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01.
arXiv (CS.AI) 2026-06-15

When and How Severely: Scenario-Specific Safety Envelopes for Driving VLAs

arXiv:2606.14238v1 Announce Type: cross Abstract: Safety certification of Vision-Language-Action (VLA) driving planners under ISO 21448 (SOTIF) rests on an Operational Design Domain (ODD) specification that answers two complementary questions: when does the planner start to fail, and how severely does it fail once it does? We evaluate Alpamayo R1, a 10B-parameter open-weight driving VLA, on 15,968 (clip, attack) pairs. We find a conservative-aggregate gap: an aggregate safe threshold of $\sigma \leq 50$ under a 15% average displacement error (ADE) budget masks well-sampled scenarios that tolerate the top of the tested grid ($\sigma = 70$). A Gaussian Mixture Model (GMM) on the changed-explanation subset identifies six discrete severity bands (BIC-optimal $k{=}6$), so two perturbation conditions with the same mean error can differ materially in their share of high-severity (C4/C5) failures. Joining the two analyses on the same corpus surfaces a finding neither yields in isolation: the scenarios with the loosest noise thresholds are not those with the lowest high-severity rate: STOP_SIGNAL concentrates roughly $4\times$ the C4/C5 share of LANE_KEEPING despite tolerating a larger $\sigma$. A deployable SOTIF ODD specification for driving VLAs therefore requires a two-dimensional safety envelope, not a single aggregate value per hazard.

02.
arXiv (CS.CL) 2026-06-17

ProvenanceGuard: Source-Aware Factuality Verification for MCP-Based LLM Agents

Tool-using LLM agents increasingly use the Model Context Protocol (MCP) to answer from heterogeneous evidence sources, including search, APIs, databases, clinical records, and formulary tools. Standard factuality metrics usually test whether an answer is supported by pooled evidence, missing a provenance-sensitive failure mode: a claim may be supported somewhere while being attributed to the wrong source. We call this cross-source conflation. We introduce ProvenanceGuard, a source-aware verifier for MCP-grounded answers. It consumes captured MCP traces with stable tool IDs, source IDs, and raw outputs; decomposes answers into atomic claims; routes claims to source-specific evidence; checks support with NLI and a token-alignment proxy; compares stated attribution with the routed source; and returns per-claim verdicts plus an answer-level allow/block decision. Blocked answers can be repaired with retrieval-augmented answer revision and re-verified. We evaluate on 281 medical-domain MCP-agent traces. A 266-trace adjudicated subset yields 2,325 LLM-assisted claim labels split by trace; 361 held-out labels are human-verified. On the 40-trace held-out split, ProvenanceGuard achieves block F1 0.802 and source accuracy 0.858 over 260 source-eligible claims, outperforming source-blind baselines that do not emit claim-to-source IDs. On a harder multi-source benchmark it reaches block F1 0.846, while source-plus-relation accuracy drops to 0.229, showing that exact source ownership remains difficult with semantically close sources. Repair-and-reverify resolves all blocked answers in the full trace set, often via conservative fallback. In 50 controlled clinical conflation probes, ProvenanceGuard detects all injected attribution swaps with no retained wrong attribution. These results show that source attribution is an independent axis for factuality verification in MCP-based agents.

03.
arXiv (CS.CL) 2026-06-17

Speaking in Self-Assessing Tongues: On the Verbalized Confidence of LLMs in Machine Translation

The rapid rise in popularity of large language models (LLMs) for translation calls for a thorough study of the reliability of their confidence in their own outputs. Unlike many generation tasks, translation errors and confidence levels can be useful at different levels of granularity (tokens, words, or spans). Unsupervised approaches based on internal signals like predicted probabilities can be misleading because they reflect certainty among alternatives rather than correctness. In addition, they require access to such internal signals. Here, we devise five verbalized methods of extracting an LLM's per-token confidence without those shortcomings and compare their reliability with that of the model's internal signals of certainty. We evaluate reliability using two forms of alignment: fine-grained error detection and calibration. For both, internal and verbalized methods perform similarly, although results vary by model. Interestingly, we find little to no correlation between internal and verbalized methods.

