PreprintCited by 26Artificial Intelligence in Healthcare and EducationMachine Learning in HealthcareTopic Modeling

Automating Evaluation of AI Text Generation in Healthcare with a Large Language Model (LLM)-as-a-Judge

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Croxford, Emma, Gao, Yanjun, First, Elliot, Pellegrino, Nicholas, Schnier, Miranda, Caskey, John, Oguss, Madeline, Wills, Graham +9 more·2025·medRxiv

Abstract

Electronic Health Records (EHRs) store vast amounts of clinical information that are difficult for healthcare providers to summarize and synthesize relevant details to their practice. To reduce cognitive load on providers, generative AI with Large Language Models have emerged to automatically summarize patient records into clear, actionable insights and offload the cognitive burden for providers. However, LLM summaries need to be precise and free from errors, making evaluations on the quality of the summaries necessary. While human experts are the gold standard for evaluations, their involvement is time-consuming and costly. Therefore, we introduce and validate an automated method for evaluating real-world EHR multi-document summaries using an LLM as the evaluator, referred to as LLM-as-a-Judge. Benchmarking against the validated Provider Documentation Summarization Quality Instrument (PDSQI)-9 for human evaluation, our LLM-as-a-Judge framework demonstrated strong inter-rater reliability with human evaluators. GPT-o3-mini achieved the highest intraclass correlation coefficient of 0.818 (95% CI 0.772, 0.854), with a median score difference of 0 from human evaluators, and completes evaluations in just 22 seconds. Overall, the reasoning models excelled in inter-rater reliability, particularly in evaluations that require advanced reasoning and domain expertise, outperforming non-reasoning models, those trained on the task, and multi-agent workflows. Cross-task validation on the Problem Summarization task similarly confirmed high reliability. By automating high-quality evaluations, medical LLM-as-a-Judge offers a scalable, efficient solution to rapidly identify accurate and safe AI-generated summaries in healthcare settings.

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Crossref · 10.1101/2025.04.22.25326219

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  • Only a few studies report high consistency between LLM-as-a-judge and expert outputs that overall met the researchers' needs.

    “However, only a few studies report high consistency between LLM-as-a-judge and expert outputs that overall met the researchers’ needs [22,23].”

    From Evaluating Medical Text Summaries Using Automatic Evaluation Metrics and LLM-as-a-Judge Approach: A Pilot Study (2025) · cites this paper as [23]

    The Results (Single LLM Framework; page unavailable) report high agreement between one LLM-as-a-Judge configuration and human evaluators (ICC 0.818), and the Discussion describes strong inter-rater reliability for clinical summaries. The Introduction says performance data are limited in the medical domain, but the paper does not establish that only a few studies overall achieved high consistency or that their results met their researchers’ needs. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 2

  1. [15]Xiong W. Effective Long-Context Scaling of Foundation Models en. in Proceedings of the 2024 Conference of the North American Chapter of the Association for Computational Linguistics: Human Language Technologies (Volume 1: Long Papers) (Association for Computational Linguistics, Mexico City, Mexico, 2024), 4643– 4663. https://aclanthology.org/2024.naacl-long.260.
  2. [41]Akiba T., Sano S., Yanase T., Ohta T. & Koyama M. Optuna: A Next-Generation Hyperparameter Optimization Framework in The 25th ACM SIGKDD International Conference on Knowledge Discovery & Data Mining (2019), 2623– 2631.

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Authors
Croxford, E., Gao, Y., First, E., Pellegrino, N., Schnier, M., Caskey, J., Oguss, M., Wills, G., Chen, G., Dligach, D., Churpek, M. M., Mayampurath, A., Liao, F., Goswami, C., Wong, K. K., Patterson, B. W., & Afshar, M.
Affiliations
  • University of Wisconsin–Madison (US)
  • University of Colorado Anschutz (US)
  • Epic Systems (United States) (US)
  • University of Wisconsin Health (US)
Corresponding author
Afshar, Majid
Venue
medRxiv
Publisher
openRxiv
Published
2025-04-22
OpenAlex
W4409709519
Cited by
25
References
22
Citations by year
2026: 21 · 2025: 4
Type
posted content
Language
en
Open access
Locations
  • medRxiv (acceptedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
Funders
U.S. National Library of Medicine (T15LM007359, R01LM012973, R00LM014308)
Topics
  • Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
  • Physical Sciences › Computer Science › Artificial Intelligence › Machine Learning in Healthcare
  • Physical Sciences › Computer Science › Artificial Intelligence › Topic Modeling
Keywords
LLM-as-a-judge, clinical summarization, electronic health records, multi-document summarization, inter-rater reliability, large language models, GPT-3.5

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