The Taxonomies, Training, and Applications of Event Stream Modelling for Electronic Health Records

Electronic health records (EHR) are irregular, asynchronous multivariate time series. As time-series foundation models increasingly tokenize events rather than discretizing time, the input layout becomes a key design choice. Grids expose time$\times$variable structure but require imputation or missingness masks, risking error or sampling-policy shortcuts. Point-set tokenization avoids discretization but loses within-variable trajectories and time-local cross-variable context (Fig.1). We restore these priors in STructure-AwaRe (STAR) Set Transformer by adding parameter-efficient soft attention biases: a temporal locality penalty $-|Δt|/τ$ with learnable timescales and a variable-type affinity $B_{s_i,s_j}$ from a learned feature-compatibility matrix. We benchmark 10 depth-wise fusion schedules (Fig.2). On three ICU prediction tasks, STAR-Set achieves AUC/APR of 0.7158/0.0026 (CPR), 0.9164/0.2033 (mortality), and 0.8373/0.1258 (vasopressor use), outperforming regular-grid, event-time grid, and prior set baselines. Learned $τ$ and $B$ provide interpretable summaries of temporal context and variable interactions, offering a practical plug-in for context-informed time-series models.

Patient world models and clinical agents aim to predict changes in patients' health and support clinical work. Developing these systems requires reliable histories of patient conditions, treatments, and the information available at each decision. Electronic health records (EHRs) contain these histories, but differences in how events are recorded make them difficult to use consistently. We present EHR2Trace, a system that converts EHRs from different sources into traceable patient events for model training and evaluation. It links events to source records, separates event time from information availability, and distinguishes medication orders, dispensing, and administration. A shared event representation supports both OMOP and MEDS exports, with automated validation and reproducible builds. Across three clinical datasets, EHR2Trace converted 846.4 million events, with every applicable check passing except one unit-consistency check on MIMIC-IV, and detected all 28 injected faults. A controlled prediction experiment showed that assigning later diagnoses to admission time substantially inflated measured performance, and that a model trained on such data lost accuracy when deployed on histories filtered by availability. EHR2Trace provides a reusable data foundation for patient world models and clinical agents, helping researchers inspect patient histories, check conversion decisions, and evaluate models with explicit data rules.

Feature engineering for Electronic Health Records (EHR) is complicated by irregular observation intervals, variable measurement frequencies, and structural sparsity inherent to clinical time series. Existing automated methods either lack clinical domain awareness or assume clean, regularly sampled inputs, limiting their applicability to real-world EHR data. We present FeatEHR-LLM, a framework that leverages Large Language Models (LLMs) to generate clinically meaningful tabular features from irregularly sampled EHR time series. To limit patient privacy exposure, the LLM operates exclusively on dataset schemas and task descriptions rather than raw patient records. A tool-augmented generation mechanism equips the LLM with specialized routines for querying irregular temporal data, enabling it to produce executable feature-extraction code that explicitly handles uneven observation patterns and informative sparsity. FeatEHR-LLM supports both univariate and multivariate feature generation through an iterative, validation-in-the-loop pipeline. Evaluated on eight clinical prediction tasks across four ICU datasets, our framework achieves the highest mean AUROC on 7 out of 8 tasks, with improvements of up to 6 percentage points over strong baselines. Code is available at github.com/hojjatkarami/FeatEHR-LLM.