04.
arXiv (math.PR) 2026-06-18

Kemeny's constant minimization for reversible Markov chains via structure-preserving perturbations

arXiv:2510.24679v4 Announce Type: replace-cross Abstract: Kemeny's constant measures the efficiency of a Markov chain in traversing its states. We investigate whether structure-preserving perturbations to the transition probabilities of a reversible Markov chain can improve its connectivity while maintaining a fixed stationary distribution. Although the minimum achievable value for Kemeny's constant can be estimated, the required perturbations may be infeasible. We reformulate the problem as an optimization task, focusing on solution existence and efficient algorithms, with an emphasis on the problem of minimizing Kemeny's constant under sparsity constraints.

05.
arXiv (CS.AI) 2026-06-19

PrefSQA: Pairwise Preference Prediction for Speech Quality Assessment and the Critical Role of High Quality Datasets

arXiv:2606.19597v1 Announce Type: cross Abstract: Mean opinion scores (MOS) are widely used for speech quality assessment, yet scalar labels are sensitive to rater variability and listening test differences. This introduces labeling noise, which limits the reliability of MOS prediction. Preference prediction reduces this variability as listeners compare signals directly, producing cleaner labels. We study MOS-free preference prediction and propose PrefSQA, which incorporates uncertainty-aware logits, an impairment attention head, and a module based on non-matching-reference comparisons. We use and refine five datasets, including MOS-derived and low-noise simulated sets with matching and non-matching content, experiment with human preference sets, and test on unseen data. Experiments show small improvements on MOS-derived data, while other sets reveal clear improvement over the baselines, highlighting the value of high-quality preference data and demonstrating the effectiveness of the proposed method.

06.
arXiv (CS.AI) 2026-06-24

Visualizing "We the People": Bridging the Perception Gap through Pluralistic Data Storytelling

arXiv:2606.24635v1 Announce Type: cross Abstract: Traditional visual data storytelling relies on binary graphics that depict two simplified groups in conflict. This can increase political polarization by oversimplifying intra-group disagreements and erasing ambiguity and shared ideas or values. This can inadvertently foster "us versus them" thinking. Intentional, pluralistic design choices for AI-enabled digital platforms can produce visualizations that emphasize nuance, opinion distribution, and intergroup commonalities. To demonstrate this potential, we examine deliberative technologies that map high-dimensional opinion spaces and highlight areas of both consensus and dissensus. The paper highlights the We the People deliberation conducted by Jigsaw and the Napolitan Institute in September 2025, which engaged over 2,400 Americans across all 435 congressional districts in an AI-supported, asynchronous dialogue regarding freedom and equality. By utilizing AI to synthesize long-form, text-based participant inputs into interactive "opinion landscapes," the initiative provided an alternative format for pluralistic data storytelling that humanized diverse viewpoints and revealed hidden areas of substantial broad consensus. The paper concludes that shifting from divisive, contrast-heavy visual frameworks to distribution-focused, interactive models represents a highly scalable, low-cost intervention capable of bridging perceptual gaps and cultivating a more resilient, collaborative democratic culture.

07.
arXiv (math.PR) 2026-06-24

Scheduling jobs with unknown size distribution in a M/G/1 queue: the shifted empirical Gittins

arXiv:2606.24703v1 Announce Type: new Abstract: In this paper we consider a M/G/1 queue for which we want to minimize the expected response time. We show how to compute indices from $n$ samples of the job size distribution such that the corresponding index policy is asymptotically optimal as $n$ grows. This construction is based on a discretization of the bounded support of the job size distribution and a shift of the samples to their nearest discrete point to the right. We show that the Gittins index of the empirical distribution of these shifted samples is close to the Gittins index of the original distribution. This translates to the asymptotic optimality of the corresponding index policy for minimizing the expected response time. Numerical comparison with other approaches further confirm the efficiency of our approach.

