Jonathan Chen

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.

Nigam H. Shah, Nerissa Ambers, Abby Pandya et al.

While large language models (LLMs) can support clinical documentation needs, standalone tools struggle with "workflow friction" from manual data entry. We developed ChatEHR, a system that enables the use of LLMs with the entire patient timeline spanning several years. ChatEHR enables automations - which are static combinations of prompts and data that perform a fixed task - and interactive use in the electronic health record (EHR) via a user interface (UI). The resulting ability to sift through patient medical records for diverse use-cases such as pre-visit chart review, screening for transfer eligibility, monitoring for surgical site infections, and chart abstraction, redefines LLM use as an institutional capability. This system, accessible after user-training, enables continuous monitoring and evaluation of LLM use. In 1.5 years, we built 7 automations and 1075 users have trained to become routine users of the UI, engaging in 23,000 sessions in the first 3 months of launch. For automations, being model-agnostic and accessing multiple types of data was essential for matching specific clinical or administrative tasks with the most appropriate LLM. Benchmark-based evaluations proved insufficient for monitoring and evaluation of the UI, requiring new methods to monitor performance. Generation of summaries was the most frequent task in the UI, with an estimated 0.73 hallucinations and 1.60 inaccuracies per generation. The resulting mix of cost savings, time savings, and revenue growth required a value assessment framework to prioritize work as well as quantify the impact of using LLMs. Initial estimates are $6M savings in the first year of use, without quantifying the benefit of the better care offered. Such a "build-from-within" strategy provides an opportunity for health systems to maintain agency via a vendor-agnostic, internally governed LLM platform.

Alison Callahan, Duncan McElfresh, Juan M. Banda et al.

The impact of using artificial intelligence (AI) to guide patient care or operational processes is an interplay of the AI model's output, the decision-making protocol based on that output, and the capacity of the stakeholders involved to take the necessary subsequent action. Estimating the effects of this interplay before deployment, and studying it in real time afterwards, are essential to bridge the chasm between AI model development and achievable benefit. To accomplish this, the Data Science team at Stanford Health Care has developed a Testing and Evaluation (T&E) mechanism to identify fair, useful and reliable AI models (FURM) by conducting an ethical review to identify potential value mismatches, simulations to estimate usefulness, financial projections to assess sustainability, as well as analyses to determine IT feasibility, design a deployment strategy, and recommend a prospective monitoring and evaluation plan. We report on FURM assessments done to evaluate six AI guided solutions for potential adoption, spanning clinical and operational settings, each with the potential to impact from several dozen to tens of thousands of patients each year. We describe the assessment process, summarize the six assessments, and share our framework to enable others to conduct similar assessments. Of the six solutions we assessed, two have moved into a planning and implementation phase. Our novel contributions - usefulness estimates by simulation, financial projections to quantify sustainability, and a process to do ethical assessments - as well as their underlying methods and open source tools, are available for other healthcare systems to conduct actionable evaluations of candidate AI solutions.

Elvis Hsieh, Preston Fu, Jonathan Chen

Language models (LMs) trained on web-scale datasets are largely successful due to their ability to memorize large amounts of training data, even if only present in a few examples. These capabilities are often desirable in evaluation on tasks such as question answering but raise questions about whether these models can exhibit genuine reasoning or succeed only at mimicking patterns from the training data. This distinction is particularly salient in forecasting tasks, where the answer is not present in the training data, and the model must reason to make logical deductions. We present Reasoning and Tools for Forecasting (RTF), a framework of reasoning-and-acting (ReAct) agents that can dynamically retrieve updated information and run numerical simulation with equipped tools. We evaluate our model with questions from competitive forecasting platforms and demonstrate that our method is competitive with and can outperform human predictions. This suggests that LMs, with the right tools, can indeed think and adapt like humans, offering valuable insights for real-world decision-making.

