The rapid digitization of real-world data offers an unprecedented opportunity for optimizing healthcare delivery and accelerating biomedical discovery. In practice, however, such data is most abundantly available in unstructured forms, such as clinical notes in electronic medical records (EMRs), and it is generally plagued by confounders. In this paper, we present TRIALSCOPE, a unifying framework for distilling real-world evidence from population-level observational data. TRIALSCOPE leverages biomedical language models to structure clinical text at scale, employs advanced probabilistic modeling for denoising and imputation, and incorporates state-of-the-art causal inference techniques to combat common confounders. Using clinical trial specification as generic representation, TRIALSCOPE provides a turn-key solution to generate and reason with clinical hypotheses using observational data. In extensive experiments and analyses on a large-scale real-world dataset with over one million cancer patients from a large US healthcare network, we show that TRIALSCOPE can produce high-quality structuring of real-world data and generates comparable results to marquee cancer trials. In addition to facilitating in-silicon clinical trial design and optimization, TRIALSCOPE may be used to empower synthetic controls, pragmatic trials, post-market surveillance, as well as support fine-grained patient-like-me reasoning in precision diagnosis and treatment.

As the complexity of machine learning (ML) models increases, resulting in a lack of prediction explainability, several methods have been developed to explain a model's behavior in terms of the training data points that most influence the model. However, these methods tend to mark outliers as highly influential points, limiting the insights that practitioners can draw from points that are not representative of the training data. In this work, we take a step towards finding influential training points that also represent the training data well. We first review methods for assigning importance scores to training points. Given importance scores, we propose a method to select a set of DIVerse INfluEntial (DIVINE) training points as a useful explanation of model behavior. As practitioners might not only be interested in finding data points influential with respect to model accuracy, but also with respect to other important metrics, we show how to evaluate training data points on the basis of group fairness. Our method can identify unfairness-inducing training points, which can be removed to improve fairness outcomes. Our quantitative experiments and user studies show that visualizing DIVINE points helps practitioners understand and explain model behavior better than earlier approaches.