial as achieving high predictive accuracy. While traditional neural networks excel at prediction, their black-box nature obscures underlying functional relationships. Kolmogorov--Arnold Networks (KANs) address this by employing learnable spline-based activation functions on edges, enabling recovery of symbolic representations while maintaining competitive performance. However, KAN's architecture presents unique challenges for network pruning. Conventional magnitude-based methods become unreliable due to sensitivity to input coordinate shifts. We propose \textbf{ShapKAN}, a pruning framework using Shapley value attribution to assess node importance in a shift-invariant manner. Unlike magnitude-based approaches, ShapKAN quantifies each node's actual contribution, ensuring consistent importance rankings regardless of input parameterization. Extensive experiments on synthetic and real-world datasets demonstrate that ShapKAN preserves true node importance while enabling effective network compression. Our approach improves KAN's interpretability advantages, facilitating deployment in resource-constrained environments.

Yilin Ning, Yian Ma, Mingxuan Liu et al.

Fairness in artificial intelligence (AI) prediction models is increasingly emphasized to support responsible adoption in high-stakes domains such as health care and criminal justice. Guidelines and implementation frameworks highlight the importance of both predictive accuracy and equitable outcomes. However, current fairness toolkits often evaluate classification performance disparities in isolation, with limited attention to other critical aspects such as calibration. To address these gaps, we present seeBias, an R package for comprehensive evaluation of model fairness and predictive performance. seeBias offers an integrated evaluation across classification, calibration, and other performance domains, providing a more complete view of model behavior. It includes customizable visualizations to support transparent reporting and responsible AI implementation. Using public datasets from criminal justice and healthcare, we demonstrate how seeBias supports fairness evaluations, and uncovers disparities that conventional fairness metrics may overlook. The R package is available on GitHub, and a Python version is under development.

Yu He Ke, Liyuan Jin, Kabilan Elangovan et al.

Large Language Models (LLMs) are emerging as powerful tools in healthcare, particularly for complex, domain-specific tasks. This study describes the development and evaluation of the PErioperative AI CHatbot (PEACH), a secure LLM-based system integrated with local perioperative guidelines to support preoperative clinical decision-making. PEACH was embedded with 35 institutional perioperative protocols in the secure Claude 3.5 Sonet LLM framework within Pair Chat (developed by Singapore Government) and tested in a silent deployment with real-world data. Accuracy, safety, and usability were assessed. Deviations and hallucinations were categorized based on potential harm, and user feedback was evaluated using the Technology Acceptance Model (TAM). Updates were made after the initial silent deployment to amend one protocol. In 240 real-world clinical iterations, PEACH achieved a first-generation accuracy of 97.5% (78/80) and an overall accuracy of 96.7% (232/240) across three iterations. The updated PEACH demonstrated improved accuracy of 97.9% (235/240), with a statistically significant difference from the null hypothesis of 95% accuracy (p = 0.018, 95% CI: 0.952-0.991). Minimal hallucinations and deviations were observed (both 1/240 and 2/240, respectively). Clinicians reported that PEACH expedited decisions in 95% of cases, and inter-rater reliability ranged from kappa 0.772-0.893 within PEACH and 0.610-0.784 among attendings. PEACH is an accurate, adaptable tool that enhances consistency and efficiency in perioperative decision-making. Future research should explore its scalability across specialties and its impact on clinical outcomes.

Rui Yang, Yilin Ning, Emilia Keppo et al.

Generative artificial intelligence (AI) has brought revolutionary innovations in various fields, including medicine. However, it also exhibits limitations. In response, retrieval-augmented generation (RAG) provides a potential solution, enabling models to generate more accurate contents by leveraging the retrieval of external knowledge. With the rapid advancement of generative AI, RAG can pave the way for connecting this transformative technology with medical applications and is expected to bring innovations in equity, reliability, and personalization to health care.

