Abstract:Privacy-preserving medical inference must balance data locality, diagnostic reliability, and deployment efficiency. This paper presents EcoFair, a simulated vertically partitioned inference framework for dermatological diagnosis in which raw image and tabular data remain local and only modality-specific embeddings are transmitted for server-side multimodal fusion. EcoFair introduces a lightweight-first routing mechanism that selectively activates a heavier image encoder when local uncertainty or metadata-derived clinical risk indicates that additional computation is warranted. The routing decision combines predictive uncertainty, a safe--danger probability gap, and a tabular neurosymbolic risk score derived from patient age and lesion localisation. Experiments on three dermatology benchmarks show that EcoFair can substantially reduce edge-side inference energy in representative model pairings while remaining competitive in classification performance. The results further indicate that selective routing can improve subgroup-sensitive malignant-case behaviour in representative settings without modifying the global training objective. These findings position EcoFair as a practical framework for privacy-preserving and energy-aware medical inference under edge deployment constraints.
Abstract:Artificial intelligence (AI) is increasingly being explored in health and social care to reduce administrative workload and allow staff to spend more time on patient care. This paper evaluates a voice-enabled Care Home Smart Speaker designed to support everyday activities in residential care homes, including spoken access to resident records, reminders, and scheduling tasks. A safety-focused evaluation framework is presented that examines the system end-to-end, combining Whisper-based speech recognition with retrieval-augmented generation (RAG) approaches (hybrid, sparse, and dense). Using supervised care-home trials and controlled testing, we evaluated 330 spoken transcripts across 11 care categories, including 184 reminder-containing interactions. These evaluations focus on (i) correct identification of residents and care categories, (ii) reminder recognition and extraction, and (iii) end-to-end scheduling correctness under uncertainty (including safe deferral/clarification). Given the safety-critical nature of care homes, particular attention is also paid to reliability in noisy environments and across diverse accents, supported by confidence scoring, clarification prompts, and human-in-the-loop oversight. In the best-performing configuration (GPT-5.2), resident ID and care category matching reached 100% (95% CI: 98.86-100), while reminder recognition reached 89.09\% (95% CI: 83.81-92.80) with zero missed reminders (100% recall) but some false positives. End-to-end scheduling via calendar integration achieved 84.65% exact reminder-count agreement (95% CI: 78.00-89.56), indicating remaining edge cases in converting informal spoken instructions into actionable events. The findings suggest that voice-enabled systems, when carefully evaluated and appropriately safeguarded, can support accurate documentation, effective task management, and trustworthy use of AI in care home settings.