Chukwuebuka Anyaegbuna, Eduardo Juan Perez Guerrero, Jerry Liu et al.

Language barriers affect 27.3 million U.S. residents with non-English language preference, yet professional medical translation remains costly and often unavailable. We evaluated four frontier large language models (GPT-5.1, Claude Opus 4.5, Gemini 3 Pro, Kimi K2) translating 22 medical documents into 8 languages spanning high-resource (Spanish, Chinese, Russian, Vietnamese), medium-resource (Korean, Arabic), and low-resource (Tagalog, Haitian Creole) categories using a five-layer validation framework. Across 704 translation pairs, all models achieved high semantic preservation (LaBSE greater than 0.92), with no significant difference between high- and low-resource languages (p = 0.066). Cross-model back-translation confirmed results were not driven by same-model circularity (delta = -0.0009). Inter-model concordance across four independently trained models was high (LaBSE: 0.946), and lexical borrowing analysis showed no correlation between English term retention and fidelity scores in low-resource languages (rho = +0.018, p = 0.82). These converging results suggest frontier LLMs preserve medical meaning across resource levels, with implications for language access in healthcare.

Peter G. Brodeur, Thomas A. Buckley, Zahir Kanjee et al.

A seminal paper published by Ledley and Lusted in 1959 introduced complex clinical diagnostic reasoning cases as the gold standard for the evaluation of expert medical computing systems, a standard that has held ever since. Here, we report the results of a physician evaluation of a large language model (LLM) on challenging clinical cases against a baseline of hundreds of physicians. We conduct five experiments to measure clinical reasoning across differential diagnosis generation, display of diagnostic reasoning, triage differential diagnosis, probabilistic reasoning, and management reasoning, all adjudicated by physician experts with validated psychometrics. We then report a real-world study comparing human expert and AI second opinions in randomly-selected patients in the emergency room of a major tertiary academic medical center in Boston, MA. We compared LLMs and board-certified physicians at three predefined diagnostic touchpoints: triage in the emergency room, initial evaluation by a physician, and admission to the hospital or intensive care unit. In all experiments--both vignettes and emergency room second opinions--the LLM displayed superhuman diagnostic and reasoning abilities, as well as continued improvement from prior generations of AI clinical decision support. Our study suggests that LLMs have achieved superhuman performance on general medical diagnostic and management reasoning, fulfilling the vision put forth by Ledley and Lusted, and motivating the urgent need for prospective trials.

Matthew Guzdial, Nicholas Liao, Jonathan Chen et al.

Machine learning advances have afforded an increase in algorithms capable of creating art, music, stories, games, and more. However, it is not yet well-understood how machine learning algorithms might best collaborate with people to support creative expression. To investigate how practicing designers perceive the role of AI in the creative process, we developed a game level design tool for Super Mario Bros.-style games with a built-in AI level designer. In this paper we discuss our design of the Morai Maker intelligent tool through two mixed-methods studies with a total of over one-hundred participants. Our findings are as follows: (1) level designers vary in their desired interactions with, and role of, the AI, (2) the AI prompted the level designers to alter their design practices, and (3) the level designers perceived the AI as having potential value in their design practice, varying based on their desired role for the AI.

Matthew Guzdial, Joshua Reno, Jonathan Chen et al.

Procedural content generation via Machine Learning (PCGML) is the umbrella term for approaches that generate content for games via machine learning. One of the benefits of PCGML is that, unlike search or grammar-based PCG, it does not require hand authoring of initial content or rules. Instead, PCGML relies on existing content and black box models, which can be difficult to tune or tweak without expert knowledge. This is especially problematic when a human designer needs to understand how to manipulate their data or models to achieve desired results. We present an approach to Explainable PCGML via Design Patterns in which the design patterns act as a vocabulary and mode of interaction between user and model. We demonstrate that our technique outperforms non-explainable versions of our system in interactions with five expert designers, four of whom lack any machine learning expertise.