VeriFact: Verifying Facts in LLM-Generated Clinical Text with Electronic Health Records

Methods to ensure factual accuracy of text generated by large language models (LLM) in clinical medicine are lacking. VeriFact is an artificial intelligence system that combines retrieval-augmented generation and LLM-as-a-Judge to verify whether LLM-generated text is factually supported by a patient's medical history based on their electronic health record (EHR). To evaluate this system, we introduce VeriFact-BHC, a new dataset that decomposes Brief Hospital Course narratives from discharge summaries into a set of simple statements with clinician annotations for whether each statement is supported by the patient's EHR clinical notes. Whereas highest agreement between clinicians was 88.5%, VeriFact achieves up to 92.7% agreement when compared to a denoised and adjudicated average human clinican ground truth, suggesting that VeriFact exceeds the average clinician's ability to fact-check text against a patient's medical record. VeriFact may accelerate the development of LLM-based EHR applications by removing current evaluation bottlenecks.

Zero-Shot Clinical Trial Patient Matching with LLMs

Matching patients to clinical trials is a key unsolved challenge in bringing new drugs to market. Today, identifying patients who meet a trial's eligibility criteria is highly manual, taking up to 1 hour per patient. Automated screening is challenging, however, as it requires understanding unstructured clinical text. Large language models (LLMs) offer a promising solution. In this work, we explore their application to trial matching. First, we design an LLM-based system which, given a patient's medical history as unstructured clinical text, evaluates whether that patient meets a set of inclusion criteria (also specified as free text). Our zero-shot system achieves state-of-the-art scores on the n2c2 2018 cohort selection benchmark. Second, we improve the data and cost efficiency of our method by identifying a prompting strategy which matches patients an order of magnitude faster and more cheaply than the status quo, and develop a two-stage retrieval pipeline that reduces the number of tokens processed by up to a third while retaining high performance. Third, we evaluate the interpretability of our system by having clinicians evaluate the natural language justifications generated by the LLM for each eligibility decision, and show that it can output coherent explanations for 97% of its correct decisions and 75% of its incorrect ones. Our results establish the feasibility of using LLMs to accelerate clinical trial operations.