Will large language models transform clinical prediction?

objectiveLarge language models (LLMs) are attracting increasing interest in healthcare. This commentary evaluates the potential of LLMs to improve clinical prediction models (CPMs) for diagnostic and prognostic tasks, with a focus on their ability to process longitudinal electronic health record (EHR) data.

findingsLLMs show promise in handling multimodal and longitudinal EHR data and can support multi-outcome predictions for diverse health conditions. However, methodological, validation, infrastructural, and regulatory challenges remain. These include inadequate methods for time-to-event modelling, poor calibration of predictions, limited external validation, and bias affecting underrepresented groups. High infrastructure costs and the absence of clear regulatory frameworks further prevent adoption. IMPLICATIONS: Further work and interdisciplinary collaboration are needed to support equitable and effective integration into the clinical prediction. Developing temporally aware, fair, and explainable models should be a priority focus for transforming clinical prediction workflow.