Bridging the Reproducibility Divide: Open Source Software's Role in Standardizing Healthcare AI

The reproducibility crisis has directed the AI research community toward improving documentation practices. Several studies have identified methodological issues, and in response, the most impactful venues in the field have introduced reproducibility checklists. We seek to understand whether documentation practices have changed over time by assessing all published papers at five leading AI conferences over the past decade. Seven reproducibility variables were identified, quality-assured and used to analyse 56 800 publications. Our analysis reveals that in the period 2014 to 2024, documentation practices have improved; papers sharing both code and data increased nearly sixfold, from 11% to 64% Building on empirical reproducibility rates from a prior study, we estimate - inferred from documentation practices, not direct testing - that reproducibility increased from 28% in 2014 to 64% in 2024. Improvements in documentation practices predate the introduction of reproducibility checklists, suggesting these changes reflect a broader movement toward open science rather than a direct response to formal requirements.

Analytical code is essential for reproducing diagnostic and prognostic prediction model research, yet code availability in the published literature remains limited. While the TRIPOD statements set standards for reporting prediction model methods, they do not define explicit standards for repository structure and documentation. This review quantifies current code-sharing practices to inform the development of TRIPOD-Code, a TRIPOD extension reporting guideline focused on code sharing. We conducted a scoping review of PubMed-indexed articles citing TRIPOD or TRIPOD+AI as of Aug 11, 2025, restricted to studies retrievable via the PubMed Central Open Access API. Eligible studies developed, updated, or validated multivariable prediction models. A large language model-assisted pipeline was developed to screen articles and extract code availability statements and repository links. Repositories were assessed with the same LLM against 14 predefined reproducibility-related features. Our code is made publicly available. Among 3,967 eligible articles, 12.2% included code sharing statements. Code sharing increased over time, reaching 15.8% in 2025, and was higher among TRIPOD+AI-citing studies than TRIPOD-citing studies. Sharing prevalence varied widely by journal and country. Repository assessment showed substantial heterogeneity in reproducibility features: most repositories contained a README file (80.5%), but fewer specified dependencies (37.6%; version-constrained 21.6%) or were modular (42.4%). In prediction model research, code sharing remains relatively uncommon, and when shared, often falls short of being reusable. These findings provide an empirical baseline for the TRIPOD-Code extension and underscore the need for clearer expectations beyond code availability, including documentation, dependency specification, licensing, and executable structure.

Healthcare disparities persist across socioeconomic boundaries, often attributed to unequal access to screening, diagnostics, and therapeutics. However, this perspective highlights that critical biases can emerge much earlier, during data collection and research prioritization, long before clinical implementation, particularly in studies focused on molecular and omics data. A vast number of studies focus on collecting omics data, but the demographic information associated with these datasets is often not reported, and when it is reported, it reveals substantial biases. An automated analysis of 4514 PubMed-indexed omics publications from 2015 to 2024, examining reporting across multiple demographic dimensions, reveals limited reporting overall; for example, only 2.7% of studies report ancestry or ethnicity information and geographic origin reporting is limited to 2.5%. Analysis of large-scale datasets commonly used for model training, such as CellxGene and GEO, reveals substantial population bias where European-ancestry data dominates. As biomedical foundation models become central to biomedical discovery with a paradigm in which base models are pretrained on large datasets and reusing them repeatedly for many different downstream tasks, they risk perpetuating or amplifying these early-stage biases, leading to cascading inequities that regulatory interventions cannot fully reverse. We propose a community-wide focus on three foundational principles: Provenance, Openness, and Reliability through Evaluation Transparency. Together, these principles can help make biases and limitations more visible to model developers and users, supporting more informed model development, evaluation, and deployment decisions in biomedical AI.