health it developers

Abstract: Decision support systems (DSS) assist with clinical decision-making. Little is known, however, about the decision-making process with DSS in clinical practice and the extent to which clinicians consider or rely on the predictions. Studies on human-AI decision-making usually focus on laypeople, simplified decision tasks, or one-shot interactions with prototypes that are not integrated into existing workflows. To gain insights from real-world practice, we conducted an online survey (n=12) and semi-structured interviews (n=10) with clinicians from two different medical cohorts each working with a DSS. Findings show, amongst other things, that the interaction with DSS changes as experience increases, the predictions become more important in complex cases, that decisions are discussed with colleagues, and that workflow integration affects decision-making. Our findings on human, technical, contextual, and organisational factors contribute to a socio-technical perspective on DSS reliance behaviour. We conclude by discussing the implications of our findings for the design of DSS.

Abstract: Clinical oncology documentation records decisive information in free text, where it remains readable but not retrievable at scale, leaving cohort identification dependent on incomplete diagnostic codes or manual review. The current standard, coding individual terms, captures what a document mentions, not what it asserts: meaning lies in how those terms relate to one another. We present a method for deriving queryable knowledge graphs from clinical narratives, conforming to the Extended Grammar of SNOMED CT across multiple ontologies. The method specifies how entities should be annotated and related. It defines five relation classes, each bound to a construction rule that assembles the entities and relations into post-coordinated expressions. A deterministic implementation, UNIGRAPHE, applies those rules to construct knowledge graphs from annotated text. Applied to expert-annotated real-world oncology documentation, UNIGRAPHE reconstructed 5,299 annotations into 2,196 post-coordinated expressions and shows that relation structure is the missing piece to make clinical narrative formally queryable.

Abstract: A skill is a modular package of natural-language instructions, executable scripts, and reference resources that an agent can load at runtime to extend its capabilities for a specific task. Skill-based agent systems therefore enable flexible reuse of third-party capabilities, but the openness of this skill ecosystem also opens up a new attack surface. Prior work has focused on vulnerabilities within individual skills, but little attention has been paid to risks that arise from interactions across skills. In this paper, we introduce skill cascading attacks, a threat paradigm in which a malicious objective is distributed across multiple skills so that each modification looks benign in isolation, yet their combined execution is harmful. For instance, in a prescription-review pipeline, the first skill weakens signals of recently discontinued medications in the extracted history, the second downgrades the severity of any drug interaction tied to them, and the third suppresses the resulting low-priority alert in the final summary, so that a severe drug-interaction warning silently disappears before reaching the physician. To systematically study this safety blind spot, we develop SkillCascade, an automated multi-agent red-teaming framework, and release SkillCascade-Bench, a benchmark of 213 validated cascading test cases across multiple agent systems and domains. Across representative agents (e.g., OpenClaw, Claude Code, Codex) and LLM backbones, cascaded interactions reliably induce harmful behaviors while evading existing per-skill scanners and runtime monitors. Our findings highlight a gap between component-level integrity and system-level safety, and call for defenses that reason over cross-skill interactions rather than individual skills in isolation.

Abstract: Prospective stroke risk stratification in primary care is challenging because early risk signals are distributed across routine biomarkers and unstructured clinical narratives. We propose MedGate-Fusion, a multi-modal gated architecture that integrates transformer-based embeddings of first-encounter narratives with ten routinely recorded risk markers. We used electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Starting from 808,921 encounter-level observations, we constructed a first-encounter cohort and retained 102,736 unique patient records with non-empty narratives and sufficient data to evaluate a five-year stroke outcome. To reduce explicit target leakage from diagnostic mentions in notes, we applied dictionary-based redaction of stroke-related terms prior to semantic encoding.

Abstract: This paper addresses the challenge of making complex healthcare information more accessible through automated Plain Language Adaptation (PLA). PLA aims to simplify technical medical language, bridging a critical gap between the complexity of healthcare texts and patients' reading comprehension. Recent advances in Large Language Models (LLMs), such as GPT and BART, have opened new possibilities for PLA, especially in zero-shot and few-shot learning contexts where task-specific data is limited. In this work, we leverage the capabilities of LLMs such as GPT-4o-mini, Gemini-1.5-pro, and LLaMA for text simplification. Additionally, we incorporate Mixture-of-Agents (MoA) techniques to enhance adaptability and robustness in PLA tasks. Key contributions include a comparative analysis of prompting strategies, finetuning with QLoRA on different LLMs, and the integration of MoA technique. Our findings demonstrate the effectiveness of LLM-driven PLA, showcasing its potential in making healthcare information more comprehensible while preserving essential content.