Recent Advances, Applications, and Open Challenges in Machine Learning for Health: Reflections from Research Roundtables at ML4H 2023 Symposium

The third ML4H symposium was held in person on December 10, 2023, in New Orleans, Louisiana, USA. The symposium included research roundtable sessions to foster discussions between participants and senior researchers on timely and relevant topics for the \ac{ML4H} community. Encouraged by the successful virtual roundtables in the previous year, we organized eleven in-person roundtables and four virtual roundtables at ML4H 2022. The organization of the research roundtables at the conference involved 17 Senior Chairs and 19 Junior Chairs across 11 tables. Each roundtable session included invited senior chairs (with substantial experience in the field), junior chairs (responsible for facilitating the discussion), and attendees from diverse backgrounds with interest in the session's topic. Herein we detail the organization process and compile takeaways from these roundtable discussions, including recent advances, applications, and open challenges for each topic. We conclude with a summary and lessons learned across all roundtables. This document serves as a comprehensive review paper, summarizing the recent advancements in machine learning for healthcare as contributed by foremost researchers in the field.

Zero-Shot Clinical Trial Patient Matching with LLMs

Matching patients to clinical trials is a key unsolved challenge in bringing new drugs to market. Today, identifying patients who meet a trial's eligibility criteria is highly manual, taking up to 1 hour per patient. Automated screening is challenging, however, as it requires understanding unstructured clinical text. Large language models (LLMs) offer a promising solution. In this work, we explore their application to trial matching. First, we design an LLM-based system which, given a patient's medical history as unstructured clinical text, evaluates whether that patient meets a set of inclusion criteria (also specified as free text). Our zero-shot system achieves state-of-the-art scores on the n2c2 2018 cohort selection benchmark. Second, we improve the data and cost efficiency of our method by identifying a prompting strategy which matches patients an order of magnitude faster and more cheaply than the status quo, and develop a two-stage retrieval pipeline that reduces the number of tokens processed by up to a third while retaining high performance. Third, we evaluate the interpretability of our system by having clinicians evaluate the natural language justifications generated by the LLM for each eligibility decision, and show that it can output coherent explanations for 97% of its correct decisions and 75% of its incorrect ones. Our results establish the feasibility of using LLMs to accelerate clinical trial operations.

Open World Object Detection in the Era of Foundation Models

Object detection is integral to a bevy of real-world applications, from robotics to medical image analysis. To be used reliably in such applications, models must be capable of handling unexpected - or novel - objects. The open world object detection (OWD) paradigm addresses this challenge by enabling models to detect unknown objects and learn discovered ones incrementally. However, OWD method development is hindered due to the stringent benchmark and task definitions. These definitions effectively prohibit foundation models. Here, we aim to relax these definitions and investigate the utilization of pre-trained foundation models in OWD. First, we show that existing benchmarks are insufficient in evaluating methods that utilize foundation models, as even naive integration methods nearly saturate these benchmarks. This result motivated us to curate a new and challenging benchmark for these models. Therefore, we introduce a new benchmark that includes five real-world application-driven datasets, including challenging domains such as aerial and surgical images, and establish baselines. We exploit the inherent connection between classes in application-driven datasets and introduce a novel method, Foundation Object detection Model for the Open world, or FOMO, which identifies unknown objects based on their shared attributes with the base known objects. FOMO has ~3x unknown object mAP compared to baselines on our benchmark. However, our results indicate a significant place for improvement - suggesting a great research opportunity in further scaling object detection methods to real-world domains. Our code and benchmark are available at https://orrzohar.github.io/projects/fomo/.

Clinfo.ai: An Open-Source Retrieval-Augmented Large Language Model System for Answering Medical Questions using Scientific Literature

The quickly-expanding nature of published medical literature makes it challenging for clinicians and researchers to keep up with and summarize recent, relevant findings in a timely manner. While several closed-source summarization tools based on large language models (LLMs) now exist, rigorous and systematic evaluations of their outputs are lacking. Furthermore, there is a paucity of high-quality datasets and appropriate benchmark tasks with which to evaluate these tools. We address these issues with four contributions: we release Clinfo.ai, an open-source WebApp that answers clinical questions based on dynamically retrieved scientific literature; we specify an information retrieval and abstractive summarization task to evaluate the performance of such retrieval-augmented LLM systems; we release a dataset of 200 questions and corresponding answers derived from published systematic reviews, which we name PubMed Retrieval and Synthesis (PubMedRS-200); and report benchmark results for Clinfo.ai and other publicly available OpenQA systems on PubMedRS-200.

MedAlign: A Clinician-Generated Dataset for Instruction Following with Electronic Medical Records

The ability of large language models (LLMs) to follow natural language instructions with human-level fluency suggests many opportunities in healthcare to reduce administrative burden and improve quality of care. However, evaluating LLMs on realistic text generation tasks for healthcare remains challenging. Existing question answering datasets for electronic health record (EHR) data fail to capture the complexity of information needs and documentation burdens experienced by clinicians. To address these challenges, we introduce MedAlign, a benchmark dataset of 983 natural language instructions for EHR data. MedAlign is curated by 15 clinicians (7 specialities), includes clinician-written reference responses for 303 instructions, and provides 276 longitudinal EHRs for grounding instruction-response pairs. We used MedAlign to evaluate 6 general domain LLMs, having clinicians rank the accuracy and quality of each LLM response. We found high error rates, ranging from 35% (GPT-4) to 68% (MPT-7B-Instruct), and an 8.3% drop in accuracy moving from 32k to 2k context lengths for GPT-4. Finally, we report correlations between clinician rankings and automated natural language generation metrics as a way to rank LLMs without human review. We make MedAlign available under a research data use agreement to enable LLM evaluations on tasks aligned with clinician needs and preferences.