From Days to Minutes: An Autonomous AI Agent Achieves Reliable Clinical Triage in Remote Patient Monitoring
Authors: Seunghwan Kim, Tiffany H. Kung, Heena Verma, Dilan Edirisinghe, Kaveh Sedehi, Johanna Alvarez, Diane Shilling, Audra Lisa Doyle, Ajit Chary, William Borden, Ming Jack Po
Organizations: AnsibleHealth Inc., San Francisco, USA · AnsibleHealth Inc., San Francisco, CA, USA · Stanford School of Medicine, Stanford, USA · Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, Stanford, CA · George Washington University, Washington, D.C., USA · Department of Medicine, Division of Cardiology, George Washington University, Washington, DC
Background: Remote patient monitoring (RPM) generates vast data, yet landmark trials (Tele-HF, BEAT-HF) failed because data volume overwhelmed clinical staff. While TIM-HF2 showed 24/7 physician-led monitoring reduces mortality by 30%, this model remains prohibitively expensive and unscalable. Methods: We developed Sentinel, an autonomous AI agent using Model Context Protocol (MCP) for contextual triage of RPM vitals via 21 clinical tools and multi-step reasoning. Evaluation included: (1) self-consistency (100 readings x 5 runs); (2) comparison against rule-based thresholds; and (3) validation against 6 clinicians (3 physicians, 3 NPs) using a connected matrix design. A leave-one-out (LOO) analysis compared the agent against individual clinicians; severe overtriage cases underwent independent physician adjudication. Results: Against a human majority-vote standard (N=467), the agent achieved 95.8% emergency sensitivity and 88.5% sensitivity for all actionable alerts (85.7% specificity). Four-level exact accuracy was 69.4% (quadratic-weighted kappa=0.778); 95.9% of classifications were within one severity level. In LOO analysis, the agent outperformed every clinician in emergency sensitivity (97.5% vs. 60.0% aggregate) and actionable sensitivity (90.9% vs. 69.5%). While disagreements skewed toward overtriage (22.5%), independent adjudication of severe gaps (>=2 levels) validated agent escalation in 88-94% of cases; consensus resolution validated 100%. The agent showed near-perfect self-consistency (kappa=0.850). Median cost was $0.34/triage. Conclusions: Sentinel triages RPM vitals with sensitivity exceeding individual clinicians. By automating systematic context synthesis, Sentinel addresses the core limitation of prior RPM trials, offering a scalable path toward the intensive monitoring shown to reduce mortality while maintaining a clinically defensible overtriage profile.
We present Veritas-RPM, a provenance-guided multi-agent architecture comprising five processing layers: VeritasAgent (ground-truth assembly), SentinelLayer (anomaly detection), DirectorAgent (specialist routing), six domain Specialist Agents, and MetaSentinelAgent (conflict resolution and final decision). We construct a 98-case synthetic taxonomy of false-positive scenarios derived from documented RPM patterns. Synthetic patient epochs (n = 530) were generated directly from taxonomy parameters and processed through the pipeline. Ground-truth labels are known for all cases. Performance is reported as True Suppression Rate (TSR), False Escalation Rate (FER), and Indeterminate Rate (INDR).
Aswini Misro, Vikash Sharma, Shreyank N Gowda
YouDiagnose Limited / NHS, London, UK · YouDiagnose Limited, London, UK · School of Computer Science, University of Nottingham, Nottingham, UK
Objective: Heart failure (HF) presents a healthcare challenge due to its high comorbidity burden, aging patient population and frequent hospitalizations. Remote monitoring offers a promising approach to managing HF patients by early detection of health deterioration. Developing autonomous systems to detect signs of worsening in telemonitoring data is of interest to reduce the workload of healthcare personnel. Methods: We propose the TRACER model, a Transformer with Contrastive Event Representation, designed to predict timelines leading to rare hospitalization events in low-resolution and irregularly sampled telemonitoring data. TRACER incorporates time-aware embeddings for each biomarker, contrastive pre-training to enhance anomaly detection via representation learning, and independent binary classifiers for detection. We used measurement data containing remotely recorded biomarker sequences from 276 HF patients segmented into overlapping windows based on temporal rules, and labeled the windows based on the occurrence of HF relevant hospitalizations at the latter edge of the window. Results: TRACER was able to correctly predict 66.7% timelines leading up to HF hospitalizations in the highly imbalanced real-world dataset with an overestimation of 7.9%. Reformulating the training of TRACER as an event detection problem improved the predictive performance compared with training directly on forecasting windows, enabling more effective use of the limited hospitalization events. Conclusion: TRACER demonstrated superior performance in detecting signs of worsening status in real-world telemonitoring data compared to the other tested models. Significance: TRACER shows promise in identifying signs of clinical deterioration that allow for alerts to be generated to provide counteractive treatment in patients with HF.
Erik Aerts, Yinan Yu, Annika Rosengren +5
Department of Computer Science and Engineering, Chalmers Universiy of Technology, Gothenburg, Sweden · Department of Computer Science and Engineering, University of Gothenburg, Gothenburg, Sweden · Center for Digital Health, Sahlgrenska University Hospital, Gothenburg, Sweden +3
Existing ECG report generation is tightly coupled -- interpretation and reporting fused end-to-end, so errors propagate without stage-level recourse -- while agent-based systems decouple tasks but remain single-pass, never revisiting earlier outputs. Clinical ECG reporting instead unfolds iteratively, requiring progressive context integration and bidirectional editing. We present ATRIA, a multi-agent ECG reporting system that mirrors the clinician's iterative workflow: it binds every report claim to its supporting evidence, flags statements unsupported by that evidence, incorporates additional context mid-session, and lets clinicians verify and revise individual findings rather than accept one opaque output. Because its agents use ECG analysis models already in clinical use, the underlying findings are clinically trustworthy; and as a cloud-based web service, ATRIA is ready for immediate deployment. We demonstrate ATRIA through four interaction cases, with a live demo and video available.