Paulius Mui, Dean F. Sittig, Steve Labkoff +1cs.AI cs.HC
Clinical artificial intelligence is increasingly embedded in real-world care, yet existing safety mechanisms are poorly suited to reconstructing and learning from individual AI-related errors and near-misses. Aggregate model monitoring can identify performance changes, and traditional patient safety reporting can capture adverse events, but neither is designed to explain how risk emerges across the interaction among AI systems, clinicians, workflows, and institutional controls. We propose AI Morbidity and Mortality (AI M&M), a structured, blameless framework for case-based review of clinical AI failures. The framework combines standardized case intake, evidence preservation and investigator-level reconstruction, tool-in-loop attribution, and corrective-action tracking. Each event is classified across four linked dimensions: Trigger - Mechanism - Clinical Pathway - Corrective Action, separating the condition that exposed a vulnerability from the process that produced risk, its consequence for care, and the remediation assigned. We demonstrate the framework using five illustrative outpatient medication and clinical decision-support cases; two clinician reviewers independently applied all four classification axes and reached agreement across all 20 axis-level classifications. AI M&M is intended to complement, rather than replace, model monitoring, patient safety reporting, and regulatory oversight by converting individual AI-in-workflow failures into actionable institutional learning. Prospective evaluation across institutions, AI systems, and clinical settings is needed.
Jacob Idoko, Siddhartha Paudel, Mariana Bento +2cs.AI
Artificial intelligence is increasingly being introduced into healthcare workflows, yet most evaluations emphasize model accuracy rather than whether adoption is economically worthwhile in real clinical settings. This study proposes FLARE, a systematic and uncertainty-aware framework for evaluating the financial and operational implications of adopting AI in healthcare. FLARE combines fuzzy logic, time-driven activity-based costing, and return on investment analysis to estimate the cost of clinical service delivery, the cost of AI development and operation, and the economic consequences of workflow integration under uncertainty. The framework was demonstrated through an early health technology assessment case study of AI-assisted large vessel occlusion detection in the CT stroke pathway for acute ischemic stroke. The case study shows how FLARE can quantify conventional pathway cost, AI-related development and recurring costs, and AI-enabled service savings within a unified activity-based model. Under expected assumptions, the analysis identified a break-even threshold of approximately 3,992 patients per year, with positive first-year return on investment at typical annual stroke volumes of about 5,000 patients. The results further show that economic benefit depends not only on algorithmic performance, but also on patient volume, verification time, infrastructure choices, and workflow design. FLARE provides a transparent and practical decision-support framework for early-stage evaluation of AI adoption in healthcare. By making uncertainty, resource use, and implementation trade-offs explicit, it helps clinicians, administrators, and policymakers determine when AI deployment is economically viable and where operational changes may improve value.
Kushagra Yadav, Nalin Prabhath, Amit Lamba +3cs.LG cs.AI
Clinical records contain rich evidence about patient state, but converting that evidence into reliable, structured knowledge graphs remains difficult because extraction errors, ontology mismatch, missing relations, and temporal ambiguity can propagate into downstream systems. We propose a clinical knowledge graph construction and refinement framework that combines multi-agent relation proposal, ontology-aware normalization, deterministic evidence scoring, and JEPA-based latent refinement. Rather than treating a clinical knowledge graph as a static extraction artifact, we treat it as a predictive patient-state representation. For each admission, the system constructs an evidence-scored graph from structured MIMIC-IV records and inferred clinical cross-links, then learns to recover held-out clinical relations from the observed graph context. We evaluate the refiner with leakage-free leave-one-out edge recovery (MRR and Hits@k) and held-out batch-mask evaluation (AUC and MRR). To isolate the contribution of discharge-note context, we compare a note-embedding-free configuration with a note-augmented configuration that injects real discharge-note representations only into note-grounded entities. Under the same cohort and evaluation protocol, entity-grounded note injection improves overall leave-one-out MRR by 31% relative improvement.
Neuro-oncology decisions require coordinated interpretation of serial MRI, pathology, molecular markers, treatment history, performance status, and evolving guidelines. We present TumorBoard, a multi-agent decision-support system built around a shared longitudinal case state and an auditable claim-evidence ledger. Specialist agents for radiology, neuropathology, molecular diagnosis, guidelines, and therapy planning produce atomic claims with provenance. An adversarial critic exposes contradictions, and a safety governor releases, qualifies, or defers recommendations according to evidence sufficiency and temporal validity. On a 360-case hidden benchmark at a matched token budget, TumorBoard achieved an action F1 of 0.772 and evidence entailment of 0.914. It exceeded the strongest typed-council baseline by 3.1 percentage points (95% CI: 1.6 to 4.7, adjusted p = 0.0012), while recommendation-to-evidence coverage reached 0.927. Under evidence deletion, the system deferred 84.2% of unsafe cases and limited harmful recommendations to 5.8%. The safety governor reduced harmful release by 7.8 percentage points at a false-deferral cost of 4.3 percentage points. Ablation studies of the ledger, critic, and governor produced the predicted failure patterns, establishing structured coordination as the source of the measured multi-agent advantage.
