Foundation Models that are capable of processing and generating multi-modal data have transformed AI's role in medicine. However, a key limitation of their reliability is hallucination, where inaccurate or fabricated information can impact clinical decisions and patient safety. We define medical hallucination as any instance in which a model generates misleading medical content. This paper examines the unique characteristics, causes, and implications of medical hallucinations, with a particular focus on how these errors manifest themselves in real-world clinical scenarios. Our contributions include (1) a taxonomy for understanding and addressing medical hallucinations, (2) benchmarking models using medical hallucination dataset and physician-annotated LLM responses to real medical cases, providing direct insight into the clinical impact of hallucinations, and (3) a multi-national clinician survey on their experiences with medical hallucinations. Our results reveal that inference techniques such as Chain-of-Thought (CoT) and Search Augmented Generation can effectively reduce hallucination rates. However, despite these improvements, non-trivial levels of hallucination persist. These findings underscore the ethical and practical imperative for robust detection and mitigation strategies, establishing a foundation for regulatory policies that prioritize patient safety and maintain clinical integrity as AI becomes more integrated into healthcare. The feedback from clinicians highlights the urgent need for not only technical advances but also for clearer ethical and regulatory guidelines to ensure patient safety. A repository organizing the paper resources, summaries, and additional information is available at https://github.com/mitmedialab/medical hallucination.

We present RelCon, a novel self-supervised Relative Contrastive learning approach that uses a learnable distance measure in combination with a softened contrastive loss for training an motion foundation model from wearable sensors. The learned distance provides a measurement of semantic similarity between a pair of accelerometer time-series segments, which is used to measure the distance between an anchor and various other sampled candidate segments. The self-supervised model is trained on 1 billion segments from 87,376 participants from a large wearables dataset. The model achieves strong performance across multiple downstream tasks, encompassing both classification and regression. To our knowledge, we are the first to show the generalizability of a self-supervised learning model with motion data from wearables across distinct evaluation tasks. Advances in self-supervised learning (SSL) combined with the availability of large-scale datasets have resulted in a proliferation of foundation models (FMs) in computer vision (Oquab et al., 2023), NLP (OpenAI et al., 2023), and speech understanding (Yang et al., 2024). These models provide powerful, general-purpose representations for a particular domain of data, and support generalization to a broad set of downstream tasks without the need for finetuning. For example, the image representation contained in the DINOv2 (Oquab et al., 2023) model was trained in an entirely selfsupervised way and achieves state-of-the-art performance on multiple dense image prediction tasks such as depth estimation and semantic segmentation, by decoding a frozen base representation with task-specific heads. In contrast to these advances, the times-series have not yet benefited from the foundation model approach, with a few exceptions (Abbaspourazad et al., 2024; Das et al., 2023). This is particularly unfortunate for problems in mobile health (mHealth) signal analysis, which encompasses data modalities such as accelerometry, PPG, and ECG (Rehg et al., 2017), as the collection of mHealth data from participants can be time-consuming and expensive. However, recent advances in self-supervised learning for mHealth signals (Abbaspourazad et al., 2024; Yuan et al., 2024; Xu et al., 2024) have shown promising performance, raising the question of whether it is now feasible to train foundation models for mHealth signals. In this paper, we demonstrate, for the first time, the feasibility of adopting a foundation model approach for the analysis of accelerometry data across tasks. Accelerometry is an important mHealth signal modality that is used in human activity recognition (HAR) (Haresamudram et al., 2022), physical health status assessment (Xu et al., 2022), energy expenditure estimation (Stutz et al., 2024), and gait assessment (Apple, 2021), among many other tasks.

Medical Decision-Making (MDM) is a multi-faceted process that requires clinicians to assess complex multi-modal patient data patient, often collaboratively. Large Language Models (LLMs) promise to streamline this process by synthesizing vast medical knowledge and multi-modal health data. However, single-agent are often ill-suited for nuanced medical contexts requiring adaptable, collaborative problem-solving. Our MDAgents addresses this need by dynamically assigning collaboration structures to LLMs based on task complexity, mimicking real-world clinical collaboration and decision-making. This framework improves diagnostic accuracy and supports adaptive responses in complex, real-world medical scenarios, making it a valuable tool for clinicians in various healthcare settings, and at the same time, being more efficient in terms of computing cost than static multi-agent decision making methods.

Sepsis is a life-threatening condition defined by end-organ dysfunction due to a dysregulated host response to infection. Although the Surviving Sepsis Campaign has launched and has been releasing sepsis treatment guidelines to unify and normalize the care for sepsis patients, it has been reported in numerous studies that disparities in care exist across the trajectory of patient stay in the emergency department and intensive care unit. Here, we apply a number of reinforcement learning techniques including behavioral cloning, imitation learning, and inverse reinforcement learning, to learn the optimal policy in the management of septic patient subgroups using expert demonstrations. Then we estimate the counterfactual optimal policies by applying the model to another subset of unseen medical populations and identify the difference in cure by comparing it to the real policy. Our data comes from the sepsis cohort of MIMIC-IV and the clinical data warehouses of the Mass General Brigham healthcare system. The ultimate objective of this work is to use the optimal learned policy function to estimate the counterfactual treatment policy and identify deviations across sub-populations of interest. We hope this approach would help us identify any disparities in care and also changes in cure in response to the publication of national sepsis treatment guidelines.

Electrocardiograms (ECGs) are an established technique to screen for abnormal cardiac signals. Recent work has established that it is possible to detect arrhythmia directly from the ECG signal using deep learning algorithms. While a few prior approaches with contrastive learning have been successful, the best way to define a positive sample remains an open question. In this project, we investigate several ways to define positive samples, and assess which approach yields the best performance in a downstream task of classifying arrhythmia. We explore spatiotemporal invariances, generic augmentations, demographic similarities, cardiac rhythms, and wave attributes of ECG as potential ways to match positive samples. We then evaluate each strategy with downstream task performance, and find that learned representations invariant to patient identity are powerful in arrhythmia detection.

