Massive Online Open Validation and Evaluation of Large Language Models for Resource Constrained Settings - a Study of Contextual Awareness, Safety, and Accuracy (SilentMOOVE)
Healthcare settings in low and middle income countries, clinicians are frequently required to manage a wide range of acute conditions under the constraints of time pressure, limited diagnostic resources, and variable availability of up-to-date clinical guidelines. Large language models (LLMs), which can synthesize and generate medical information in a natural language, have been proposed as potential clinical decision support tools. Most evaluations of LLMs in medicine have relied on standardized benchmark examinations or hypothetical case vignettes, often derived from high-income country contexts. MOOVE (Massive online open validation and evaluation) framework was developed to address the need for rigorous and context-sensitive evaluation of LLMs through a staged approach.
Study is a non-interventional, prospective study designed to test LLMs safely in real clinical settings, evaluate their performance against human care, and explore how feasible their future implementation in healthcare might be.
Studieöversikt
Status
Betingelser
Intervention / Behandling
Detaljerad beskrivning
SilentMOOVE (Silent massive online open validation and evaluation) phase of the MOOVE project, which represents the intermediate step between previous hypothetical testing study and future interventional trial. In silentMOOVE, patients are prospectively recruited during routine clinical care in participating outpatient health facilities. Clinical and demographic data collected during consultations are used to prompt LLMs retrospectively without influencing patient care. The routine diagnosis and care plan of the treating clinicians (human care plan) are also captured. LLM outputs are subsequently evaluated by a panel of independent clinical experts against the human care plan as a comparator. Patient clinical outcomes are collected on 7 and 28 days after enrolment to establish a baseline and to be used in the evaluation of LLMs.
The rationale for this study is to generate robust, prospective evidence on the safety and performance of LLMs in real-world clinical contexts, while minimizing risk to participants by fully separating model evaluation from clinical decision-making.
Study also provides the opportunity to assess the usability and gather early insights on implementation readiness of the LLM prompting interface. For this reason, besides evaluating the performance and safety of various LLMs, this study includes an implementation feasibility component. These activities are needed to better understand the context and any amelioration needed before future implementation in healthcare settings. Learnings from the implementation feasibility research will be shared among countries, especially applicable within a given use case. Implementation feasibility research will be grounded in artificial intelligence in healthcare implementation frameworks and other Implementation science frameworks Primary objectives
- To evaluate the overall performance profile of LLMs on real-world clinical scenarios using the human care plan as a comparator
- To assess whether each LLM being evaluated is not inferior to the human comparator with respect to safety on real-world clinical scenarios, based on structured retrospective assessment of model- and human-generated care plans.
Implementation feasibility research objectives
- Assess clinician experience with the LLM prompting interface: ease of use, time burden, and alignment with clinical workflow.
- Gather clinician impressions of LLM output disclosed and reviewed post-consultation: clarity, relevance, perceived safety, alignment with local clinical guidelines, and trust in LLM outputs.
- Facilitators and Barriers to Future Implementation: Identify site-level infrastructure, staff capacity, and organizational readiness factors that may support or hinder future implementation of LLM feedback in real-time
Studietyp
Inskrivning (Beräknad)
Kontakter och platser
Studiekontakt
- Namn: Mary-Anne Hartley
- Telefonnummer: +41216930828
- E-post: mary-anne.hartley@epfl.ch
Studera Kontakt Backup
- Namn: Kristina Keitel
- Telefonnummer: +41216932039
- E-post: Kristina.keitel@epfl.ch
Studieorter
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Nairobi County
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Nairobi, Nairobi County, Kenya, 19676
- Har inte rekryterat ännu
- University of Nairobi College of health sciences
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Kontakt:
- Paul Macharia
- E-post: pmachariah@gmail.com
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Huvudutredare:
- Paul Macharia
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Blantyre
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Blantyre, Blantyre, Malawi, 303
- Rekrytering
- Malawi University of Business and Applied Sciences (MUBAS)
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Kontakt:
- Chiyembekezo Kachimanga
- Telefonnummer: +265 887247777
- E-post: chembekachimanga@yahoo.co.uk
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Huvudutredare:
- Chiyembekezo Kachimanga
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Dar es Salaam Region
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Dar es Salaam, Dar es Salaam Region, Tanzania
- Har inte rekryterat ännu
- Muhimbili University of Health and Allied Sciences (MUHAS)
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Kontakt:
- Hendry R Sawe
- Telefonnummer: +255754885658
- E-post: hendry_sawe@yahoo.com
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Huvudutredare:
- Hendry R Sawe
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Dodoma
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Dodoma, Dodoma, Tanzania
- Rekrytering
- Ifakara Health Institute (IHI)
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Kontakt:
- Grace Mhalu
- Telefonnummer: +255655888891
- E-post: gmhalu@ihi.or.tz
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Huvudutredare:
- Grace Mhalu
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Deltagandekriterier
Urvalskriterier
Åldrar som är berättigade till studier
Tar emot friska volontärer
Kön som är behöriga för studier
Testmetod
Studera befolkning
The study population consists of patients of any age presenting to participating health facilities for a distinct care-seeking episode related to a clinical condition within the defined use case (e.g. primary care, emergency care).
Both adult and pediatric patients are eligible, reflecting the real-world case mix of the participating facilities.
