Bridging the Post-discharge Gap: A Traceable Multi-agent Framework for Safe and Continuous Care
Authors: Runwei Guan, Yi Zhou, Heyi Lin, Jinjing Zhu, Mingyuan Hou, Yang Yang, Fang Yuan, Xiaohong Lin, +7 more
Organizations: Thrust of Artificial Intelligence, The Hong Kong University of Science and Technology (Guangzhou), Guangzhou, 511453, Guangdong, China. · Distinct Healthcare, Shenzhen, 10587, Guangdong, China.
Abstract
Post-discharge clinical follow-up is critical for maintaining continuity of care and mitigating long-term health risks. However, traditional follow-up paradigms suffer from shortage of health workforce, fragmented patient histories, and information silos across clinical departments. While large language models have demonstrated potential in medical question-answering, their deployment in continuous care is hindered by hallucination risks and a fundamental inability to reason over longitudinal, patient-specific constraints. Here we present Healink, a memory-enhanced multi-agent framework to support AI-assisted post-discharge follow-up by generating prescription-grounded, traceable responses that improved completeness and perceived clinical utility in retrospective and physician-blinded evaluations. The architecture seamlessly integrates a triage routing mechanism, a unified memory enhancement module utilizing a robust relational database for optimal latency, and a strict constraint-based retrieval-augmented generation engine. By vectorizing historical clinical records and employing weighted similarity functions across diverse phenotypic and intervention dimensions, Healink ensures precise inter-patient and intra-patient case matching while actively preventing cross-departmental drug conflicts. We evaluated Healink on a dataset comprising 400 continuous and 85 highly complex real-world follow-up cases, alongside the webMedQA benchmark. In a rigorous single-blind evaluation conducted by clinical experts, the framework outperformed human physician baselines in both authoritativeness and clinical safety. By generating a traceable, white-box evidence chain, Healink provides a scalable, safe, and highly effective paradigm for intelligent patient management, ultimately enhancing societal healthcare outcomes.
As Large Language Model (LLM) agents transition from single-session tools to persistent systems managing longitudinal healthcare journeys, their memory architectures face a critical challenge: reconciling two imperfect sources of truth. The patient's evolving self-report is current but prone to recall bias, while the Electronic Health Record (EHR) is medically validated but frequently stale. General-purpose agent memory systems optimize for coherence by overwriting older facts with the user's latest statement, a pattern that risks safety failures when applied to clinical data. We introduce a Dual-Stream Memory Architecture that strictly separates the patient narrative from the structured clinical record (FHIR), governed by a dedicated Reconciliation Engine that evaluates every extracted memory against the patient's FHIR profile and classifies discrepancies by type, severity, and the specific FHIR resources involved. We evaluate this architecture on 26 patients across 675 longitudinal wellness coaching sessions, using a hybrid dataset that interleaves real provider-patient transcripts with synthetic, FHIR-grounded clinical scenarios. In isolated testing, the engine detects 84.4% of designed clinical discrepancies with 86.7% safety-critical recall. By coupling extraction and reconciliation evaluation on the same data, we directly quantify a 13.6% error cascade, tracing the degradation to clinical details lost during memory extraction from unstructured conversation rather than to downstream classification errors. These findings establish that validating patient-reported memories against clinical records is both feasible and necessary for safe deployment of longitudinal health agents.
Samuel L Pugh, Eric Yang, Alexander Muir Sutherland +1
Recent advances in Large Language Models (LLMs) and multi-agent systems have driven the rise of Agentic AI, showing promise for medical reasoning. However, open-ended conversational agents remain prone to two critical failure modes: premature diagnostic handoff and silent clinical hallucinations that may go undetected before reaching the patient. In this work, we propose a multi-agent framework that addresses both issues by replacing ``LLM-as-a-judge'' routing with deterministic orchestration constraints. The framework incorporates two safety mechanisms. First, a neuro-symbolic state-tracking gate enforces completeness of the OLDCARTS clinical protocol (Onset, Location, Duration, Character, Aggravating/Alleviating factors, Radiation, Timing, and Severity) by blocking diagnostic transitions until all required dimensions are collected. Second, an epistemic uncertainty quantification (UQ) gate computes semantic entropy (H) across K=5 independent diagnostic samples to identify and intercept divergent outputs before delivery. We evaluate the system using simulated patient agents powered by the llama-3.1-70b-instruct model on 150 test cases. The full architecture achieves 49.3% diagnostic precision, representing an absolute improvement of 11.3 percentage points over an unconstrained baseline. Additionally, we observe a statistically significant negative correlation (r = -0.181, p < 0.05) between OLDCARTS completeness (σ) and semantic entropy (H), suggesting that structured information gathering is associated with reduced diagnostic uncertainty.
Discharge summaries require extracting critical information from lengthy electronic health records (EHRs), a process that is labor-intensive when performed manually. Large language models (LLMs) can improve generation efficiency; however, they are prone to producing faithfulness hallucinations, statements that contradict source records, posing direct risks to patient safety. To address this, we present CuraView, a multi-agent framework for sentence-level detection and evidence-grounded explanation of faithfulness hallucinations in discharge summaries. CuraView constructs a GraphRAG-based knowledge graph from patient-level EHRs and implements a closed-loop generation-detection pipeline with sentence-level evidence retrieval and classification spanning four evidence grades from strong support to direct contradiction (E1-E4), yielding structured and interpretable evidence chains. We evaluate CuraView on a subset of 250 patients from the Discharge-Me benchmark, with 50 patients held out for testing. Our fine-tuned Qwen3-14B detection model achieves an F1 of 0.831 on the safety-critical E4 metric (90.9% recall, 76.5% precision) and an F1 of 0.823 on E3+E4, representing a 50.0% relative improvement over the base model and outperforming RAGTruth-style and QAGS-style baselines. These results demonstrate that evidence-chain-based graph retrieval verification substantially improves the factual reliability of clinical documentation, while simultaneously producing reusable annotated datasets for downstream model training and distillation.