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Jun 18

A multimodal and temporal foundation model for virtual patient representations at healthcare system scale

Modern medicine generates vast multimodal data across siloed systems, yet no existing model integrates the full breadth and temporal depth of the clinical record into a unified patient representation. We introduce Apollo, a multimodal temporal foundation model trained and evaluated on over three decades of longitudinal hospital records from a major US hospital system, composed of 25 billion records from 7.2 million patients, representing 28 distinct medical modalities and 12 major medical specialties. Apollo learns a unified representation space integrating over 100 thousand unique medical events in our clinical vocabulary as well as images and clinical text. This "atlas of medical concepts" forms a computational substrate for modeling entire patient care journeys comprised of sequences of structured and unstructured events, which are compressed by Apollo into virtual patient representations. To assess the potential of these whole-patient representations, we created 322 prognosis and retrieval tasks from a held-out test set of 1.4 million patients. We demonstrate the generalized clinical forecasting potential of Apollo embeddings, including predicting new disease onset risk up to five years in advance (95 tasks), disease progression (78 tasks), treatment response (59 tasks), risk of treatment-related adverse events (17 tasks), and hospital operations endpoints (12 tasks). Using feature attribution techniques, we show that model predictions align with clinically-interpretable multimodal biomarkers. We evaluate semantic similarity search on 61 retrieval tasks, and moreover demonstrate the potential of Apollo as a multimodal medical search engine using text and image queries. Together, these modeling capabilities establish the foundation for computable medicine, where the full context of patient care becomes accessible to computational reasoning.

  • 11 authors
·
Apr 20

Envision: Benchmarking Unified Understanding & Generation for Causal World Process Insights

Current multimodal models aim to transcend the limitations of single-modality representations by unifying understanding and generation, often using text-to-image (T2I) tasks to calibrate semantic consistency. However, their reliance on static, single-image generation in training and evaluation leads to overfitting to static pattern matching and semantic fusion, while fundamentally hindering their ability to model dynamic processes that unfold over time. To address these constraints, we propose Envision-a causal event progression benchmark for chained text-to-multi-image generation. Grounded in world knowledge and structured by spatiotemporal causality, it reorganizes existing evaluation dimensions and includes 1,000 four-stage prompts spanning six scientific and humanities domains. To transition evaluation from single images to sequential frames and assess whether models truly internalize world knowledge while adhering to causal-temporal constraints, we introduce Envision-Score, a holistic metric integrating multi-dimensional consistency, physicality, and aesthetics. Comprehensive evaluation of 15 models (10 specialized T2I models, 5 unified models) uncovers: specialized T2I models demonstrate proficiency in aesthetic rendering yet lack intrinsic world knowledge. Unified multimodal models bridge this gap, consistently outperforming specialized counterparts in causal narrative coherence. However, even these unified architectures remain subordinate to closed-source models and struggle to overcome the core challenge of spatiotemporal consistency. This demonstrates that a focus on causally-isolated single images impedes multi-frame reasoning and generation, promoting static pattern matching over dynamic world modeling-ultimately limiting world knowledge internalization, generation.

opendatalab OpenDataLab
·
Dec 1, 2025 5

Cost-effectiveness analysis for therapy sequence in advanced cancer: A microsimulation approach with application to metastatic prostate cancer

Purpose. Patients with advanced cancer may undergo multiple lines of treatment, switching therapies as their disease progresses. Motivated by a study of metastatic prostate cancer, we develop a microsimulation framework to study therapy sequence. Methods. We propose a discrete-time state transition model to study two lines of anti-cancer therapy. Based on digitized published progression-free survival (PFS) and overall survival (OS) curves, we infer event types (progression or death), and estimate transition probabilities using cumulative incidence functions with competing risks. Our model incorporates within-patient dependence over time, such that response to first-line therapy informs subsequent event probabilities. Parameters governing the degree of within-patient dependence can be used to calibrate the model-based results to those of a target trial. We demonstrate these methods in a study of two therapy sequences for metastatic prostate cancer, where Docetaxel (DCT) and Abiraterone Acetate (AA) are both appropriate for use in either first or second line treatment. We assess costs, Quality-Adjusted Life Years (QALYs) and Incremental Cost Effectiveness Ratio (ICER) for two treatment strategies: DCT then AA vs AA then DCT. Results. Using digitized survival curves from relevant clinical trials, we identified 8.6-13.9% of PFS times that should be categorized as deaths, allowing for estimation of cumulative incidence functions. Models assuming within-patient independence overestimated OS time, corrected with our calibration approach. Correction resulted in meaningful changes in the difference in QALYs between treatment strategies (0.07 vs 0.15) and the ICER (-\76,836/QALY vs -21,030/QALY). Conclusions. Microsimulation models can be successfully used to study cost-effectiveness of therapy sequences, taking care to account correctly for within-patient dependence.

  • 5 authors
·
Oct 10, 2022