# SHIFT-M3: Pre-fusion Alignment-based Consistency Screening for Multimodal ECG Record Integrity

arXiv: https://arxiv.org/abs/2609.13874 · HTML: https://mlsanity.com/paper/2609.13874/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 13 of its 40 references that are in the map.
- First posted on arXiv 12 Sep 2026.

## Builds on (most cited first, 13 of 13)

- [A Simple Framework for Contrastive Learning of Visual Representations](https://mlsanity.com/paper/2002.05709/) (2020)
- [MiniLM: Deep Self-Attention Distillation for Task-Agnostic Compression of Pre-Trained Transformers](https://mlsanity.com/paper/2002.10957/) (2020)
- [M3-Embedding: Multi-Linguality, Multi-Functionality, Multi-Granularity Text Embeddings Through Self-Knowledge Distillation](https://mlsanity.com/paper/2402.03216/) (2024)
- [Publicly Available Clinical BERT Embeddings](https://mlsanity.com/paper/1904.03323/) (2019)
- [Zero-Shot ECG Classification with Multimodal Learning and Test-time Clinical Knowledge Enhancement](https://mlsanity.com/paper/2403.06659/) (2024)
- [A Multimodal Transformer: Fusing Clinical Notes with Structured EHR Data for Interpretable In-Hospital Mortality Prediction](https://mlsanity.com/paper/2208.10240/) (2022)
- [Style-Aware Radiology Report Generation with RadGraph and Few-Shot Prompting](https://mlsanity.com/paper/2310.17811/) (2023)
- [MEIT: Multimodal Electrocardiogram Instruction Tuning on Large Language Models for Report Generation](https://mlsanity.com/paper/2403.04945/) (2024)
- [Contrasting with Symile: Simple Model-Agnostic Representation Learning for Unlimited Modalities](https://mlsanity.com/paper/2411.01053/) (2024)
- [Controllable Chest X-Ray Report Generation from Longitudinal Representations](https://mlsanity.com/paper/2310.05881/) (2023)
- [From Token to Rhythm: A Multi-Scale Approach for ECG-Language Pretraining](https://mlsanity.com/paper/2506.21803/) (2025)
- [Knowledge-enhanced Multimodal ECG Representation Learning with Arbitrary-Lead Inputs](https://mlsanity.com/paper/2502.17900/) (2025)
- [MEETI: A Multimodal ECG Dataset from MIMIC-IV-ECG with Signals, Images, Features and Interpretations](https://mlsanity.com/paper/2507.15255/) (2025)

## Abstract (arXiv)

Multimodal clinical AI typically assumes that the waveform, report, metadata, and downstream predictions attached to a record belong to the same patient. In practice, linkage failures can silently assemble individually plausible but cross-patient components, creating a safety problem that standard predictive models are not designed to detect. We study this problem as multimodal record integrity triage: given an assembled record, should its modalities be trusted to belong together? We introduce SHIFT-M3, a lightweight text-based pre-fusion screen that measures alignment-based consistency between two separately produced ECG text views: an LLM-generated interpretation and a clinical report summary. On 784,680 MEETI ECG records, SHIFT-M3 achieves 97.6% TPR@5% FPR for full text-view swaps (AUROC 0.996), 90.3% for partial swaps (AUROC 0.974), and 97.7% for label-matched hard negatives (AUROC 0.996) with only 573,569 parameters. Compared with same-dataset lexical baselines, the gains are largest on partial swaps and hard negatives, suggesting that the model is learning more than surface overlap. We also introduce the CMST (Conflict-type Multimodal Stress Test) evaluation taxonomy, a three-seed stability study, a loss ablation, a temporal-tolerance sweep, and a shared-token masking control. The main remaining failure mode is longitudinal ambiguity: at the default operating point, same-patient cross-visit pairs still produce 87.0% Type-II false positives.