Beskrivning
Inclusion Criteria:
- Presentation at a participating facility for a distinct care seeking episode related to a clinical condition.
- Use case specific inclusion criteria
- Willing and able to provide written informed consent.
Exclusion Criteria:
- Prolonged care-seeking episode.
- Previously enrolled in the same study.
- Use case specific exclusion criteria
- Immediate life-threatening condition requiring emergency intervention precluding study procedures.
Studieplan
Hur är studien utformad?
Designdetaljer
- Observationsmodeller: COHORT
- Tidsperspektiv: PROSPECTIVE
Kohorter och interventioner
Grupp / Kohort |
Intervention / Behandling |
|---|---|
|
Non interventional study
Non interventional study |
Non interventional study |
Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
|
Performance Scores
Tidsram: Day 0
|
Scoring is between -2 to +2 where '-2' means minimum, and '-2' means maximum. Score to be >0. Higher score means better outcome. |
Day 0
|
|
Safety performance threshold achievement
Tidsram: 'Day 7' and 'Day 28'
|
The mean safety score (minimum is -2 and maximum is +2) is formally compared between each LLM and the human comparator to assess non-inferiority within a UCA (use case appendix) dependent pre-specified margin. |
'Day 7' and 'Day 28'
|
Sekundära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
|
Implementation Feasibility Research
Tidsram: week 4 until study completion
|
Usability: Quantitative scoring rubric for clinicians; semi-structured interviews with clinicians; evaluation methods will be used |
week 4 until study completion
|
|
Implementation Feasibility Research
Tidsram: week 4 until study completion
|
Workflow integration feasibility: This will be evaluated using semi structured interviews and questionnaires |
week 4 until study completion
|
|
Implementation Feasibility Research
Tidsram: week 4 until study completion
|
Acceptability and perceived trust: This will be evaluated with Quantitative scoring rubric for clinicians; semi-structured interviews with clinicians |
week 4 until study completion
|
|
Implementation Feasibility Research
Tidsram: week 4 until study completion
|
Implementation facilitators and barriers: This will be evaluated using semi-structured interviews and questionnaires |
week 4 until study completion
|
Samarbetspartners och utredare
Samarbetspartners
Utredare
- Huvudutredare: Mary-Anne Hartley, LIGHT
Publikationer och användbara länkar
Allmänna publikationer
- 1. Arora RK, Wei J, Hicks RS, Bowman P, et al. HealthBench: Evaluating Large Language Models Towards Improved Human Health. Preprint [Under Review]. 2025. 2. Burnell R, Schellaert W, Burden J, Ullman TD, Martinez-Plumed F, Tenenbaum JB, et al. Rethink reporting of evaluation results in AI. Science. 2023;380: 136-138. doi:10.1126/SCIENCE.ADF6369. 3. Hager P, Jungmann F, Holland R, Bhagat K, Hubrecht I, Knauer M, et al. Evaluation and mitigation of the limitations of large language models in clinical decision-making. Nature Medicine 2024 30:9. 2024;30: 2613-2622. doi:10.1038/s41591-024-03097-1. 4. Singhal, K., Azizi, S., Tu, T., Mahdavi, S. S., Wei, J., Chung, H. W., et al. (2023). Large language models encode clinical knowledge. Nature, 620(7972), 172-180. https://doi.org/10.1038/s41586-023-06291-2 5. WHO. Towards the Development of guidance on ethics and governance of artificial intelligence for health. 2019. 6. Azad TD, Krumholz HM, Saria S. Principles to guide clinical AI readiness and move from benchmarks to real-world evaluation. Nature Medicine. 2026;32:802-804. doi:10.1038/s41591-025-04198-1 7. Declaration of Helsinki https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects 8. European Parliament and Council of the European Union, 2016. Regulation (EU) 2016/679 (General Data Protection Regulation). Official Journal of the European Union, L119, pp.1-88. 9. International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH), 2016. Integrated Addendum to ICH E6(R1): Guideline for Good Clinical Practice E6(R2). Step 4, 9 November 2016. 10. U.S. Food and Drug Administration. 21 CFR Part 11-Electronic Records; Electronic Signatures. Code of Federal Regulations. Title 21, Part 11. Revised 2024.
Studieavstämningsdatum
Studera stora datum
Studiestart (Faktisk)
Primärt slutförande (Beräknad)
Avslutad studie (Beräknad)
Studieregistreringsdatum
Först inskickad
Först inskickad som uppfyllde QC-kriterierna
Första postat (Faktisk)
Uppdateringar av studier
Senaste uppdatering publicerad (Faktisk)
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
Senast verifierad
Mer information
Termer relaterade till denna studie
Nyckelord
Andra studie-ID-nummer
- LiGHT-26-02
- INV-076674 (Annat bidrag/finansieringsnummer: BILL and Melinda gates foundation)
Plan för individuella deltagardata (IPD)
Planerar du att dela individuella deltagardata (IPD)?
IPD-planbeskrivning
We will share IPD within 12 months of study completion.
Tidsram för IPD-delning
IPD information will be shared within 12 months of study completion.
Kriterier för IPD Sharing Access
Will be confirmed within 12 months of study completion
IPD-delning som stöder informationstyp
- STUDY_PROTOCOL
Läkemedels- och apparatinformation, studiedokument
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