ClinTraceBench: Source-Verifiable Longitudinal Clinical Reasoning over EHR-Derived Dialogues

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.

As large language models empower healthcare, intelligent clinical decision support has developed rapidly. Longitudinal electronic health records (EHR) provide essential temporal evidence for accurate clinical diagnosis and analysis. However, current large language models have critical flaws in longitudinal EHR reasoning. First, lacking fine-grained statistical reasoning, they often hallucinate clinical trends and metrics when quantitative evidence is textually implied, biasing diagnostic inference. Second, non-uniform time series and scarce labels in longitudinal EHR hinder models from capturing long-range temporal dependencies, limiting reliable clinical reasoning. To address the above limitations, this work presents the Probabilistic Chain-of-Thought Completion Agent (COTCAgent), a hierarchical reasoning framework for longitudinal electronic health records. It consists of three core modules. The Temporal-Statistics Adapter (TSA) converts analytical plans into executable code for standardized trend output. The Chain-of-Thought Completion (COTC) layer leverages a symptom-trend-disease knowledge base with weighted scoring to evaluate disease risk, while the bounded completion module acquires structured evidence through standardized inquiries and iterative scoring constraints to ensure rigorous reasoning. By decoupling statistical computation, feature matching, and language generation, the framework eliminates reliance on complex multi-modal inputs and enables efficient longitudinal record analysis with lower computational overhead. Experimental results show that COTCAgent powered by Baichuan-M2 achieves 90.47% Top-1 accuracy on the self-built dataset and 70.41% on HealthBench, outperforming existing medical agents and mainstream large language models. The code is available at https://github.com/FrankDengAI/COTCAgent/.

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.