arXiv subjects

Alyssa Unell

Publications and source records attributed to Alyssa Unell.

12 recordsLinked to original sources

arXiv2026

Metric Match: A Subset Selection Approach to Evaluating LLM Judge Reliability

LLM judges are used to reduce the need for costly human labor in evaluating open-ended text generation. However, the reliability of these judges depends critically on their alignment with human raters -- a property that itself depends on costly human annotations. In this work, we develop a method (Metric Match) for estimating correlation-based reliability metrics of LLM judges from limited annotations. Metric Match selects a subset of samples for human annotation such that the subset matches the population reliability metric with respect to acquired synthetic labels. We empirically show that Metric Match achieves a win-rate of 0.838 against random subset selection across four different correlation metrics and 15 datasets, with an 18.7% decrease in average estimation error and reduces annotation needs by 32.5%. We provide a cost model and highlight a medical case study where our method saves $1,041.67 compared to random selection for expert annotation. Further, we shift our task from reliability estimation to reliability classification of whether a given judge is above a deployment threshold, outperforming random selection with Metric Match. All project code is publicly available, and we additionally provide an installable package for ease of use.

cs.AI↗

arXiv2026

Deployment-Centered Evaluation: Predicting Query-Level Rejection Risk in a Clinical LLM System

Large language models (LLMs) are increasingly integrated into clinical systems, making it essential to evaluate the real-world utility of these systems. However, static benchmarks tend to measure correctness rather than user acceptance, aggregate performance across queries, and require densely annotated datasets -- leading to major blind spots for evaluating clinical systems. In this work, we perform a deployment-centered evaluation of an LLM system embedded within electronic health records at an academic medical center, where user feedback is sparse but closely reflects the deployment conditions. Specifically, we train a pre-response classifier that estimates the risk that a future interaction will result in the user rejecting the LLM response, based on query content and deployment-specific context available before generation. We conduct a prospective analysis of our model over 4.5 months of user feedback, finding that our prediction model achieves an AUROC of 0.719. Further, we estimate the benefit of such predictions in two downstream use cases (guardrail triggering and abstention). Our key conceptual insight is that making use of deployment-specific context (i.e., the provider type, department name, language model used for response), as opposed to only query content, improves the ability to predict whether the user will reject the system output. Altogether, our empirical case study demonstrates the feasibility of predicting user rejection using deployment-specific context, opening the door to targeted guardrails.

cs.AI↗

arXiv2026

Not Another EHR: Reimagining Physician Information Needs with Generative AI Technology

Electronic health records (EHRs) have improved data accessibility but have also introduced cognitive burden for physicians, given the sheer volume and complexity of the data involved. Advances in large language models (LLMs) create new opportunities to rethink how clinicians interact with medical data through dynamic, adaptive interfaces. In this position paper, we explore how generative AI can support physicians' information needs by enabling more dynamic interactions with patient data. Through semi-structured interviews with internal physicians at Microsoft, we identify key challenges in data navigation and synthesis, and characterize clinicians' information needs during diagnostic workflows. We further examine how physicians conceptualize AI can help their work process and how these mental models shape expectations for interaction and trust. Based on these insights, we discuss design considerations for generative user interfaces that support clinician-centered workflows.

