Barbara Lam

Sharon Jiang, Shannon Shen, Monica Agrawal et al. · mit

The large amount of time clinicians spend sifting through patient notes and documenting in electronic health records (EHRs) is a leading cause of clinician burnout. By proactively and dynamically retrieving relevant notes during the documentation process, we can reduce the effort required to find relevant patient history. In this work, we conceptualize the use of EHR audit logs for machine learning as a source of supervision of note relevance in a specific clinical context, at a particular point in time. Our evaluation focuses on the dynamic retrieval in the emergency department, a high acuity setting with unique patterns of information retrieval and note writing. We show that our methods can achieve an AUC of 0.963 for predicting which notes will be read in an individual note writing session. We additionally conduct a user study with several clinicians and find that our framework can help clinicians retrieve relevant information more efficiently. Demonstrating that our framework and methods can perform well in this demanding setting is a promising proof of concept that they will translate to other clinical settings and data modalities (e.g., labs, medications, imaging).

Niklas Mannhardt, Elizabeth Bondi-Kelly, Barbara Lam et al. · microsoft-research

Large language models (LLMs) have immense potential to make information more accessible, particularly in medicine, where complex medical jargon can hinder patient comprehension of clinical notes. We developed a patient-facing tool using LLMs to make clinical notes more readable by simplifying, extracting information from, and adding context to the notes. We piloted the tool with clinical notes donated by patients with a history of breast cancer and synthetic notes from a clinician. Participants (N=200, healthy, female-identifying patients) were randomly assigned three clinical notes in our tool with varying levels of augmentations and answered quantitative and qualitative questions evaluating their understanding of follow-up actions. Augmentations significantly increased their quantitative understanding scores. In-depth interviews were conducted with participants (N=7, patients with a history of breast cancer), revealing both positive sentiments about the augmentations and concerns about AI. We also performed a qualitative clinician-driven analysis of the model's error modes.

Maia Jacobs, Jeffrey He, Melanie F. Pradier et al.

Major depressive disorder is a debilitating disease affecting 264 million people worldwide. While many antidepressant medications are available, few clinical guidelines support choosing among them. Decision support tools (DSTs) embodying machine learning models may help improve the treatment selection process, but often fail in clinical practice due to poor system integration. We use an iterative, co-design process to investigate clinicians' perceptions of using DSTs in antidepressant treatment decisions. We identify ways in which DSTs need to engage with the healthcare sociotechnical system, including clinical processes, patient preferences, resource constraints, and domain knowledge. Our results suggest that clinical DSTs should be designed as multi-user systems that support patient-provider collaboration and offer on-demand explanations that address discrepancies between predictions and current standards of care. Through this work, we demonstrate how current trends in explainable AI may be inappropriate for clinical environments and consider paths towards designing these tools for real-world medical systems.