08.
arXiv (CS.LG) 2026-06-15

Beyond a Single Explanation of the Adam–SGD Gap

arXiv:2606.14259v1 Announce Type: new Abstract: Prior work has identified several factors that can contribute to the performance gap between Adam and SGD, spanning data aspects, architecture design, and optimization properties. Yet these explanations are often studied in isolation, leaving their relative importance unclear. In this work, we revisit these hypotheses through a controlled empirical study across vision, language, genomics, and graph tasks, spanning modern and classical architectures, and carefully designed training setups. Our results suggest that no single factor consistently explains the Adam–SGD gap. For instance, the Adam advantage can (1) persist under a uniform vocabulary distribution yet nearly disappear under a heavy-tailed one; (2) reverse in favor of SGD in softmax-attention models; and (3) become larger under soft architectural modifications, e.g., when ReLU is replaced by a GeLU nonlinearity. This suggests that the gap arises from nontrivial data and architecture interactions, rather than from a single common factor. Yet, we observe a pattern across our settings: a crossover batch size at which the relative advantage shifts from SGD to Adam as the batch size scales. These empirical results are captured by our theoretical gap model, which predicts this batch-size-dependent crossover. Our perspective helps reconcile several existing hypotheses while offering practical insights across domains.

10.
arXiv (CS.CV) 2026-06-17

Improving and Evaluating Hand-Object Interaction Detection

Understanding hands and the objects they interact with, both directly and through tools, is a key step for tasks ranging from action perception to 3D reconstruction and robotics. Our paper provides several contributions to the Hand-Object Interaction (HOI) understanding literature: (1) HOI-DETR, a new framework that introduces hand-object and object-object interactions to the Co-DETR architecture to produce a state-of-the-art method; (2) a comprehensive HOI evaluation suite of 4 diverse datasets, including a video benchmark derived from the HD-EPIC dataset and fresh annotations that improve the Hands23 benchmark and (3) a trained checkpoint that significantly improves the state of the art across Hands23, HOIST, FineBio, and HD-EPIC, including mAP gains of over 20 percentage points on Hands23 and FineBio. Our ablations confirm the contributions of each model component.

12.
arXiv (CS.AI) 2026-06-16

SCAN: A Decision-Making Framework for Effective Task Allocation with Generative AI

arXiv:2606.15601v1 Announce Type: cross Abstract: We introduce SCAN – a human-centric decision-making framework to facilitate learners for effective task allocation with Generative Artificial Intelligence (GenAI) based on Vygotsky's Zone of Proximal Development and Metacognition. In SCAN, we systematize and formalize AI-human interaction by introducing a task-identification approach with four "sub-zones": Substitute, Complement, Aid, and Non-negotiable. After describing the four sub-zones, we demonstrate how SCAN framework can be applied for knowledge workers in the workplace and students in education to metacognitively "scan" their use of Generative AI. We then discuss how such framework can be related to cognitive load theory, cognitive offloading, sycophancy, three decision-making modes in human-AI interactions (automation, augmentation, and collaboration), future of work such as upskilling and deskilling, and how it accounts for both human-human and human-AI learning. We propose that SCAN offers a great starting point before discussing whether GenAI complements or replaces our abilities when completing a task, with a general objective of sustaining lifelong learning, and a specific goal of reaching hybrid intelligence.

14.
arXiv (CS.CV) 2026-06-11

NSVQ: Mitigating Codebook Collapse by Stabilizing Encoder Drift in Vector Quantization

Vector quantization is central to modern generative modeling pipelines, but large-codebook VQ models often suffer from codebook collapse. We identify encoder drift as a key driver of this failure: as the encoder moves the latent distribution, sparsely updated code vectors can lag behind, lose assignments, and increase quantization error, creating a feedback loop through the straight-through estimator. We propose NSVQ, a non-stationary-aware VQ training strategy that combines a dense non-stationary embedding loss, codebook replacement, and stage-wise encoder freezing. NSVQ first helps the codebook track encoder drift during early training, then freezes the encoder to consolidate the codebook under a fixed latent geometry, and finally reintroduces adversarial refinement. Experiments on ImageNet-1k show that NSVQ improves reconstruction quality while maintaining full codebook utilization. On ImageNet-1k at 128$\times$128 with 65,536 codes, NSVQ reduces rFID from 2.39 to 2.10 compared with SimVQ, while both methods maintain 100\% utilization. Additional latent diffusion experiments show that NSVQ also improves downstream ImageNet generation FID.