cs.HC↗

arXiv2026

Adoption and Use of LLMs at an Academic Medical Center

While large language models (LLMs) can support clinical documentation needs, standalone tools struggle with "workflow friction" from manual data entry. We developed ChatEHR, a system that enables the use of LLMs with the entire patient timeline spanning several years. ChatEHR enables automations - which are static combinations of prompts and data that perform a fixed task - and interactive use in the electronic health record (EHR) via a user interface (UI). The resulting ability to sift through patient medical records for diverse use-cases such as pre-visit chart review, screening for transfer eligibility, monitoring for surgical site infections, and chart abstraction, redefines LLM use as an institutional capability. This system, accessible after user-training, enables continuous monitoring and evaluation of LLM use. In 1.5 years, we built 7 automations and 1075 users have trained to become routine users of the UI, engaging in 23,000 sessions in the first 3 months of launch. For automations, being model-agnostic and accessing multiple types of data was essential for matching specific clinical or administrative tasks with the most appropriate LLM. Benchmark-based evaluations proved insufficient for monitoring and evaluation of the UI, requiring new methods to monitor performance. Generation of summaries was the most frequent task in the UI, with an estimated 0.73 hallucinations and 1.60 inaccuracies per generation. The resulting mix of cost savings, time savings, and revenue growth required a value assessment framework to prioritize work as well as quantify the impact of using LLMs. Initial estimates are $6M savings in the first year of use, without quantifying the benefit of the better care offered. Such a "build-from-within" strategy provides an opportunity for health systems to maintain agency via a vendor-agnostic, internally governed LLM platform.

cs.CY↗

arXiv2025

Structured Prompts Improve Evaluation of Language Models

As language models (LMs) are increasingly adopted across domains, high-quality benchmarking frameworks are essential for guiding deployment decisions. In practice, however, frameworks such as Holistic Evaluation of Language Models (HELM) typically evaluate models under a single static prompt configuration, even though model behavior depends strongly on prompt choice. As a result, reported scores can reflect prompt choice as much as model capability. Declarative prompting frameworks such as DSPy offer a scalable way to evaluate models under a set of structured prompting strategies rather than a static prompt configuration. We present a reproducible DSPy+HELM framework for studying how prompt choice impacts reported benchmark outcomes. Using five prompting methods, we evaluate four frontier and two open-source LMs across seven benchmarks against existing HELM baseline scores. By evaluating LMs across a family of prompt configurations, we find that prompt choice can materially impact leaderboard outcomes. In particular, structured prompting improves performance (by 6% on average), alters comparisons (leaderboard rankings shift on 5/7 benchmarks), with most gains coming from introducing chain-of-thought, and little additional benefit from more advanced optimizers. To our knowledge, this is the first study to systematically integrate structured prompting into an established evaluation framework and quantify how prompt choice alone can impact benchmark conclusions. We open-source (i) DSPy+HELM Evaluation (https://github.com/stanford-crfm/helm/pull/3893) and (ii) Prompt Optimization Pipeline (https://github.com/StanfordMIMI/dspy-helm).

cs.CL↗

arXiv2025

DISCO: A Browser-Based Privacy-Preserving Framework for Distributed Collaborative Learning

Data is often impractical to share for a range of well considered reasons, such as concerns over privacy, intellectual property, and legal constraints. This not only fragments the statistical power of predictive models, but creates an accessibility bias, where accuracy becomes inequitably distributed to those who have the resources to overcome these concerns. We present DISCO: an open-source DIStributed COllaborative learning platform accessible to non-technical users, offering a means to collaboratively build machine learning models without sharing any original data or requiring any programming knowledge. DISCO's web application trains models locally directly in the browser, making our tool cross-platform out-of-the-box, including smartphones. The modular design of \disco offers choices between federated and decentralized paradigms, various levels of privacy guarantees and several approaches to weight aggregation strategies that allow for model personalization and bias resilience in the collaborative training. Code repository is available at https://github.com/epfml/disco and a showcase web interface at https://discolab.ai

