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This article details the architecture and methodology behind Foresight-E, a 243-million-parameter transformer decoder trained on NHS England's electronic health records to predict medical events during the pandemic. Although quantitative results are currently unavailable due to paused data access, the study offers significant value as a methodological template for building population-scale generative foundation models in healthcare settings. The work highlights critical challenges and strategies relevant to researchers developing large language models specifically designed for longitudinal clinical data analysis.
Foresight-England: Development of a National-Scale Generative AI Model of Electronic Health Records for Medical Event Prediction across the COVID-19 Pandemic
arXiv:2608.16273v1 Announce Type: new Abstract: Foresight-England (Foresight-E) is the first national-scale generative foundation model of electronic health records (EHRs), developed as a research pilot strictly for COVID-19 research. We evaluated its ability to model the direct and indirect effects of the pandemic. Trained from scratch entirely within the NHS England Secure Data Environment, Foresight-E is a 243-million-parameter transformer decoder. It was trained and evaluated on de-identified, longitudinal EHRs of approximately 61 million individuals, integrating primary/secondary care, death registrations, and COVID-19 data. Training and validation used a 90% subset (54.9 million) spanning November 2018 to December 2022; the remaining 10% (6.1 million) was held out for evaluation. Foresight-E models patient timelines autoregressively, predicting the next medical event given their prior history. At inference, it operates zero-shot, predicting any concept in its ~40,000-code vocabulary without task-specific training. Our tokenisation scheme retains the clinical granularity of ICD-10, OPCS-4, and SNOMED CT codes, jointly representing absolute and relative timing. We designed an evaluation framework for 30-day COVID-19 hospitalisation and mortality, including subgroup analyses by demographic factors and vaccination status. To assess generalisation to unseen future data and the pandemic's indirect effects, we tested the model on medical events from 2023 (beyond its training period), benchmarking against logistic regression and XGBoost. As detailed in the Project Status section, NHS England has paused access to data for the Foresight-E project, meaning quantitative results are currently unavailable. Instead, we share our strategy for tokenisation, architecture, training, inference, and evaluation as a methodological template and case study in the challenges of building population-scale EHR foundation models.
Abstract:Foresight-England (Foresight-E) is the first national-scale generative foundation model of electronic health records (EHRs), developed as a research pilot strictly for COVID-19 research. We evaluated its ability to model the direct and indirect effects of the pandemic. Trained from scratch entirely within the NHS England Secure Data Environment, Foresight-E is a 243-million-parameter transformer decoder. It was trained and evaluated on de-identified, longitudinal EHRs of approximately 61 million individuals, integrating primary/secondary care, death registrations, and COVID-19 data. Training and validation used a 90% subset (54.9 million) spanning November 2018 to December 2022; the remaining 10% (6.1 million) was held out for evaluation. Foresight-E models patient timelines autoregressively, predicting the next medical event given their prior history. At inference, it operates zero-shot, predicting any concept in its ~40,000-code vocabulary without task-specific training. Our tokenisation scheme retains the clinical granularity of ICD-10, OPCS-4, and SNOMED CT codes, jointly representing absolute and relative timing. We designed an evaluation framework for 30-day COVID-19 hospitalisation and mortality, including subgroup analyses by demographic factors and vaccination status. To assess generalisation to unseen future data and the pandemic's indirect effects, we tested the model on medical events from 2023 (beyond its training period), benchmarking against logistic regression and XGBoost. As detailed in the Project Status section, NHS England has paused access to data for the Foresight-E project, meaning quantitative results are currently unavailable. Instead, we share our strategy for tokenisation, architecture, training, inference, and evaluation as a methodological template and case study in the challenges of building population-scale EHR foundation models.
Methodology and evaluation framework for Foresight-England. As detailed in the Project Status section, NHS England has paused access to data for the Foresight-E project, meaning quantitative results are not currently available. On behalf of the CVD-COVID-UK/COVID-IMPACT Consortium
Machine Learning (cs.LG); Artificial Intelligence (cs.AI)
arXiv:2608.16273 [cs.LG]
(or arXiv:2608.16273v1 [cs.LG] for this version)
https://doi.org/10.48550/arXiv.2608.16273 arXiv-issued DOI via DataCite (pending registration)
Full text under the publisher's open licence · 311 words