Seyed Ehsan Saffari, Yilin Ning, Xie Feng et al.

Background: Risk prediction models are useful tools in clinical decision-making which help with risk stratification and resource allocations and may lead to a better health care for patients. AutoScore is a machine learning-based automatic clinical score generator for binary outcomes. This study aims to expand the AutoScore framework to provide a tool for interpretable risk prediction for ordinal outcomes. Methods: The AutoScore-Ordinal framework is generated using the same 6 modules of the original AutoScore algorithm including variable ranking, variable transformation, score derivation (from proportional odds models), model selection, score fine-tuning, and model evaluation. To illustrate the AutoScore-Ordinal performance, the method was conducted on electronic health records data from the emergency department at Singapore General Hospital over 2008 to 2017. The model was trained on 70% of the data, validated on 10% and tested on the remaining 20%. Results: This study included 445,989 inpatient cases, where the distribution of the ordinal outcome was 80.7% alive without 30-day readmission, 12.5% alive with 30-day readmission, and 6.8% died inpatient or by day 30 post discharge. Two point-based risk prediction models were developed using two sets of 8 predictor variables identified by the flexible variable selection procedure. The two models indicated reasonably good performance measured by mean area under the receiver operating characteristic curve (0.785 and 0.793) and generalized c-index (0.737 and 0.760), which were comparable to alternative models. Conclusion: AutoScore-Ordinal provides an automated and easy-to-use framework for development and validation of risk prediction models for ordinal outcomes, which can systematically identify potential predictors from high-dimensional data.

Yilin Ning, Siqi Li, Marcus Eng Hock Ong et al.

Risk scores are widely used for clinical decision making and commonly generated from logistic regression models. Machine-learning-based methods may work well for identifying important predictors, but such 'black box' variable selection limits interpretability, and variable importance evaluated from a single model can be biased. We propose a robust and interpretable variable selection approach using the recently developed Shapley variable importance cloud (ShapleyVIC) that accounts for variability across models. Our approach evaluates and visualizes overall variable contributions for in-depth inference and transparent variable selection, and filters out non-significant contributors to simplify model building steps. We derive an ensemble variable ranking from variable contributions, which is easily integrated with an automated and modularized risk score generator, AutoScore, for convenient implementation. In a study of early death or unplanned readmission, ShapleyVIC selected 6 of 41 candidate variables to create a well-performing model, which had similar performance to a 16-variable model from machine-learning-based ranking.

Yilin Ning, Marcus Eng Hock Ong, Bibhas Chakraborty et al.

Interpretable machine learning has been focusing on explaining final models that optimize performance. The current state-of-the-art is the Shapley additive explanations (SHAP) that locally explains variable impact on individual predictions, and it is recently extended for a global assessment across the dataset. Recently, Dong and Rudin proposed to extend the investigation to models from the same class as the final model that are "good enough", and identified a previous overclaim of variable importance based on a single model. However, this method does not directly integrate with existing Shapley-based interpretations. We close this gap by proposing a Shapley variable importance cloud that pools information across good models to avoid biased assessments in SHAP analyses of final models, and communicate the findings via novel visualizations. We demonstrate the additional insights gain compared to conventional explanations and Dong and Rudin's method using criminal justice and electronic medical records data.

Feng Xie, Han Yuan, Yilin Ning et al.

