arXiv subjects

Steven Lin

Publications and source records attributed to Steven Lin.

7 recordsLinked to original sources

arXiv2025

SmartAlert: Implementing Machine Learning-Driven Clinical Decision Support for Inpatient Lab Utilization Reduction

Repetitive laboratory testing unlikely to yield clinically useful information is a common practice that burdens patients and increases healthcare costs. Education and feedback interventions have limited success, while general test ordering restrictions and electronic alerts impede appropriate clinical care. We introduce and evaluate SmartAlert, a machine learning (ML)-driven clinical decision support (CDS) system integrated into the electronic health record that predicts stable laboratory results to reduce unnecessary repeat testing. This case study describes the implementation process, challenges, and lessons learned from deploying SmartAlert targeting complete blood count (CBC) utilization in a randomized controlled pilot across 9270 admissions in eight acute care units across two hospitals between August 15, 2024, and March 15, 2025. Results show significant decrease in number of CBC results within 52 hours of SmartAlert display (1.54 vs 1.82, p <0.01) without adverse effect on secondary safety outcomes, representing a 15% relative reduction in repetitive testing. Implementation lessons learned include interpretation of probabilistic model predictions in clinical contexts, stakeholder engagement to define acceptable model behavior, governance processes for deploying a complex model in a clinical environment, user interface design considerations, alignment with clinical operational priorities, and the value of qualitative feedback from end users. In conclusion, a machine learning-driven CDS system backed by a deliberate implementation and governance process can provide precision guidance on inpatient laboratory testing to safely reduce unnecessary repetitive testing.

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↗

arXiv2024

Crowdsourcing Dermatology Images with Google Search Ads: Creating a Real-World Skin Condition Dataset

Background: Health datasets from clinical sources do not reflect the breadth and diversity of disease in the real world, impacting research, medical education, and artificial intelligence (AI) tool development. Dermatology is a suitable area to develop and test a new and scalable method to create representative health datasets. Methods: We used Google Search advertisements to invite contributions to an open access dataset of images of dermatology conditions, demographic and symptom information. With informed contributor consent, we describe and release this dataset containing 10,408 images from 5,033 contributions from internet users in the United States over 8 months starting March 2023. The dataset includes dermatologist condition labels as well as estimated Fitzpatrick Skin Type (eFST) and Monk Skin Tone (eMST) labels for the images. Results: We received a median of 22 submissions/day (IQR 14-30). Female (66.72%) and younger (52% < age 40) contributors had a higher representation in the dataset compared to the US population, and 32.6% of contributors reported a non-White racial or ethnic identity. Over 97.5% of contributions were genuine images of skin conditions. Dermatologist confidence in assigning a differential diagnosis increased with the number of available variables, and showed a weaker correlation with image sharpness (Spearman's P values <0.001 and 0.01 respectively). Most contributions were short-duration (54% with onset < 7 days ago ) and 89% were allergic, infectious, or inflammatory conditions. eFST and eMST distributions reflected the geographical origin of the dataset. The dataset is available at github.com/google-research-datasets/scin . Conclusion: Search ads are effective at crowdsourcing images of health conditions. The SCIN dataset bridges important gaps in the availability of representative images of common skin conditions.

cs.CY↗

arXiv2024

Closing the AI generalization gap by adjusting for dermatology condition distribution differences across clinical settings

Recently, there has been great progress in the ability of artificial intelligence (AI) algorithms to classify dermatological conditions from clinical photographs. However, little is known about the robustness of these algorithms in real-world settings where several factors can lead to a loss of generalizability. Understanding and overcoming these limitations will permit the development of generalizable AI that can aid in the diagnosis of skin conditions across a variety of clinical settings. In this retrospective study, we demonstrate that differences in skin condition distribution, rather than in demographics or image capture mode are the main source of errors when an AI algorithm is evaluated on data from a previously unseen source. We demonstrate a series of steps to close this generalization gap, requiring progressively more information about the new source, ranging from the condition distribution to training data enriched for data less frequently seen during training. Our results also suggest comparable performance from end-to-end fine tuning versus fine tuning solely the classification layer on top of a frozen embedding model. Our approach can inform the adaptation of AI algorithms to new settings, based on the information and resources available.

eess.IV↗

arXiv2019

Planning with Goal-Conditioned Policies

Planning methods can solve temporally extended sequential decision making problems by composing simple behaviors. However, planning requires suitable abstractions for the states and transitions, which typically need to be designed by hand. In contrast, model-free reinforcement learning (RL) can acquire behaviors from low-level inputs directly, but often struggles with temporally extended tasks. Can we utilize reinforcement learning to automatically form the abstractions needed for planning, thus obtaining the best of both approaches? We show that goal-conditioned policies learned with RL can be incorporated into planning, so that a planner can focus on which states to reach, rather than how those states are reached. However, with complex state observations such as images, not all inputs represent valid states. We therefore also propose using a latent variable model to compactly represent the set of valid states for the planner, so that the policies provide an abstraction of actions, and the latent variable model provides an abstraction of states. We compare our method with planning-based and model-free methods and find that our method significantly outperforms prior work when evaluated on image-based robot navigation and manipulation tasks that require non-greedy, multi-staged behavior.

cs.LG↗

arXiv2019

Skew-Fit: State-Covering Self-Supervised Reinforcement Learning

Autonomous agents that must exhibit flexible and broad capabilities will need to be equipped with large repertoires of skills. Defining each skill with a manually-designed reward function limits this repertoire and imposes a manual engineering burden. Self-supervised agents that set their own goals can automate this process, but designing appropriate goal setting objectives can be difficult, and often involves heuristic design decisions. In this paper, we propose a formal exploration objective for goal-reaching policies that maximizes state coverage. We show that this objective is equivalent to maximizing goal reaching performance together with the entropy of the goal distribution, where goals correspond to full state observations. To instantiate this principle, we present an algorithm called Skew-Fit for learning a maximum-entropy goal distributions. We prove that, under regularity conditions, Skew-Fit converges to a uniform distribution over the set of valid states, even when we do not know this set beforehand. Our experiments show that combining Skew-Fit for learning goal distributions with existing goal-reaching methods outperforms a variety of prior methods on open-sourced visual goal-reaching tasks. Moreover, we demonstrate that Skew-Fit enables a real-world robot to learn to open a door, entirely from scratch, from pixels, and without any manually-designed reward function.

cs.LG↗

arXiv2018

Visual Reinforcement Learning with Imagined Goals

For an autonomous agent to fulfill a wide range of user-specified goals at test time, it must be able to learn broadly applicable and general-purpose skill repertoires. Furthermore, to provide the requisite level of generality, these skills must handle raw sensory input such as images. In this paper, we propose an algorithm that acquires such general-purpose skills by combining unsupervised representation learning and reinforcement learning of goal-conditioned policies. Since the particular goals that might be required at test-time are not known in advance, the agent performs a self-supervised "practice" phase where it imagines goals and attempts to achieve them. We learn a visual representation with three distinct purposes: sampling goals for self-supervised practice, providing a structured transformation of raw sensory inputs, and computing a reward signal for goal reaching. We also propose a retroactive goal relabeling scheme to further improve the sample-efficiency of our method. Our off-policy algorithm is efficient enough to learn policies that operate on raw image observations and goals for a real-world robotic system, and substantially outperforms prior techniques.

cs.LG↗