15.
arXiv (quant-ph) 2026-06-19

Applications of quantum annealing to magnetic dipole hyperfine structure constants: First results beyond energies for atoms

arXiv:2606.20166v1 Announce Type: new Abstract: We report the first results of the magnetic dipole hyperfine structure (HFS) constants of neutral $\mathrm{Li}$, Li-like $\mathrm{Be}$, neutral $\mathrm{Na}$, and Na-like $\mathrm{Mg}$ using a modified version of the Quantum Annealer Eigensolver (QAE) algorithm on D-Wave's quantum hardware. The results are benchmarked against relativistic configuration interaction with multiconfiguration Dirac Hartree-Fock (MCDHF) calculations using the General-purpose Relativistic Atomic Structure Package (GRASP), and simulated annealing. In our modified QAE, a zooming-and-sigma-annealing approach with a floating-point encoding scheme is adopted to estimate the ground-state eigenvalue and eigenvector of the relativistic Dirac-Coulomb Hamiltonian matrices ($H_{\mathrm{DC}}$) constructed from 11 or fewer configuration state functions (CSFs). For calculations with extended correlation orbital sets, we applied a CSF truncation scheme, retaining only CSFs (up to 12) that make significant contributions to the ground-state wavefunction. Our modified QAE precision is kept limited to three decimal places (up to 10 qubits). Hardware demonstrations on the D-Wave quantum processing unit (QPU) yielded results that were completely consistent with GRASP (at the chosen precision) in determining the magnetic dipole HFS constants, with accuracy varying across systems and $H_{\mathrm{DC}}$ matrix dimensions.

16.
arXiv (CS.CV) 2026-06-24

Configurable Holography: Towards Display and Scene Adaptation

Rendering holograms for holographic displays is often an iterative and computationally costly process. Emerging learned holography methods have alleviated this bottleneck by enabling fast hologram rendering with improved reconstruction quality. However, existing methods still depend on fixed display hardware and scene parameters, requiring retraining for each new configuration. This limits rapid adaptation to different visual needs, including scene brightness, user focus preference, and hardware compatibility. We introduce Configurable Holography, a learned CGH framework in which a single model adapts to diverse display-scene parameters through explicit conditioning, eliminating the need for retraining. As a prototype, we present a configurable structure and derive a family of models that continuously adapt to propagation distance, volume depth, peak brightness, pixel pitch, and wavelength. To further improve efficiency, we incorporate auxiliary monocular depth estimation for depth-aware 3D hologram synthesis from RGB-only inputs and apply knowledge distillation for interactive inference. Our extensive simulation and hardware experiments on three holographic display prototypes with different combinations of configurations show on-par reconstruction quality with existing methods, offering up to 2x speed-up in fp32. Our work represents an initial step toward flexible, general-purpose learned holography systems that can seamlessly adapt across diverse hardware and user-specific visual requirements.

