Training-Free Adaptation of New-Generation LLMs using Legacy Clinical Models

Adapting language models to the clinical domain through continued pretraining and fine-tuning requires costly retraining for each new model generation. We propose Cross-Architecture Proxy Tuning (CAPT), a model-ensembling approach that enables training-free adaptation of state-of-the-art general-domain models using existing clinical models. CAPT supports models with disjoint vocabularies, leveraging contrastive decoding to selectively inject clinically relevant signals while preserving the general-domain model's reasoning and fluency. On six clinical classification and text-generation tasks, CAPT with a new-generation general-domain model and an older-generation clinical model consistently outperforms both models individually and state-of-the-art ensembling approaches (average +17.6% over UniTE, +41.4% over proxy tuning across tasks). Through token-level analysis and physician case studies, we demonstrate that CAPT amplifies clinically actionable language, reduces context errors, and increases clinical specificity.

Monitoring Deployed AI Systems in Health Care

Post-deployment monitoring of artificial intelligence (AI) systems in health care is essential to ensure their safety, quality, and sustained benefit-and to support governance decisions about which systems to update, modify, or decommission. Motivated by these needs, we developed a framework for monitoring deployed AI systems grounded in the mandate to take specific actions when they fail to behave as intended. This framework, which is now actively used at Stanford Health Care, is organized around three complementary principles: system integrity, performance, and impact. System integrity monitoring focuses on maximizing system uptime, detecting runtime errors, and identifying when changes to the surrounding IT ecosystem have unintended effects. Performance monitoring focuses on maintaining accurate system behavior in the face of changing health care practices (and thus input data) over time. Impact monitoring assesses whether a deployed system continues to have value in the form of benefit to clinicians and patients. Drawing on examples of deployed AI systems at our academic medical center, we provide practical guidance for creating monitoring plans based on these principles that specify which metrics to measure, when those metrics should be reviewed, who is responsible for acting when metrics change, and what concrete follow-up actions should be taken-for both traditional and generative AI. We also discuss challenges to implementing this framework, including the effort and cost of monitoring for health systems with limited resources and the difficulty of incorporating data-driven monitoring practices into complex organizations where conflicting priorities and definitions of success often coexist. This framework offers a practical template and starting point for health systems seeking to ensure that AI deployments remain safe and effective over time.

MedHELM: Holistic Evaluation of Large Language Models for Medical Tasks

While large language models (LLMs) achieve near-perfect scores on medical licensing exams, these evaluations inadequately reflect the complexity and diversity of real-world clinical practice. We introduce MedHELM, an extensible evaluation framework for assessing LLM performance for medical tasks with three key contributions. First, a clinician-validated taxonomy spanning 5 categories, 22 subcategories, and 121 tasks developed with 29 clinicians. Second, a comprehensive benchmark suite comprising 35 benchmarks (17 existing, 18 newly formulated) providing complete coverage of all categories and subcategories in the taxonomy. Third, a systematic comparison of LLMs with improved evaluation methods (using an LLM-jury) and a cost-performance analysis. Evaluation of 9 frontier LLMs, using the 35 benchmarks, revealed significant performance variation. Advanced reasoning models (DeepSeek R1: 66% win-rate; o3-mini: 64% win-rate) demonstrated superior performance, though Claude 3.5 Sonnet achieved comparable results at 40% lower estimated computational cost. On a normalized accuracy scale (0-1), most models performed strongly in Clinical Note Generation (0.73-0.85) and Patient Communication & Education (0.78-0.83), moderately in Medical Research Assistance (0.65-0.75), and generally lower in Clinical Decision Support (0.56-0.72) and Administration & Workflow (0.53-0.63). Our LLM-jury evaluation method achieved good agreement with clinician ratings (ICC = 0.47), surpassing both average clinician-clinician agreement (ICC = 0.43) and automated baselines including ROUGE-L (0.36) and BERTScore-F1 (0.44). Claude 3.5 Sonnet achieved comparable performance to top models at lower estimated cost. These findings highlight the importance of real-world, task-specific evaluation for medical use of LLMs and provides an open source framework to enable this.

Efficient and Private Marginal Reconstruction with Local Non-Negativity

Differential privacy is the dominant standard for formal and quantifiable privacy and has been used in major deployments that impact millions of people. Many differentially private algorithms for query release and synthetic data contain steps that reconstruct answers to queries from answers to other queries measured by the mechanism. Reconstruction is an important subproblem for such mechanisms to economize the privacy budget, minimize error on reconstructed answers, and allow for scalability to high-dimensional datasets. In this paper, we introduce a principled and efficient postprocessing method ReM (Residuals-to-Marginals) for reconstructing answers to marginal queries. Our method builds on recent work on efficient mechanisms for marginal query release, based on making measurements using a residual query basis that admits efficient pseudoinversion, which is an important primitive used in reconstruction. An extension GReM-LNN (Gaussian Residuals-to-Marginals with Local Non-negativity) reconstructs marginals under Gaussian noise satisfying consistency and non-negativity, which often reduces error on reconstructed answers. We demonstrate the utility of ReM and GReM-LNN by applying them to improve existing private query answering mechanisms: ResidualPlanner and MWEM.

Joint Selection: Adaptively Incorporating Public Information for Private Synthetic Data

Mechanisms for generating differentially private synthetic data based on marginals and graphical models have been successful in a wide range of settings. However, one limitation of these methods is their inability to incorporate public data. Initializing a data generating model by pre-training on public data has shown to improve the quality of synthetic data, but this technique is not applicable when model structure is not determined a priori. We develop the mechanism jam-pgm, which expands the adaptive measurements framework to jointly select between measuring public data and private data. This technique allows for public data to be included in a graphical-model-based mechanism. We show that jam-pgm is able to outperform both publicly assisted and non publicly assisted synthetic data generation mechanisms even when the public data distribution is biased.

Does network complexity help organize Babel's library?

In this work, we study properties of texts from the perspective of complex network theory. Words in given texts are linked by co-occurrence and transformed into networks, and we observe that these display topological properties common to other complex systems. However, there are some properties that seem to be exclusive to texts; many of these properties depend on the frequency of words in the text, while others seem to be strictly determined by the grammar. Precisely, these properties allow for a categorization of texts as either with a sense and others encoded or senseless.