Synthesis and Evaluation of Long-term History-aware Medical Dialogue
Authors: Hebin Hu, Renke Dai, Ah-Hwee Tan, Yilin Kang
Abstract
An effective healthcare agent must be able to recall and reason over a patient's longitudinal medical history. However, the absence of datasets with realistic long-term dialogue timelines limits systematic evaluation. Real clinical text is constrained by privacy and ethics, while existing benchmarks focus on isolated interactions, failing to capture cross-session reasoning. We introduce a framework for synthesizing high-quality, long-term medical dialogues with LLMs. Our approach entails a knowledge-guided decomposition into three stages: constructing synthetic patient profiles with diverse disease and complication trajectories, generating multi-turn dialogues per encounter, and integrating them into a coherent longitudinal history dataset, MediLongChat. We establish three benchmark tasks-In-dialogue Reasoning, Cross-dialogue Reasoning, and Synthesis Reasoning-to evaluate the memory capabilities of healthcare agents. To assess data quality, we introduce a multi-dimensional evaluation framework combining vector-based metrics with LLM-as-a-judge assessments. Specifically, we define automatic measures-Faithfulness, Coherence, and Diversity-together with two LLM-based evaluations: Correctness and Realism. Benchmark experiments show that even state-of-the-art LLMs struggle with MediLongChat. These findings highlight the benchmark's applicability and underscore the need for tailored methods to advance healthcare agents.
In this work, we introduce LongMedBench, a real-world EHR-based benchmark for long-horizon clinical decision-making. Prior evaluations of LLM-based medical agents have largely emphasized short-context knowledge QA and tool use. However, real-world medical care is inherently longitudinal, and clinicians must aggregate evidence across repeated visits, tests, and evolving treatments. Therefore, long-horizon interaction is essential for realistic assessment. LongMedBench is constructed via a reproducible pipeline that integrates MIMIC-IV admission records and clinical notes into time-series event streams and long-context memory datasets, enabling long-horizon, multi-session interactions between agents and a clinical environment. It comprises 335 patients, with 19.72 inpatient visits per patient on average and 44.91 medical events per visit. Guided by the long-horizon decision process, we propose an evaluation taxonomy with three suites: fact-based QA, temporal reasoning, and long-horizon decision-making. This taxonomy measures how agents understand and leverage historical patient information over extended horizons. Our experiments show that while recent LLMs can make good use of explicit timestamps, they have challenges in implicit time inference; The RAG and agent memory system can improve the performance of information retrieval tasks, but the performance of decision-making tasks is highly dependent on the model's immediate context.
The large-scale deployment of personalized healthcare agents demands memory mechanisms that are exceptionally precise, safe, and capable of long-term clinical tracking. However, existing benchmarks primarily focus on daily open-domain conversations, failing to capture the high-stakes complexity of real-world medical applications. Motivated by the stringent production requirements of an industry-leading health management agent serving tens of millions of active users, we introduce MedMemoryBench. We develop a human-agent collaborative pipeline to synthesize highly realistic, long-horizon medical trajectories based on clinically grounded, synthetic patient archetypes. This process yields a massive, expertly validated dataset comprising approximately 2,000 sessions and 16,000 interaction turns. Crucially, MedMemoryBench departs from traditional static evaluations by pioneering an "evaluate-while-constructing" streaming assessment protocol, which precisely mirrors dynamic memory accumulation in production environments. Furthermore, we formalize and systematically investigate the critical phenomenon of memory saturation, where sustained information influx actively degrades retrieval and reasoning robustness. Comprehensive benchmarking reveals severe bottlenecks in mainstream architectures, particularly concerning complex medical reasoning and noise resilience. By exposing these fundamental flaws, MedMemoryBench establishes a vital foundation for developing robust, production-ready medical agents.
In existing memory benchmarks for Large Language Models (LLMs), the evaluated dialogue sessions often lack long-term semantic consistency, and the underlying personas tend to be flat and static. Furthermore, in real-world scenarios, interactions between users and assistants involve more diverse, heterogeneous data streams, such as documents and emails. These shortcomings significantly limit the realism and effectiveness of current evaluations. To address these limitations, we introduce RHELM (Realistic, Heterogeneous, and Evolving Long-term Memory). Driven by meticulously crafted user profiles and a novel LOOP (pLan-rOllout-evOlve-Prune) module, we construct realistic dialogues across diverse interaction scenarios that exhibit dynamic temporal evolution and long-term coherence. Crucially, these dialogues are deeply integrated with heterogeneous external sources synchronized with the user's temporal event trajectory. The resulting benchmark encompasses challenging question-answer pairs spanning seven inquiry types, with each question mapping to at least one of 27 critical memory characteristics that we identify as essential yet underexplored in current research. Comprehensive experiments across full-context models, retrieval-augmented generation (RAG) methods, and representative memory frameworks reveal that contemporary approaches still expose critical weaknesses in complex, real-world settings, particularly in resolving multi-source aggregation and real-world contextual reasoning.