AI and large language models can recover clinically meaningful features from electronic health records (EHRs), but predictive usefulness does not establish admissibility for causal inference. We introduce information set emulation: an AI typed lift attaches source evidence, clinical and recording times, decision-time availability, representation version, proposed causal roles, and unresolved ambiguity to extracted features under a locked target trial. Causal certificates record auditable evidence for those roles. Features with unresolved downstream roles are routed to compatible reporting or separate analyses. Typed evidence defines an observational fiber of causal worlds consistent with the observed law. The locked scalar estimand maps this fiber to a compatible image whose squared Chebyshev radius equals the residual minimax mean squared error when the image is nonempty and compact. This classical identity provides a target-specific measure of information ambiguity. The contribution is its integration with a joint EHR observation map and an auditable certificate architecture. Under explicit exchangeability, positivity, and nuisance-consistency conditions, we give identification and cross-fitted augmented inverse probability weighted estimation, distinguishing empirical and population targets. An EHR compression-drift identity separates the roles of frame presence, treatment assignment, and outcome observation. Artificial simulations and a common-law finite-world example illustrate estimation failures and information-radius reduction. Synthetic Phase 0 notes demonstrate audit diagnostics; a separate role-specific analysis spread illustrates routing and is not an exact fiber radius. All experiments are synthetic. The framework specifies when reconstructed information can support a point claim and when compatible reporting is required.
Feature engineering for Electronic Health Records (EHR) is complicated by irregular observation intervals, variable measurement frequencies, and structural sparsity inherent to clinical time series. Existing automated methods either lack clinical domain awareness or assume clean, regularly sampled inputs, limiting their applicability to real-world EHR data. We present \textbf{FeatEHR-LLM}, a framework that leverages Large Language Models (LLMs) to generate clinically meaningful tabular features from irregularly sampled EHR time series. To limit patient privacy exposure, the LLM operates exclusively on dataset schemas and task descriptions rather than raw patient records. A tool-augmented generation mechanism equips the LLM with specialized routines for querying irregular temporal data, enabling it to produce executable feature-extraction code that explicitly handles uneven observation patterns and informative sparsity. FeatEHR-LLM supports both univariate and multivariate feature generation through an iterative, validation-in-the-loop pipeline. Evaluated on eight clinical prediction tasks across four ICU datasets, our framework achieves the highest mean AUROC on 7 out of 8 tasks, with improvements of up to 6 percentage points over strong baselines. Code is available at github.com/hojjatkarami/FeatEHR-LLM.
Hojjat Karami, David Atienza, Jean-Philippe Thiran +1
Causal inference has traditionally centered on scalar outcomes: whether a patient recovers, how much a worker earns, or how many visits a website receives. Modern studies increasingly ask causal questions about outcomes with richer form, such as clinical notes, open-ended survey responses, and images. A hospital may want to know how an AI documentation tool changes the notes physicians write, or how a nurse training program alters what patients say in survey responses. For such outcomes, the usual average treatment effect is ill-defined: one cannot meaningfully subtract one text or image from another. To this end, we propose a causal query for unstructured outcomes. The key idea is to learn what features of the outcome are most causally affected by the treatment, which we call the maximally contrasting feature (MCF). To estimate the MCF, we learn a feature-scoring function that maps each outcome to a scalar and exposes the sharpest contrast between treated and control potential outcomes. We develop identification conditions and estimation algorithms for this query, and extend it to heterogeneous effects by allowing the feature-scoring function to depend on observed covariates. We also handle settings where both the treatment and the outcome are unstructured. Empirical studies on text and images show that the algorithm recovers salient aspects of an outcome changed by a treatment.
Longitudinal electronic health records (EHRs) capture years of patient history across notes, codes, labs, and procedures, and contain evidence needed to reason about likely clinical outcomes. However, comprehensive clinician review of these records is impractical, and LLM-based processing is costly and often unreliable, missing some relevant observations while hallucinating others. We therefore propose EviGen, a three-layer framework for verifiable clinical rationale generation that addresses these challenges. The first layer is a patient-conditioned retriever that uses learnable queries to find evidence predictive of, not just textually relevant to, a clinical outcome and ranks it by prediction attribution scores. The second layer is an LLM generator that consumes this ranked evidence as a scaffold to produce a clinical rationale grounded in the retrieved spans. The third layer is a process-supervised verifier that checks the generated rationale at the reasoning-step level, flagging unreliable claims. Across three medical prediction datasets, EviGen improves prediction performance and rationale faithfulness over full-context LLM and RAG baselines, and is preferred by clinical reviewers in a usability evaluation.