Objective: Temporal electronic health records (EHRs) can be a wealth of information for secondary uses, such as clinical events prediction or chronic disease management. However, challenges exist for temporal data representation. We therefore sought to identify these challenges and evaluate novel methodologies for addressing them through a systematic examination of deep learning solutions. Methods: We searched five databases (PubMed, EMBASE, the Institute of Electrical and Electronics Engineers [IEEE] Xplore Digital Library, the Association for Computing Machinery [ACM] digital library, and Web of Science) complemented with hand-searching in several prestigious computer science conference proceedings. We sought articles that reported deep learning methodologies on temporal data representation in structured EHR data from January 1, 2010, to August 30, 2020. We summarized and analyzed the selected articles from three perspectives: nature of time series, methodology, and model implementation. Results: We included 98 articles related to temporal data representation using deep learning. Four major challenges were identified, including data irregularity, data heterogeneity, data sparsity, and model opacity. We then studied how deep learning techniques were applied to address these challenges. Finally, we discuss some open challenges arising from deep learning. Conclusion: Temporal EHR data present several major challenges for clinical prediction modeling and data utilization. To some extent, current deep learning solutions can address these challenges. Future studies can consider designing comprehensive and integrated solutions. Moreover, researchers should incorporate additional clinical domain knowledge into study designs and enhance the interpretability of the model to facilitate its implementation in clinical practice.

Han Yuan, Feng Xie, Marcus Eng Hock Ong et al.

Background: Medical decision-making impacts both individual and public health. Clinical scores are commonly used among a wide variety of decision-making models for determining the degree of disease deterioration at the bedside. AutoScore was proposed as a useful clinical score generator based on machine learning and a generalized linear model. Its current framework, however, still leaves room for improvement when addressing unbalanced data of rare events. Methods: Using machine intelligence approaches, we developed AutoScore-Imbalance, which comprises three components: training dataset optimization, sample weight optimization, and adjusted AutoScore. All scoring models were evaluated on the basis of their area under the curve (AUC) in the receiver operating characteristic analysis and balanced accuracy (i.e., mean value of sensitivity and specificity). By utilizing a publicly accessible dataset from Beth Israel Deaconess Medical Center, we assessed the proposed model and baseline approaches in the prediction of inpatient mortality. Results: AutoScore-Imbalance outperformed baselines in terms of AUC and balanced accuracy. The nine-variable AutoScore-Imbalance sub-model achieved the highest AUC of 0.786 (0.732-0.839) while the eleven-variable original AutoScore obtained an AUC of 0.723 (0.663-0.783), and the logistic regression with 21 variables obtained an AUC of 0.743 (0.685-0.800). The AutoScore-Imbalance sub-model (using down-sampling algorithm) yielded an AUC of 0. 0.771 (0.718-0.823) with only five variables, demonstrating a good balance between performance and variable sparsity. Conclusions: The AutoScore-Imbalance tool has the potential to be applied to highly unbalanced datasets to gain further insight into rare medical events and to facilitate real-world clinical decision-making.

Feng Xie, Yilin Ning, Han Yuan et al.

Scoring systems are highly interpretable and widely used to evaluate time-to-event outcomes in healthcare research. However, existing time-to-event scores are predominantly created ad-hoc using a few manually selected variables based on clinician's knowledge, suggesting an unmet need for a robust and efficient generic score-generating method. AutoScore was previously developed as an interpretable machine learning score generator, integrated both machine learning and point-based scores in the strong discriminability and accessibility. We have further extended it to time-to-event data and developed AutoScore-Survival, for automatically generating time-to-event scores with right-censored survival data. Random survival forest provides an efficient solution for selecting variables, and Cox regression was used for score weighting. We illustrated our method in a real-life study of 90-day mortality of patients in intensive care units and compared its performance with survival models (i.e., Cox) and the random survival forest. The AutoScore-Survival-derived scoring model was more parsimonious than survival models built using traditional variable selection methods (e.g., penalized likelihood approach and stepwise variable selection), and its performance was comparable to survival models using the same set of variables. Although AutoScore-Survival achieved a comparable integrated area under the curve of 0.782 (95% CI: 0.767-0.794), the integer-valued time-to-event scores generated are favorable in clinical applications because they are easier to compute and interpret. Our proposed AutoScore-Survival provides an automated, robust and easy-to-use machine learning-based clinical score generator to studies of time-to-event outcomes. It provides a systematic guideline to facilitate the future development of time-to-event scores for clinical applications.