17.
arXiv (CS.AI) 2026-06-16

Explainable deep learning improves human mental models of self-driving cars

arXiv:2411.18714v3 Announce Type: replace-cross Abstract: Self-driving cars increasingly rely on deep neural networks to achieve human-like driving. The opacity of such black-box planners makes it challenging to accurately anticipate when they will fail, with potentially catastrophic consequences. While research into interpreting these systems has surged, most of it is confined to simulations or toy setups due to the difficulty of real-world deployment, leaving the practical utility of such techniques unknown. Here, we introduce the Concept-Wrapper Network (CW-Net), a method for faithfully explaining the behavior of machine-learning-based planners that causally grounds their reasoning in human-interpretable concepts without sacrificing performance. We deploy CW-Net on a real self-driving car and show that the resulting explanations improve the human driver's mental model of the vehicle, allowing them to better predict its behavior, particularly in surprising situations. This demonstrates that explainable deep learning integrated into self-driving cars can be both understandable and useful in a realistic deployment setting. We anticipate our method could be applied to other safety-critical systems, such as autonomous drones and robotic surgeons, as well as to other architectures, such as end-to-end learning systems and vision-language-action models. Overall, our study establishes a deployment-validated pathway to interpretability for autonomous agents, which could help make them more transparent and safe.

18.
arXiv (CS.LG) 2026-06-19

Predictability as a Fine-Grained Measure for Privacy

arXiv:2606.20546v1 Announce Type: new Abstract: Differential privacy (DP) ensures rigorous individual-level privacy guarantees against even the most knowledgeable attackers, but its worst-case nature can impose a costly privacy-accuracy tradeoff. We introduce privacy via predictability, a fine-grained framework that explicitly incorporates the attacker's core knowledge, a compromised portion of the dataset generated by a stochastic process, and a specified family of queries. Predictability measures privacy leakage as the incremental gain in an attacker's ability to predict sensitive information about unknown individuals after observing the algorithm's output, beyond what can already be inferred from the compromised data. We show that predictability and DP are generally incomparable: each can be small while the other is large. However, in the worst-case regime where all but one individual is compromised, and all binary queries are considered sensitive, predictability implies mutual-information DP. More generally, predictability provides a finer-grained privacy metric tailored to specific sensitive information and specific attacker models. We introduce a general framework, using the generalized method of moments (GMM), to analyze asymptotic predictability when the compromised data is generated by a stationary, ergodic, mixing process. Using this analysis, we derive a predictability-calibrated output perturbation scheme for ERM. Our approach is complementary to DP and can be used alongside DP to provide fine-grained privacy control.

19.
arXiv (CS.AI) 2026-06-16

Hierarchical Modeling of ICD Codes in EHR Foundation Models

arXiv:2606.15447v1 Announce Type: new Abstract: Electronic health record foundation models typically treat ICD diagnosis codes as flat tokens, overlooking the clinically meaningful hierarchical structure that captures disease families, subcategories, and fine-grained diagnostic detail. As a result, existing EHR representation learning methods do not explicitly exploit the hierarchical structure already present in the coding system. In this work, we study ICD-10-CM hierarchy as a general inductive bias for clinical representation learning. We investigate two complementary mechanisms for incorporating hierarchy: first, by augmenting diagnosis sequences in a BERT-style transformer with tokens corresponding to different levels of the ICD hierarchy, and second, by injecting hierarchy into graph-based code representations through hierarchy-aware edges combined with diagnosis co-occurrence structure. Across these settings, we evaluate whether explicit hierarchy improves downstream prediction, which levels of the hierarchy are most useful, whether hierarchy encoding improves transfer across datasets, and how hierarchy reshapes embedding similarity structure. We conduct experiments on two large-scale real-world clinical datasets: MIMIC-IV, used for pretraining and in-domain evaluation, and eICU, used to assess cross-dataset transfer via frozen encoder probing. Our findings show that explicitly encoding ICD hierarchy improves over flat code representations in both in-domain and cross-dataset settings, while revealing that the most useful level of hierarchy depends on both the task and the modeling approach. More broadly, we focus on hierarchy-aware EHR representation learning and show that the benefits of encoding hierarchy are generalizable across modeling settings and hierarchy levels.