The rapid growth of the global aging population presents severe challenges to healthcare systems, necessitating efficient, equitable, and patient-centered care models. While Industrial Engineering and Operations Research (OR) provide robust optimization and decision-support tools to address these multidimensional complexities, current applications often remain fragmented. This paper presents a thematic review of 30 seminal studies at the intersection of OR and elderly care, categorizing the literature into home healthcare operations, polypharmacy management, and clinical chronotherapy. Our analysis highlights a significant methodological evolution from static, deterministic models toward dynamic and stochastic frameworks integrated with artificial intelligence (AI). Despite these advancements, a critical translational gap persists: the current OR literature is heavily dominated by process-level optimizations, such as staff routing, and struggles to translate these operational efficiencies into measurable clinical outcomes. Furthermore, holistic models bridging the transition between hospital and community care remain critically underexplored. To develop resilient and smart healthcare systems, this study proposes a conceptual framework that shifts the research focus from isolated operational tasks to integrated, multi-level decision-making. We emphasize the critical need for robust systems analysis, human-inclusive design, and the smartification of care through emerging digital technologies - including digital twins and large language models - to successfully bridge the gap between theoretical operational metrics and tangible patient-level health outcomes.
Bladder cancer treatment requires personalized and adaptive decision-making, particularly for recurrent disease, where treatment effectiveness changes across successive clinical episodes. Conventional clinical decision support systems typically rely on static treatment guidelines or single-step predictive models, limiting their ability to capture disease progression over time. This paper presents a recurrent patient state-transition simulation framework for bladder cancer treatment planning that integrates predictive state-transition modeling with a Markov Decision Process (MDP) and a Deep Q-Network (DQN) reinforcement learning environment. The predictive module estimates changes in tumor characteristics following treatment, while the reinforcement learning agent sequentially optimizes treatment decisions by interacting with simulated patient trajectories. This framework enables dynamic, patient-specific treatment planning by continuously adapting recommendations to evolving clinical states. It also generates interpretable treatment trajectories and detailed simulation logs to improve transparency and support clinical decision-making. The proposed framework was evaluated against existing reinforcement learning-based treatment planning approaches. It achieved a cumulative reward of 63,918.87, an average training loss per episode of 0.0056, and a policy improvement score of 6.62%, demonstrating effective sequential learning and robust treatment optimization in a simulated recurrent treatment environment. These findings highlight the potential of recurrent patient state-transition simulation with reinforcement learning as a flexible decision-support framework for personalized bladder cancer treatment planning and AI-assisted precision oncology.
Hantavirus genomic surveillance is limited by the distribution of sequence data, non-IID source heterogeneity, and constrained expert-review capacity. We propose HantaWatch, a federated learning framework that enables laboratories and surveillance sites to collaboratively train sequence-based models without sharing raw data. HantaWatch integrates k-mer feature extraction, source-aware federated client construction, adaptive DU-FedProx optimization, surveillance-specific model selection, and prediction-only triage. Experiments on binary and multi-class tasks show that HantaWatch supports high-risk screening, outbreak-associated prediction, clade classification, and clinical-syndrome categorization while balancing predictive performance, false-negative risk, and update stability. The framework converts model output into risk scores, confidence estimates, uncertainty flags, and ranked expert-review priorities. HantaWatch therefore provides a practical federated decision-support layer for decentralized Hantavirus surveillance, supporting expert prioritization without replacing laboratory or public-health interpretation.
Mental health assessment commonly relies on isolated screening instruments or data-driven models that often lack interpretability and multi-dimensional integration. Existing approaches frequently focus on individual indicators such as depression or anxiety while providing limited support for comprehensive and explainable decision-making. To address this limitation, this study proposes PsyBridge, a hybrid intelligent decision-support framework designed for multi-dimensional mental health assessment through the integration of clinically validated screening tools, cognitive evaluation, and personality profiling within a unified architecture. The proposed framework incorporates PHQ-9 and GAD-7 assessments alongside cognitive and behavioural indicators using a modular design and a weighted aggregation mechanism to generate interpretable mental health risk classifications and recommendations. To evaluate the framework, a semi-synthetic dataset consisting of 500 patient profiles representing varying severity levels was constructed based on clinically grounded score distributions. Experimental results demonstrate that PsyBridge achieves an overall accuracy of 0.84, outperforming standalone PHQ-9 and GAD-7 assessments while improving precision, recall, and F1-score. Sensitivity analysis and ablation studies further indicate that integrating cognitive and personality components contributes to more stable classification performance and reduces inconsistencies in moderate-risk prediction. The findings suggest that PsyBridge provides a scalable and interpretable approach for AI-assisted mental health decision support, particularly within digital healthcare and telehealth environments.
Medical and public health experts must make real-time resource decisions, such as expanding hospital bed capacity, based on projected hospitalization trends during large-scale healthcare disruptions (e.g., operational failures or pandemics). Forecasting models can assist in this task by analyzing large volumes of resource-related data at the facility level, but they must be reliable for decision-making under real-world data conditions. Recent work shows that large language models (LLMs) can incorporate richer forms of context into numerical forecasting. Whereas traditional models rely primarily on temporal context (i.e., past observations), LLMs can also leverage non-temporal public health context such as demographic, geographic, and population-level features. However, it remains unclear how these models should be used to produce stable or decision-relevant predictions in real-world healthcare settings. To evaluate how LLMs can be effectively used in this setting, we evaluate three approaches across 60 counties with low-,mid-, and high-hospitalization intensities in the United States: direct LLM-based forecasting, classical time-series models, and a context-augmented hybrid pipeline (HybridARX) that incorporates LLM-derived signals into structured models. Because the goal is operational decision-making rather than error minimization alone, we evaluate performance with bias and lead-lag alignment in addition to standard forecasting metrics. Our results show that HybridARX improves over classical ARX by yielding more stable and better-calibrated forecasts, particularly when incorporating noisy contextual signals into structured time-series models. These findings suggest that, in non-stationary healthcare resource forecasting, LLMs are most useful when embedded within structured hybrid models.