Santiago Castro, Ruoyao Wang, Pingxuan Huang et al.

We propose fill-in-the-blanks as a video understanding evaluation framework and introduce FIBER -- a novel dataset consisting of 28,000 videos and descriptions in support of this evaluation framework. The fill-in-the-blanks setting tests a model's understanding of a video by requiring it to predict a masked noun phrase in the caption of the video, given the video and the surrounding text. The FIBER benchmark does not share the weaknesses of the current state-of-the-art language-informed video understanding tasks, namely: (1) video question answering using multiple-choice questions, where models perform relatively well because they exploit linguistic biases in the task formulation, thus making our framework challenging for the current state-of-the-art systems to solve; and (2) video captioning, which relies on an open-ended evaluation framework that is often inaccurate because system answers may be perceived as incorrect if they differ in form from the ground truth. The FIBER dataset and our code are available at https://lit.eecs.umich.edu/fiber/.

Yuzheng Li, Chuan Chen, Nan Liu et al.

Federated learning has been widely studied and applied to various scenarios. In mobile computing scenarios, federated learning protects users from exposing their private data, while cooperatively training the global model for a variety of real-world applications. However, the security of federated learning is increasingly being questioned, due to the malicious clients or central servers' constant attack to the global model or user privacy data. To address these security issues, we proposed a decentralized federated learning framework based on blockchain, i.e., a Blockchain-based Federated Learning framework with Committee consensus (BFLC). The framework uses blockchain for the global model storage and the local model update exchange. To enable the proposed BFLC, we also devised an innovative committee consensus mechanism, which can effectively reduce the amount of consensus computing and reduce malicious attacks. We then discussed the scalability of BFLC, including theoretical security, storage optimization, and incentives. Finally, we performed experiments using real-world datasets to verify the effectiveness of the BFLC framework.

Christian Rupprecht, Ansh Kapil, Nan Liu et al.

Webly-supervised learning has recently emerged as an alternative paradigm to traditional supervised learning based on large-scale datasets with manual annotations. The key idea is that models such as CNNs can be learned from the noisy visual data available on the web. In this work we aim to exploit web data for video understanding tasks such as action recognition and detection. One of the main problems in webly-supervised learning is cleaning the noisy labeled data from the web. The state-of-the-art paradigm relies on training a first classifier on noisy data that is then used to clean the remaining dataset. Our key insight is that this procedure biases the second classifier towards samples that the first one understands. Here we train two independent CNNs, a RGB network on web images and video frames and a second network using temporal information from optical flow. We show that training the networks independently is vastly superior to selecting the frames for the flow classifier by using our RGB network. Moreover, we show benefits in enriching the training set with different data sources from heterogeneous public web databases. We demonstrate that our framework outperforms all other webly-supervised methods on two public benchmarks, UCF-101 and Thumos'14.

Wei Kang, Nan Liu

In a system that performs both encryption and lossy compression, the conventional way is to compress first and then encrypt the compressed data. This separation approach proves to be optimal. In certain applications where sensitive information should be protected as early as possible, it is preferable to perform encryption first and then compress the encrypted data, which leads to the concept of the reversed system. Johnson et al. proposed an achievability scheme for the reversed system that has a modulo-sum encryption followed by a compression using Wyner-Ziv distributed source coding with side information. However, this reversed system performs worse than the conventional system in the sense that it requires more compression rate and secrecy key rate. In this paper, we propose a new achievability scheme for the reverse system where encryption is conducted by a permutation cipher and then the encrypted data is compressed using the optimal rate-distortion code. The proposed scheme can achieve the optimal compression rate and secret key rate, and therefore shows that reversing the order of encryption and compression does not necessarily compromise the performance of an encryption-compression system. The proposed system attains weak secrecy, and we show that the information leakage is mainly contributed by the type information of the sequence, which is not concealed by the permutation cipher. Given the type of the sequence, the rest of the information leakage vanishes exponentially.