cs.LG↗

arXiv2025

CancerGUIDE: Cancer Guideline Understanding via Internal Disagreement Estimation

The National Comprehensive Cancer Network (NCCN) provides evidence-based guidelines for cancer treatment. Translating complex patient presentations into guideline-compliant treatment recommendations is time-intensive, requires specialized expertise, and is prone to error. Advances in large language model (LLM) capabilities promise to reduce the time required to generate treatment recommendations and improve accuracy. We present an LLM agent-based approach to automatically generate guideline-concordant treatment trajectories for patients with non-small cell lung cancer (NSCLC). Our contributions are threefold. First, we construct a novel longitudinal dataset of 121 cases of NSCLC patients that includes clinical encounters, diagnostic results, and medical histories, each expertly annotated with the corresponding NCCN guideline trajectories by board-certified oncologists. Second, we demonstrate that existing LLMs possess domain-specific knowledge that enables high-quality proxy benchmark generation for both model development and evaluation, achieving strong correlation (Spearman coefficient r=0.88, RMSE = 0.08) with expert-annotated benchmarks. Third, we develop a hybrid approach combining expensive human annotations with model consistency information to create both the agent framework that predicts the relevant guidelines for a patient, as well as a meta-classifier that verifies prediction accuracy with calibrated confidence scores for treatment recommendations (AUROC=0.800), a critical capability for communicating the accuracy of outputs, custom-tailoring tradeoffs in performance, and supporting regulatory compliance. This work establishes a framework for clinically viable LLM-based guideline adherence systems that balance accuracy, interpretability, and regulatory requirements while reducing annotation costs, providing a scalable pathway toward automated clinical decision support.

cs.LG↗

arXiv2025

MedHELM: Holistic Evaluation of Large Language Models for Medical Tasks

While large language models (LLMs) achieve near-perfect scores on medical licensing exams, these evaluations inadequately reflect the complexity and diversity of real-world clinical practice. We introduce MedHELM, an extensible evaluation framework for assessing LLM performance for medical tasks with three key contributions. First, a clinician-validated taxonomy spanning 5 categories, 22 subcategories, and 121 tasks developed with 29 clinicians. Second, a comprehensive benchmark suite comprising 35 benchmarks (17 existing, 18 newly formulated) providing complete coverage of all categories and subcategories in the taxonomy. Third, a systematic comparison of LLMs with improved evaluation methods (using an LLM-jury) and a cost-performance analysis. Evaluation of 9 frontier LLMs, using the 35 benchmarks, revealed significant performance variation. Advanced reasoning models (DeepSeek R1: 66% win-rate; o3-mini: 64% win-rate) demonstrated superior performance, though Claude 3.5 Sonnet achieved comparable results at 40% lower estimated computational cost. On a normalized accuracy scale (0-1), most models performed strongly in Clinical Note Generation (0.73-0.85) and Patient Communication & Education (0.78-0.83), moderately in Medical Research Assistance (0.65-0.75), and generally lower in Clinical Decision Support (0.56-0.72) and Administration & Workflow (0.53-0.63). Our LLM-jury evaluation method achieved good agreement with clinician ratings (ICC = 0.47), surpassing both average clinician-clinician agreement (ICC = 0.43) and automated baselines including ROUGE-L (0.36) and BERTScore-F1 (0.44). Claude 3.5 Sonnet achieved comparable performance to top models at lower estimated cost. These findings highlight the importance of real-world, task-specific evaluation for medical use of LLMs and provides an open source framework to enable this.

cs.CL↗

arXiv2025

TIMER: Temporal Instruction Modeling and Evaluation for Longitudinal Clinical Records

Large language models (LLMs) have emerged as promising tools for assisting in medical tasks, yet processing Electronic Health Records (EHRs) presents unique challenges due to their longitudinal nature. While LLMs' capabilities to perform medical tasks continue to improve, their ability to reason over temporal dependencies across multiple patient visits and time frames remains unexplored. We introduce TIMER (Temporal Instruction Modeling and Evaluation for Longitudinal Clinical Records), a framework that incorporate instruction-response pairs grounding to different parts of a patient's record as a critical dimension in both instruction evaluation and tuning for longitudinal clinical records. We develop TIMER-Bench, the first time-aware benchmark that evaluates temporal reasoning capabilities over longitudinal EHRs, as well as TIMER-Instruct, an instruction-tuning methodology for LLMs to learn reasoning over time. We demonstrate that models fine-tuned with TIMER-Instruct improve performance by 7.3% on human-generated benchmarks and 9.2% on TIMER-Bench, indicating that temporal instruction-tuning improves model performance for reasoning over EHR.

