# Considerations for health care institutions training large language models on electronic health records

arXiv: https://arxiv.org/abs/2309.12339 · HTML: https://mlsanity.com/paper/2309.12339/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 21 of its 36 references that are in the map.
- First posted on arXiv 24 Aug 2023.

## Builds on (most cited first, 21 of 21)

- [Language Models are Few-Shot Learners](https://mlsanity.com/paper/2005.14165/) (2020)
- [Training language models to follow instructions with human feedback](https://mlsanity.com/paper/2203.02155/) (2022)
- [LLaMA: Open and Efficient Foundation Language Models](https://mlsanity.com/paper/2302.13971/) (2023)
- [Llama 2: Open Foundation and Fine-Tuned Chat Models](https://mlsanity.com/paper/2307.09288/) (2023)
- [Scaling Laws for Neural Language Models](https://mlsanity.com/paper/2001.08361/) (2020)
- [QLoRA: Efficient Finetuning of Quantized LLMs](https://mlsanity.com/paper/2305.14314/) (2023)
- [Training Compute-Optimal Large Language Models](https://mlsanity.com/paper/2203.15556/) (2022)
- [The Pile: An 800GB Dataset of Diverse Text for Language Modeling](https://mlsanity.com/paper/2101.00027/) (2020)
- [BLOOM: A 176B-Parameter Open-Access Multilingual Language Model](https://mlsanity.com/paper/2211.05100/) (2022)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [WizardLM: Empowering large pre-trained language models to follow complex instructions](https://mlsanity.com/paper/2304.12244/) (2023)
- [The RefinedWeb Dataset for Falcon LLM: Outperforming Curated Corpora with Web Data, and Web Data Only](https://mlsanity.com/paper/2306.01116/) (2023)
- [Deduplicating Training Data Makes Language Models Better](https://mlsanity.com/paper/2107.06499/) (2021)
- [Documenting Large Webtext Corpora: A Case Study on the Colossal Clean Crawled Corpus](https://mlsanity.com/paper/2104.08758/) (2021)
- [Scaling Data-Constrained Language Models](https://mlsanity.com/paper/2305.16264/) (2023)
- [MedAlpaca -- An Open-Source Collection of Medical Conversational AI Models and Training Data](https://mlsanity.com/paper/2304.08247/) (2023)
- [GatorTron: A Large Clinical Language Model to Unlock Patient Information from Unstructured Electronic Health Records](https://mlsanity.com/paper/2203.03540/) (2022)
- [Scaling Laws and Interpretability of Learning from Repeated Data](https://mlsanity.com/paper/2205.10487/) (2022)
- [Do We Still Need Clinical Language Models?](https://mlsanity.com/paper/2302.08091/) (2023)
- [To Repeat or Not To Repeat: Insights from Scaling LLM under Token-Crisis](https://mlsanity.com/paper/2305.13230/) (2023)
- [LLM-empowered Chatbots for Psychiatrist and Patient Simulation: Application and Evaluation](https://mlsanity.com/paper/2305.13614/) (2023)

## Abstract (arXiv)

Large language models (LLMs) like ChatGPT have excited scientists across fields; in medicine, one source of excitement is the potential applications of LLMs trained on electronic health record (EHR) data. But there are tough questions we must first answer if health care institutions are interested in having LLMs trained on their own data; should they train an LLM from scratch or fine-tune it from an open-source model? For healthcare institutions with a predefined budget, what are the biggest LLMs they can afford? In this study, we take steps towards answering these questions with an analysis on dataset sizes, model sizes, and costs for LLM training using EHR data. This analysis provides a framework for thinking about these questions in terms of data scale, compute scale, and training budgets.