Scaling Wearable Foundation Models

Wearable sensors have become ubiquitous thanks to a variety of health tracking features. The resulting continuous and longitudinal measurements from everyday life generate large volumes of data; however, making sense of these observations for scientific and actionable insights is non-trivial. Inspired by the empirical success of generative modeling, where large neural networks learn powerful representations from vast amounts of text, image, video, or audio data, we investigate the scaling properties of sensor foundation models across compute, data, and model size. Using a dataset of up to 40 million hours of in-situ heart rate, heart rate variability, electrodermal activity, accelerometer, skin temperature, and altimeter per-minute data from over 165,000 people, we create LSM, a multimodal foundation model built on the largest wearable-signals dataset with the most extensive range of sensor modalities to date. Our results establish the scaling laws of LSM for tasks such as imputation, interpolation and extrapolation, both across time and sensor modalities. Moreover, we highlight how LSM enables sample-efficient downstream learning for tasks like exercise and activity recognition.

IRIS: Wireless Ring for Vision-based Smart Home Interaction

Integrating cameras into wireless smart rings has been challenging due to size and power constraints. We introduce IRIS, the first wireless vision-enabled smart ring system for smart home interactions. Equipped with a camera, Bluetooth radio, inertial measurement unit (IMU), and an onboard battery, IRIS meets the small size, weight, and power (SWaP) requirements for ring devices. IRIS is context-aware, adapting its gesture set to the detected device, and can last for 16-24 hours on a single charge. IRIS leverages the scene semantics to achieve instance-level device recognition. In a study involving 23 participants, IRIS consistently outpaced voice commands, with a higher proportion of participants expressing a preference for IRIS over voice commands regarding toggling a device's state, granular control, and social acceptability. Our work pushes the boundary of what is possible with ring form-factor devices, addressing system challenges and opening up novel interaction capabilities.

Soli-enabled Noncontact Heart Rate Detection for Sleep and Meditation Tracking

Heart rate (HR) is a crucial physiological signal that can be used to monitor health and fitness. Traditional methods for measuring HR require wearable devices, which can be inconvenient or uncomfortable, especially during sleep and meditation. Noncontact HR detection methods employing microwave radar can be a promising alternative. However, the existing approaches in the literature usually use high-gain antennas and require the sensor to face the user's chest or back, making them difficult to integrate into a portable device and unsuitable for sleep and meditation tracking applications. This study presents a novel approach for noncontact HR detection using a miniaturized Soli radar chip embedded in a portable device (Google Nest Hub). The chip has a $6.5 \mbox{ mm} \times 5 \mbox{ mm} \times 0.9 \mbox{ mm}$ dimension and can be easily integrated into various devices. The proposed approach utilizes advanced signal processing and machine learning techniques to extract HRs from radar signals. The approach is validated on a sleep dataset (62 users, 498 hours) and a meditation dataset (114 users, 1131 minutes). The approach achieves a mean absolute error (MAE) of $1.69$ bpm and a mean absolute percentage error (MAPE) of $2.67\%$ on the sleep dataset. On the meditation dataset, the approach achieves an MAE of $1.05$ bpm and a MAPE of $1.56\%$. The recall rates for the two datasets are $88.53\%$ and $98.16\%$, respectively. This study represents the first application of the noncontact HR detection technology to sleep and meditation tracking, offering a promising alternative to wearable devices for HR monitoring during sleep and meditation.

