ML-supported decisions, such as ordering tests or determining preventive custody, often involve binary classification based on probabilistic forecasts. Evaluation frameworks for such forecasts typically consider whether to prioritize independent-decision metrics (e.g., Accuracy) or top-K metrics (e.g., Precision@K), and whether to focus on fixed thresholds or threshold-agnostic measures like AUC-ROC. We highlight that a consequentialist perspective, long advocated by decision theorists, should naturally favor evaluations that support independent decisions using a mixture of thresholds given their prevalence, such as Brier scores and Log loss. However, our empirical analysis reveals a strong preference for top-K metrics or fixed thresholds in evaluations at major conferences like ICML, FAccT, and CHIL. To address this gap, we use this decision-theoretic framework to map evaluation metrics to their optimal use cases, along with a Python package, briertools, to promote the broader adoption of Brier scores. In doing so, we also uncover new theoretical connections, including a reconciliation between the Brier Score and Decision Curve Analysis, which clarifies and responds to a longstanding critique by (Assel, et al. 2017) regarding the clinical utility of proper scoring rules.

Much work aims to explain a model's prediction on a static input. We consider explanations in a temporal setting where a stateful dynamical model produces a sequence of risk estimates given an input at each time step. When the estimated risk increases, the goal of the explanation is to attribute the increase to a few relevant inputs from the past. While our formal setup and techniques are general, we carry out an in-depth case study in a clinical setting. The goal here is to alert a clinician when a patient's risk of deterioration rises. The clinician then has to decide whether to intervene and adjust the treatment. Given a potentially long sequence of new events since she last saw the patient, a concise explanation helps her to quickly triage the alert. We develop methods to lift static attribution techniques to the dynamical setting, where we identify and address challenges specific to dynamics. We then experimentally assess the utility of different explanations of clinical alerts through expert evaluation.

Effective modeling of electronic health records (EHR) is rapidly becoming an important topic in both academia and industry. A recent study showed that utilizing the graphical structure underlying EHR data (e.g. relationship between diagnoses and treatments) improves the performance of prediction tasks such as heart failure diagnosis prediction. However, EHR data do not always contain complete structure information. Moreover, when it comes to claims data, structure information is completely unavailable to begin with. Under such circumstances, can we still do better than just treating EHR data as a flat-structured bag-of-features? In this paper, we study the possibility of utilizing the implicit structure of EHR by using the Transformer for prediction tasks on EHR data. Specifically, we argue that the Transformer is a suitable model to learn the hidden EHR structure, and propose the Graph Convolutional Transformer, which uses data statistics to guide the structure learning process. Our model empirically demonstrated superior prediction performance to previous approaches on both synthetic data and publicly available EHR data on encounter-based prediction tasks such as graph reconstruction and readmission prediction, indicating that it can serve as an effective general-purpose representation learning algorithm for EHR data.