20.
arXiv (CS.AI) 2026-06-18

The Long Delay to Arithmetic Generalization: When Learned Representations Outrun Behavior

arXiv:2604.13082v2 Announce Type: replace-cross Abstract: Grokking in transformers trained on algorithmic tasks is characterized by a long delay between training-set fit and abrupt generalization, but the source of that delay remains poorly understood. In encoder-decoder arithmetic models, we argue that this delay reflects limited access to already learned structure rather than failure to acquire that structure in the first place. We study one-step Collatz prediction and find that the encoder organizes parity and residue structure within the first few thousand training steps, while output accuracy remains near chance for tens of thousands more. Causal interventions support the decoder bottleneck hypothesis. Transplanting a trained encoder into a fresh model accelerates grokking by 2.75 times, while transplanting a trained decoder actively hurts. Freezing a converged encoder and retraining only the decoder eliminates the plateau entirely and yields 97.6% accuracy, compared to 86.1% for joint training. What makes the decoder's job harder or easier depends on numeral representation. Across 15 bases, those whose factorization aligns with the Collatz map's arithmetic (e.g., base 24) reach 99.8% accuracy, while binary fails completely because its representations collapse and never recover. The choice of base acts as an inductive bias that controls how much local digit structure the decoder can exploit, producing large differences in learnability from the same underlying task.

21.
arXiv (CS.CV) 2026-06-12

ASTER: Latent Pseudo-Anomaly Generation for Unsupervised Time-Series Anomaly Detection

Time-series anomaly detection (TSAD) is critical in domains such as industrial monitoring, healthcare, and cybersecurity, but it remains challenging due to rare and heterogeneous anomalies and the scarcity of labelled data. This scarcity makes unsupervised approaches predominant, yet existing methods often rely on reconstruction or forecasting, which struggle with complex data, or on embedding-based approaches that require domain-specific anomaly synthesis and fixed distance metrics. We propose ASTER, a framework that generates pseudo-anomalies directly in the latent space, avoiding handcrafted anomaly injections and the need for domain expertise. A latent-space decoder produces tailored pseudo-anomalies to train a Transformer-based anomaly classifier, while a pre-trained LLM enriches the temporal and contextual representations of this space. Experiments on three benchmark datasets show that ASTER achieves state-of-the-art performance and sets a new standard for LLM-based TSAD.

22.
arXiv (CS.AI) 2026-06-11

PROJECTMEM: A Local-First, Event-Sourced Memory and Judgment Layer for AI Coding Agents

arXiv:2606.12329v1 Announce Type: new Abstract: AI coding assistants now support a growing share of software work, from quick scripts to production applications. Yet these agents remain largely stateless: each new session re-reads project files, re-derives prior decisions, and - most costly - may repeat debugging attempts that already failed. Reconstructing this context can consume an estimated 5,000-20,000 tokens per session; the bottleneck is often not model capability but missing project memory. We present projectmem, an open-source, local-first memory and judgment layer for AI coding agents. projectmem records development as an append-only, plain-text event log of typed events - issues, attempts, fixes, decisions, and notes - and deterministically projects that log into compact, AI-readable summaries served through the Model Context Protocol (MCP). Beyond storage, projectmem adds a deterministic pre-action gate that warns an agent before it repeats a previously failed fix or edits a known-fragile file. We frame this as Memory-as-Governance: memory that does not merely answer the agent but acts on its next action. The system runs fully offline with no telemetry; its immutable log also serves as a provenance trail for reproducible, auditable AI-assisted development. projectmem ships as a three-dependency Python package (14 MCP tools, 19 CLI commands, 37 automated tests) and is evaluated through a two-month self-study across 10 projects comprising 207 logged events. Source code: https://github.com/riponcm/projectmem.

23.
arXiv (CS.AI) 2026-06-24

Sol Video Inference Engine: Agent-Native Full-Stack Acceleration Framework for Efficient Video Generation

