OBJECTIVES: Federated Ecosystems for Analytics and Standardized Technologies (FEAST) is a modular, cloud-based platform developed through the ARPA-H Biomedical Data Fabric initiative to enable secure, federated analysis of real-world biomedical data. To guide and iteratively refine its modular design, the FEAST team conducted a cross-institutional survey to systematically identify and prioritize research needs related to authorized-access data across diverse biomedical domains. This study presents a structured synthesis of submitted use cases to uncover infrastructure gaps, data integration challenges, and translational opportunities. The results from the survey inform both front-end user-facing functionality and backend data requirements, shaping how the interface supports user interactions, data types, and compliance with security and interoperability standards. MATERIALS AND METHODS: A structured survey form was distributed to researchers affiliated with participating institutions, including DNA-HIVE, The George Washington University (GW-FEAST), Weill Cornell Medicine, Vanderbilt University Medical Center, Georgetown University, European Bioinformatics Institute, and Kaiser Permanente. Respondents completed standardized fields describing the data types of interest, project goals, analytic methods, and perceived technical barriers. The collected responses were curated and analyzed to identify common needs related to privacy, interoperability, scalability, and workflow reproducibility. RESULTS: The survey compiled 61 use cases spanning genomics, imaging, clinical phenotyping, EHR-driven analytics, and precision medicine. Common themes included the need for multi-modal data integration, HL7 FHIR-based secure access, federated model training without PII retention, and containerized microservices for scalable deployment. Convergent needs across institutions emphasized consistent demand for FAIR-compliant infrastructure and readiness for real-world data analytics. CONCLUSION: The FEAST Use Cases survey provides a cross-sectional view of biomedical informatics priorities grounded in real-world data needs. The findings offer a strategic blueprint for developing federated, privacy-preserving infrastructure to support secure, collaborative, and scalable biomedical research.

OBJECTIVES: Traditional methods for medical device post-market surveillance often fail to accurately account for operator learning effects, leading to biased assessments of device safety. These methods struggle with non-linearity, complex learning curves, and time-varying covariates, such as physician experience. To address these limitations, we sought to develop a machine learning (ML) framework to detect and adjust for operator learning effects. MATERIALS AND METHODS: A gradient-boosted decision tree ML method was used to analyze synthetic datasets that replicate the complexity of clinical scenarios involving high-risk medical devices. We designed this process to detect learning effects using a risk-adjusted cumulative sum method, quantify the excess adverse event rate attributable to operator inexperience, and adjust for these alongside patient factors in evaluating device safety signals. To maintain integrity, we employed blinding between data generation and analysis teams. Synthetic data used underlying distributions and patient feature correlations based on clinical data from the Department of Veterans Affairs between 2005 and 2012. We generated 2494 synthetic datasets with widely varying characteristics including number of patient features, operators and institutions, and the operator learning form. Each dataset contained a hypothetical study device, Device B, and a reference device, Device A. We evaluated accuracy in identifying learning effects and identifying and estimating the strength of the device safety signal. Our approach also evaluated different clinically relevant thresholds for safety signal detection. RESULTS: Our framework accurately identified the presence or absence of learning effects in 93.6% of datasets and correctly determined device safety signals in 93.4% of cases. The estimated device odds ratios' 95% confidence intervals were accurately aligned with the specified ratios in 94.7% of datasets. In contrast, a comparative model excluding operator learning effects significantly underperformed in detecting device signals and in accuracy. Notably, our framework achieved 100% specificity for clinically relevant safety signal thresholds, although sensitivity varied with the threshold applied. DISCUSSION: A machine learning framework, tailored for the complexities of post-market device evaluation, may provide superior performance compared to standard parametric techniques when operator learning is present. CONCLUSION: Demonstrating the capacity of ML to overcome complex evaluative challenges, our framework addresses the limitations of traditional statistical methods in current post-market surveillance processes. By offering a reliable means to detect and adjust for learning effects, it may significantly improve medical device safety evaluation.