Transforming Wearable Data into Health Insights using Large Language Model Agents

Despite the proliferation of wearable health trackers and the importance of sleep and exercise to health, deriving actionable personalized insights from wearable data remains a challenge because doing so requires non-trivial open-ended analysis of these data. The recent rise of large language model (LLM) agents, which can use tools to reason about and interact with the world, presents a promising opportunity to enable such personalized analysis at scale. Yet, the application of LLM agents in analyzing personal health is still largely untapped. In this paper, we introduce the Personal Health Insights Agent (PHIA), an agent system that leverages state-of-the-art code generation and information retrieval tools to analyze and interpret behavioral health data from wearables. We curate two benchmark question-answering datasets of over 4000 health insights questions. Based on 650 hours of human and expert evaluation we find that PHIA can accurately address over 84% of factual numerical questions and more than 83% of crowd-sourced open-ended questions. This work has implications for advancing behavioral health across the population, potentially enabling individuals to interpret their own wearable data, and paving the way for a new era of accessible, personalized wellness regimens that are informed by data-driven insights.

Towards a Personal Health Large Language Model

In health, most large language model (LLM) research has focused on clinical tasks. However, mobile and wearable devices, which are rarely integrated into such tasks, provide rich, longitudinal data for personal health monitoring. Here we present Personal Health Large Language Model (PH-LLM), fine-tuned from Gemini for understanding and reasoning over numerical time-series personal health data. We created and curated three datasets that test 1) production of personalized insights and recommendations from sleep patterns, physical activity, and physiological responses, 2) expert domain knowledge, and 3) prediction of self-reported sleep outcomes. For the first task we designed 857 case studies in collaboration with domain experts to assess real-world scenarios in sleep and fitness. Through comprehensive evaluation of domain-specific rubrics, we observed that Gemini Ultra 1.0 and PH-LLM are not statistically different from expert performance in fitness and, while experts remain superior for sleep, fine-tuning PH-LLM provided significant improvements in using relevant domain knowledge and personalizing information for sleep insights. We evaluated PH-LLM domain knowledge using multiple choice sleep medicine and fitness examinations. PH-LLM achieved 79% on sleep and 88% on fitness, exceeding average scores from a sample of human experts. Finally, we trained PH-LLM to predict self-reported sleep quality outcomes from textual and multimodal encoding representations of wearable data, and demonstrate that multimodal encoding is required to match performance of specialized discriminative models. Although further development and evaluation are necessary in the safety-critical personal health domain, these results demonstrate both the broad knowledge and capabilities of Gemini models and the benefit of contextualizing physiological data for personal health applications as done with PH-LLM.

LabelAId: Just-in-time AI Interventions for Improving Human Labeling Quality and Domain Knowledge in Crowdsourcing Systems

Crowdsourcing platforms have transformed distributed problem-solving, yet quality control remains a persistent challenge. Traditional quality control measures, such as prescreening workers and refining instructions, often focus solely on optimizing economic output. This paper explores just-in-time AI interventions to enhance both labeling quality and domain-specific knowledge among crowdworkers. We introduce LabelAId, an advanced inference model combining Programmatic Weak Supervision (PWS) with FT-Transformers to infer label correctness based on user behavior and domain knowledge. Our technical evaluation shows that our LabelAId pipeline consistently outperforms state-of-the-art ML baselines, improving mistake inference accuracy by 36.7% with 50 downstream samples. We then implemented LabelAId into Project Sidewalk, an open-source crowdsourcing platform for urban accessibility. A between-subjects study with 34 participants demonstrates that LabelAId significantly enhances label precision without compromising efficiency while also increasing labeler confidence. We discuss LabelAId's success factors, limitations, and its generalizability to other crowdsourced science domains.

HeAR -- Health Acoustic Representations

Health acoustic sounds such as coughs and breaths are known to contain useful health signals with significant potential for monitoring health and disease, yet are underexplored in the medical machine learning community. The existing deep learning systems for health acoustics are often narrowly trained and evaluated on a single task, which is limited by data and may hinder generalization to other tasks. To mitigate these gaps, we develop HeAR, a scalable self-supervised learning-based deep learning system using masked autoencoders trained on a large dataset of 313 million two-second long audio clips. Through linear probes, we establish HeAR as a state-of-the-art health audio embedding model on a benchmark of 33 health acoustic tasks across 6 datasets. By introducing this work, we hope to enable and accelerate further health acoustics research.