arXiv:2606.23743v1 Announce Type: cross Abstract: Modern video diffusion models achieve higher generation quality through scaling, but this also increases inference cost. Although many acceleration methods have been proposed, a central challenge is that the most effective acceleration strategy is highly instance-specific: a recipe that works well for one combination of model, hardware, and inference configuration often does not transfer to another. Different models vary in architecture, numerical sensitivity, and attention concentration patterns. Inference settings differ in spatial and temporal resolution and video duration, while hardware platforms differ in memory hierarchy, supported numerical formats, and kernel throughput. These factors create a large tuning space, making manual performance engineering costly. We present Sol Video Inference Engine, an agentic, native, training-free acceleration framework for video diffusion models. It organizes five broadly applicable techniques, cache, sparse attention, token pruning, quantization, and kernel fusion, into an agentic acceleration stack for instance-specific optimization. For a concrete deployment target defined by a model, hardware platform, and serving configuration, parallel skill agents optimize the implementation of each technique, an agent integrator composes them into a global acceleration stack, and a human validator provides feedback on generation quality. We instantiate this workflow on three video models with different sizes and architectures: 64B Cosmos3-Super, 22B LTX-2.3, and 2B SANA-Video. With little human effort, the full stack achieves more than 2x end-to-end acceleration while maintaining near-lossless VBench quality, demonstrating the effectiveness of the agent framework for video diffusion acceleration.

24.
arXiv (CS.CL) 2026-06-19

Telenor Nordics Customer Service self-help corpus

Authors:

This paper presents a multilingual customer service self-help corpus comprising 1,122 manually validated documents in Finnish, Danish, Norwegian, and Swedish, totaling 274,599 words and 1,884,833 characters. The documents have been sourced from the public self-help pages of four Nordic telecommunications operators and subsequently filtered for person-identifiable information and relevance through a combined LLM and human annotation pipeline. Domain-specific datasets for Nordic languages remain scarce, particularly in customer service: a domain of growing importance for retrieval-augmented generation, cross-lingual transfer learning, and emerging agent-based service architectures. An analysis of the corpus reveals substantial variation in document length and structure across operators, reflecting distinct editorial strategies, as well as broad topical coverage spanning network hardware, mobile services, TV and streaming, billing, and account management. The dataset is publicly available under a CC-BY-NC-SA-4.0 license at https://zenodo.org/records/20732652, intended to support reproducible research in Nordic NLP and information retrieval.

25.
medRxiv (Medicine) 2026-06-22

Multisite Real-World Validation of an Electronic Health Record-Integrated Generative Artificial Intelligence Tool for Venous Thromboembolism Risk Stratification

Background: Guiding risk-appropriate inpatient thromboprophylaxis requires venous thromboembolism (VTE) risk stratification; however, reliable risk determination remains inconsistent in routine care. Health systems increasingly pilot artificial intelligence (AI) tools, yet few studies demonstrate rigorous evaluation in the context of a learning health system (LHS). We evaluated the performance of a pilot electronic health record (EHR)-integrated generative AI (GenAI) system, inHealth General Reasoner (iHGR), for VTE risk stratification versus clinician order set classifications and physician-adjudicated chart review. Methods: This multisite retrospective validation study included adult inpatient admissions at Johns Hopkins Medicine between June 21, 2025, and Dec 18, 2025 (checklist-based order set from June 21, 2025 - November 19, 2025, and clinician judgement-based order set from November 29 - December 18, 2025). From 758 eligible admissions, we randomly sampled 500 balanced by site and order set periods. iHGR and clinician-selected order set classifications were compared with the reference standard (RS). Primary outcomes were iHGR sensitivity and specificity. Secondary analyses compared the order sets with the same RS to evaluate workflow comparators and error patterns. Results: iHGR achieved 81.8% sensitivity (95% CI 77.3-85.6) and 70.9% specificity (63.6-77.3). The checklist-based order set had 61.3% sensitivity (53.7-68.5) and 86.2% specificity (77.4-91.9). The clinician judgement-based order set had 78.1% sensitivity (71.3-83.7) and 65.4% specificity (54.3-75.0). False-negative iHGR classifications were associated with missed narrative risk factors. Conclusion: iHGR showed higher sensitivity for VTE risk than checklist-based order sets and clinician judgement without introducing systematic bias. In silico evaluation of pilot AI systems within LHSs can identify clinically important performance trade-offs and implementation targets before operational scale-up. Narrative clinical data abstraction remained a key limitation, supporting the use of GenAI to support rather than supplant clinician judgement.