Reality Check: A New Evaluation Ecosystem Is Necessary to Understand AI's Real World Effects

Conventional AI evaluation approaches concentrated within the AI stack exhibit systemic limitations for exploring, navigating and resolving the human and societal factors that play out in real world deployment such as in education, finance, healthcare, and employment sectors. AI capability evaluations can capture detail about first-order effects, such as whether immediate system outputs are accurate, or contain toxic, biased or stereotypical content, but AI's second-order effects, i.e. any long-term outcomes and consequences that may result from AI use in the real world, have become a significant area of interest as the technology becomes embedded in our daily lives. These secondary effects can include shifts in user behavior, societal, cultural and economic ramifications, workforce transformations, and long-term downstream impacts that may result from a broad and growing set of risks. This position paper argues that measuring the indirect and secondary effects of AI will require expansion beyond static, single-turn approaches conducted in silico to include testing paradigms that can capture what actually materializes when people use AI technology in context. Specifically, we describe the need for data and methods that can facilitate contextual awareness and enable downstream interpretation and decision making about AI's secondary effects, and recommend requirements for a new ecosystem.

Large Language Models to Identify Social Determinants of Health in Electronic Health Records

Social determinants of health (SDoH) have an important impact on patient outcomes but are incompletely collected from the electronic health records (EHR). This study researched the ability of large language models to extract SDoH from free text in EHRs, where they are most commonly documented, and explored the role of synthetic clinical text for improving the extraction of these scarcely documented, yet extremely valuable, clinical data. 800 patient notes were annotated for SDoH categories, and several transformer-based models were evaluated. The study also experimented with synthetic data generation and assessed for algorithmic bias. Our best-performing models were fine-tuned Flan-T5 XL (macro-F1 0.71) for any SDoH, and Flan-T5 XXL (macro-F1 0.70). The benefit of augmenting fine-tuning with synthetic data varied across model architecture and size, with smaller Flan-T5 models (base and large) showing the greatest improvements in performance (delta F1 +0.12 to +0.23). Model performance was similar on the in-hospital system dataset but worse on the MIMIC-III dataset. Our best-performing fine-tuned models outperformed zero- and few-shot performance of ChatGPT-family models for both tasks. These fine-tuned models were less likely than ChatGPT to change their prediction when race/ethnicity and gender descriptors were added to the text, suggesting less algorithmic bias (p<0.05). At the patient-level, our models identified 93.8% of patients with adverse SDoH, while ICD-10 codes captured 2.0%. Our method can effectively extracted SDoH information from clinic notes, performing better compare to GPT zero- and few-shot settings. These models could enhance real-world evidence on SDoH and aid in identifying patients needing social support.