Demographic Bias of Expert-Level Vision-Language Foundation Models in Medical Imaging

Advances in artificial intelligence (AI) have achieved expert-level performance in medical imaging applications. Notably, self-supervised vision-language foundation models can detect a broad spectrum of pathologies without relying on explicit training annotations. However, it is crucial to ensure that these AI models do not mirror or amplify human biases, thereby disadvantaging historically marginalized groups such as females or Black patients. The manifestation of such biases could systematically delay essential medical care for certain patient subgroups. In this study, we investigate the algorithmic fairness of state-of-the-art vision-language foundation models in chest X-ray diagnosis across five globally-sourced datasets. Our findings reveal that compared to board-certified radiologists, these foundation models consistently underdiagnose marginalized groups, with even higher rates seen in intersectional subgroups, such as Black female patients. Such demographic biases present over a wide range of pathologies and demographic attributes. Further analysis of the model embedding uncovers its significant encoding of demographic information. Deploying AI systems with these biases in medical imaging can intensify pre-existing care disparities, posing potential challenges to equitable healthcare access and raising ethical questions about their clinical application.

Towards Accurate Differential Diagnosis with Large Language Models

An accurate differential diagnosis (DDx) is a cornerstone of medical care, often reached through an iterative process of interpretation that combines clinical history, physical examination, investigations and procedures. Interactive interfaces powered by Large Language Models (LLMs) present new opportunities to both assist and automate aspects of this process. In this study, we introduce an LLM optimized for diagnostic reasoning, and evaluate its ability to generate a DDx alone or as an aid to clinicians. 20 clinicians evaluated 302 challenging, real-world medical cases sourced from the New England Journal of Medicine (NEJM) case reports. Each case report was read by two clinicians, who were randomized to one of two assistive conditions: either assistance from search engines and standard medical resources, or LLM assistance in addition to these tools. All clinicians provided a baseline, unassisted DDx prior to using the respective assistive tools. Our LLM for DDx exhibited standalone performance that exceeded that of unassisted clinicians (top-10 accuracy 59.1% vs 33.6%, [p = 0.04]). Comparing the two assisted study arms, the DDx quality score was higher for clinicians assisted by our LLM (top-10 accuracy 51.7%) compared to clinicians without its assistance (36.1%) (McNemar's Test: 45.7, p < 0.01) and clinicians with search (44.4%) (4.75, p = 0.03). Further, clinicians assisted by our LLM arrived at more comprehensive differential lists than those without its assistance. Our study suggests that our LLM for DDx has potential to improve clinicians' diagnostic reasoning and accuracy in challenging cases, meriting further real-world evaluation for its ability to empower physicians and widen patients' access to specialist-level expertise.

From Classification to Clinical Insights: Towards Analyzing and Reasoning About Mobile and Behavioral Health Data With Large Language Models

Passively collected behavioral health data from ubiquitous sensors holds significant promise to provide mental health professionals insights from patient's daily lives; however, developing analysis tools to use this data in clinical practice requires addressing challenges of generalization across devices and weak or ambiguous correlations between the measured signals and an individual's mental health. To address these challenges, we take a novel approach that leverages large language models (LLMs) to synthesize clinically useful insights from multi-sensor data. We develop chain of thought prompting methods that use LLMs to generate reasoning about how trends in data such as step count and sleep relate to conditions like depression and anxiety. We first demonstrate binary depression classification with LLMs achieving accuracies of 61.1% which exceed the state of the art. While it is not robust for clinical use, this leads us to our key finding: even more impactful and valued than classification is a new human-AI collaboration approach in which clinician experts interactively query these tools and combine their domain expertise and context about the patient with AI generated reasoning to support clinical decision-making. We find models like GPT-4 correctly reference numerical data 75% of the time, and clinician participants express strong interest in using this approach to interpret self-tracking data.