cs.AI↗

arXiv2024

μ-Bench: A Vision-Language Benchmark for Microscopy Understanding

Recent advances in microscopy have enabled the rapid generation of terabytes of image data in cell biology and biomedical research. Vision-language models (VLMs) offer a promising solution for large-scale biological image analysis, enhancing researchers' efficiency, identifying new image biomarkers, and accelerating hypothesis generation and scientific discovery. However, there is a lack of standardized, diverse, and large-scale vision-language benchmarks to evaluate VLMs' perception and cognition capabilities in biological image understanding. To address this gap, we introduce μ-Bench, an expert-curated benchmark encompassing 22 biomedical tasks across various scientific disciplines (biology, pathology), microscopy modalities (electron, fluorescence, light), scales (subcellular, cellular, tissue), and organisms in both normal and abnormal states. We evaluate state-of-the-art biomedical, pathology, and general VLMs on μ-Bench and find that: i) current models struggle on all categories, even for basic tasks such as distinguishing microscopy modalities; ii) current specialist models fine-tuned on biomedical data often perform worse than generalist models; iii) fine-tuning in specific microscopy domains can cause catastrophic forgetting, eroding prior biomedical knowledge encoded in their base model. iv) weight interpolation between fine-tuned and pre-trained models offers one solution to forgetting and improves general performance across biomedical tasks. We release μ-Bench under a permissive license to accelerate the research and development of microscopy foundation models.

cs.CV↗

arXiv2024

Towards an Improved Understanding and Utilization of Maximum Manifold Capacity Representations

Maximum Manifold Capacity Representations (MMCR) is a recent multi-view self-supervised learning (MVSSL) method that matches or surpasses other leading MVSSL methods. MMCR is intriguing because it does not fit neatly into any of the commonplace MVSSL lineages, instead originating from a statistical mechanical perspective on the linear separability of data manifolds. In this paper, we seek to improve our understanding and our utilization of MMCR. To better understand MMCR, we leverage tools from high dimensional probability to demonstrate that MMCR incentivizes alignment and uniformity of learned embeddings. We then leverage tools from information theory to show that such embeddings maximize a well-known lower bound on mutual information between views, thereby connecting the geometric perspective of MMCR to the information-theoretic perspective commonly discussed in MVSSL. To better utilize MMCR, we mathematically predict and experimentally confirm non-monotonic changes in the pretraining loss akin to double descent but with respect to atypical hyperparameters. We also discover compute scaling laws that enable predicting the pretraining loss as a function of gradients steps, batch size, embedding dimension and number of views. We then show that MMCR, originally applied to image data, is performant on multimodal image-text data. By more deeply understanding the theoretical and empirical behavior of MMCR, our work reveals insights on improving MVSSL methods.

cs.LG↗

arXiv2024

Why are Visually-Grounded Language Models Bad at Image Classification?

Image classification is one of the most fundamental capabilities of machine vision intelligence. In this work, we revisit the image classification task using visually-grounded language models (VLMs) such as GPT-4V and LLaVA. We find that existing proprietary and public VLMs, despite often using CLIP as a vision encoder and having many more parameters, significantly underperform CLIP on standard image classification benchmarks like ImageNet. To understand the reason, we explore several hypotheses concerning the inference algorithms, training objectives, and data processing in VLMs. Our analysis reveals that the primary cause is data-related: critical information for image classification is encoded in the VLM's latent space but can only be effectively decoded with enough training data. Specifically, there is a strong correlation between the frequency of class exposure during VLM training and instruction-tuning and the VLM's performance in those classes; when trained with sufficient data, VLMs can match the accuracy of state-of-the-art classification models. Based on these findings, we enhance a VLM by integrating classification-focused datasets into its training, and demonstrate that the enhanced classification performance of the VLM transfers to its general capabilities, resulting in an improvement of 11.8% on the newly collected ImageWikiQA dataset.

cs.CV↗