Effective, reliable, and scalable development of machine learning (ML) solutions for structured electronic health record (EHR) data requires the ability to reliably generate high-quality baseline models for diverse supervised learning tasks in an efficient and performant manner. Historically, producing such baseline models has been a largely manual effort--individual researchers would need to decide on the particular featurization and tabularization processes to apply to their individual raw, longitudinal data; and then train a supervised model over those data to produce a baseline result to compare novel methods against, all for just one task and one dataset. In this work, powered by complementary advances in core data standardization through the MEDS framework, we dramatically simplify and accelerate this process of tabularizing irregularly sampled time-series data, providing researchers the ability to automatically and scalably featurize and tabularize their longitudinal EHR data across tens of thousands of individual features, hundreds of millions of clinical events, and diverse windowing horizons and aggregation strategies, all before ultimately leveraging these tabular data to automatically produce high-caliber XGBoost baselines in a highly computationally efficient manner. This system scales to dramatically larger datasets than tabularization tools currently available to the community and enables researchers with any MEDS format dataset to immediately begin producing reliable and performant baseline prediction results on various tasks, with minimal human effort required. This system will greatly enhance the reliability, reproducibility, and ease of development of powerful ML solutions for health problems across diverse datasets and clinical settings.

Foundation models have become invaluable in advancing the medical field. Despite their promise, the strategic deployment of LLMs for effective utility in complex medical tasks remains an open question. Our novel framework, Medical Decision-making Agents (MDAgents) aims to address this gap by automatically assigning the effective collaboration structure for LLMs. Assigned solo or group collaboration structure is tailored to the complexity of the medical task at hand, emulating real-world medical decision making processes. We evaluate our framework and baseline methods with state-of-the-art LLMs across a suite of challenging medical benchmarks: MedQA, MedMCQA, PubMedQA, DDXPlus, PMC-VQA, Path-VQA, and MedVidQA, achieving the best performance in 5 out of 7 benchmarks that require an understanding of multi-modal medical reasoning. Ablation studies reveal that MDAgents excels in adapting the number of collaborating agents to optimize efficiency and accuracy, showcasing its robustness in diverse scenarios. We also explore the dynamics of group consensus, offering insights into how collaborative agents could behave in complex clinical team dynamics. Our code can be found at https://github.com/mitmedialab/MDAgents.

The third ML4H symposium was held in person on December 10, 2023, in New Orleans, Louisiana, USA. The symposium included research roundtable sessions to foster discussions between participants and senior researchers on timely and relevant topics for the \ac{ML4H} community. Encouraged by the successful virtual roundtables in the previous year, we organized eleven in-person roundtables and four virtual roundtables at ML4H 2022. The organization of the research roundtables at the conference involved 17 Senior Chairs and 19 Junior Chairs across 11 tables. Each roundtable session included invited senior chairs (with substantial experience in the field), junior chairs (responsible for facilitating the discussion), and attendees from diverse backgrounds with interest in the session's topic. Herein we detail the organization process and compile takeaways from these roundtable discussions, including recent advances, applications, and open challenges for each topic. We conclude with a summary and lessons learned across all roundtables. This document serves as a comprehensive review paper, summarizing the recent advancements in machine learning for healthcare as contributed by foremost researchers in the field.

In clinical practice, one often needs to identify whether a patient is at high risk of adverse outcomes after some key medical event; for example, the short-term risk of death after an admission for heart failure. This task is challenging due to the complexity, variability, and heterogeneity of longitudinal medical data, especially for individuals suffering from chronic diseases like heart failure. In this paper, we introduce Event-Based Contrastive Learning (EBCL), a method for learning embeddings of heterogeneous patient data that preserves temporal information before and after key index events. We demonstrate that EBCL produces models that yield better fine-tuning performance on critical downstream tasks for a heart failure cohort, including 30-day readmission, 1-year mortality, and 1-week length of stay, relative to other pretraining methods. Our findings also reveal that EBCL pretraining alone can effectively cluster patients with similar mortality and readmission risks, offering valuable insights for clinical decision-making and personalized patient care.

Heart failure is a debilitating condition that affects millions of people worldwide and has a significant impact on their quality of life and mortality rates. An objective assessment of cardiac pressures remains an important method for the diagnosis and treatment prognostication for patients with heart failure. Although cardiac catheterization is the gold standard for estimating central hemodynamic pressures, it is an invasive procedure that carries inherent risks, making it a potentially dangerous procedure for some patients. Approaches that leverage non-invasive signals - such as electrocardiogram (ECG) - have the promise to make the routine estimation of cardiac pressures feasible in both inpatient and outpatient settings. Prior models trained to estimate intracardiac pressures (e.g., mean pulmonary capillary wedge pressure (mPCWP)) in a supervised fashion have shown good discriminatory ability but have been limited to the labeled dataset from the heart failure cohort. To address this issue and build a robust representation, we apply deep metric learning (DML) and propose a novel self-supervised DML with distance-based mining that improves the performance of a model with limited labels. We use a dataset that contains over 5.4 million ECGs without concomitant central pressure labels to pre-train a self-supervised DML model which showed improved classification of elevated mPCWP compared to self-supervised contrastive baselines. Additionally, the supervised DML model that uses ECGs with access to 8,172 mPCWP labels demonstrated significantly better performance on the mPCWP regression task compared to the supervised baseline. Moreover, our data suggest that DML yields models that are performant across patient subgroups, even when some patient subgroups are under-represented in the dataset. Our code is available at https://github.com/mandiehyewon/ssldml