MedOrchestra: A Hybrid Cloud-Local LLM Approach for Clinical Data Interpretation
This addresses privacy concerns in clinical data interpretation for healthcare providers, though it is an incremental improvement over existing hybrid approaches.
The paper tackled the problem of deploying large language models in clinical settings by balancing privacy and performance, proposing MedOrchestra, a hybrid cloud-local framework that achieved 70.21% accuracy on free-text radiology reports for pancreatic cancer staging, outperforming local models and clinicians.
Deploying large language models (LLMs) in clinical settings faces critical trade-offs: cloud LLMs, with their extensive parameters and superior performance, pose risks to sensitive clinical data privacy, while local LLMs preserve privacy but often fail at complex clinical interpretation tasks. We propose MedOrchestra, a hybrid framework where a cloud LLM decomposes complex clinical tasks into manageable subtasks and prompt generation, while a local LLM executes these subtasks in a privacy-preserving manner. Without accessing clinical data, the cloud LLM generates and validates subtask prompts using clinical guidelines and synthetic test cases. The local LLM executes subtasks locally and synthesizes outputs generated by the cloud LLM. We evaluate MedOrchestra on pancreatic cancer staging using 100 radiology reports under NCCN guidelines. On free-text reports, MedOrchestra achieves 70.21% accuracy, outperforming local model baselines (without guideline: 48.94%, with guideline: 56.59%) and board-certified clinicians (gastroenterologists: 59.57%, surgeons: 65.96%, radiologists: 55.32%). On structured reports, MedOrchestra reaches 85.42% accuracy, showing clear superiority across all settings.