PrivMeSA: Privacy-Aware Self-Evolving Multi-Agent System for Medicine via Local-Remote LLM Collaboration
Organizations: Institute of Artificial Intelligence, University of Central Florida · Department of Computer Science and Operations Research, Universit´e de Montr´eal · Department of Medicine, University of Central Florida
Abstract
Clinical large language model (LLM) agents deployed locally can consult more capable remote models, but doing so risks exposing patient information. Privacy-conscious delegation places disclosure decisions with a local agent, yet removing explicit identifiers is insufficient: quasi-identifiers can accumulate across multi-turn consultations and repeated patient visits to enable re-identification. We introduce PrivMeSA, a privacy-aware self-evolving multi-agent system that learns to control disclosure and retains remote expertise for local reuse. A local agent manages each encounter and consults remote specialists that may request additional information. Reinforcement learning balances task accuracy against direct disclosure and registry-based re-identification risk, with privacy evaluated over the complete outbound transcript of each encounter. A local lesson memory distills completed consultations into generalized clinical guidance and retrieves relevant lessons before transmission, allowing subsequent cases to reuse expertise without another remote exchange. Memory grows without additional outcome labels or parameter updates. On an emergency-department benchmark built from MIMIC-IV-ED records, PrivMeSA improves mean task accuracy over delegation by up to 15.8 percentage points. In the same setting, PrivMeSA reduces the disclosure of personal details from 98.0% to 0.2% of cases and the share of cases in which the patient can be narrowed to ten or fewer registry patients from 74% to 0%.
Figures & tables
| Accuracy | Disclosure | ||||||
| Method | Disposition | Diagnosis | Procedure | Mean | Leak | Per visit | Linked |
| Local model: Gemma 4 12B | |||||||
| Delegation | 0.701 | 0.340 | 0.650 | 0.564 | 94.3% | 48% | 92% |
| PAPILLON | 0.616 | 0.340 | 0.623 | 0.526 | 21.2% | 1% | 8% |
| PrivMeSA | 0.692 | 0.380 | 0.705 | 0.592 | 0.9% | 0% | 0% |
| Local model: Granite 4.2 8B | |||||||
| Direct disclosure | Re-identification | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Per visit | Linked | |||||||||
| Method | Job | Employer | Kin | Address | Any | Ident. | Med. | Med. | ||
| Local model: Gemma 4 12B | ||||||||||
| Delegation | 69.3% | 61.8% | 72.8% | 42.4% | 94.3% | 5.96 | 12 | 48% | 1 | 92% |
| PAPILLON | 21.2% | 0.0% | 0.0% | 0.0% | 21.2% | 2.14 | 7,265 | 1% | 1,183 | 8% |
| PrivMeSA | 0.9% | 0.0% | 0.0% | 0.0% | 0.9% | 1.35 | 7,916 | 0% | 3,588 | 0% |
| Accuracy | Per-visit median | Linked median | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Model | Q1 | Q2 | Q3 | Q4 | Q1 | Q2 | Q3 | Q4 | Q1 | Q2 | Q3 | Q4 |
| PAPILLON | 0.526 | 0.525 | 0.517 | 0.541 | 7,226 | 7,343 | 7,520 | 7,476 | 3,472 | 794 | 1,902 | 1,347 |
| PrivMeSA, memory off | 0.557 | 0.620 | 0.600 | 0.579 | 7,277 | 7,780 | 7,371 | 7,459 | 3,182 | 3,558 | 3,625 | 3,176 |
| PrivMeSA, memory on | 0.558 | 0.628 | 0.606 | 0.581 | 7,746 | 7,662 | 7,774 | 7,517 | 3,363 | 3,596 | 3,548 | 3,584 |
| Accuracy | Disclosure | ||||||
| Method | Disposition | Diagnosis | Procedure | Mean | Leak | Per visit | Linked |
| PrivMeSA | 0.692 | 0.380 | 0.705 | 0.592 | 0.9% | 0% | 0% |
| PrivMeSA (Base Gemma) | 0.648 | 0.369 | 0.645 | 0.554 | 90.3% | 33% | 90% |
| PrivMeSA (no probing) | 0.704 | 0.364 | 0.695 | 0.588 | 80.8% | 17% | 81% |
| Local only | 0.655 | 0.208 | 0.591 | 0.485 | – | – | – |
| Local only + RL | 0.713 | 0.305 | 0.668 | 0.562 | – | – | – |
Appendix figures & tables8 assets
Supplementary material from the paper’s appendix.
Appendix
| Action | Effect |
|---|---|
| get_vitals | Return vital signs recorded since the previous call |
| get_medications | Return home and administered medications recorded so far |
| retrieve_past_visits | Return summaries of the most recent earlier visits |
| search_orders | Search the order catalog |
| order | Order laboratory tests, imaging, microbiology or medications |
| wait | Advance to the next recorded event |
| Task | Label source | Eligible visits |
|---|---|---|
| Disposition (home or not) | ED disposition | Home, admitted or transferred |
| Diagnosis (CCS category) | First-listed ED diagnosis | Diagnosis with a CCS category |
| Procedure (any coded) | Hospital procedure codes | Linked hospital admission |
| Per visit | Linked | ||||
|---|---|---|---|---|---|
| Attacker | Identifiers | Median | Median | ||
| GPT-5.6-Luna (evaluation) | 1.35 | 7,916 | 0% | 3,588 | 0% |
| Gemma 4 12B (training) | 1.32 | 7,578 | 0% | 3,758 | 0% |
| Task | Diagnosis |
| Key | ICD code for an adult presenting with influenza without specific occupational or environmental exposures. |
| Lesson | Use J11.1 (Influenza due to unidentified influenza virus with other respiratory manifestations) as the primary ED diagnosis for uncomplicated influenza when no specific strain or work-related exposure is documented. |
| Task | Procedure |
| Key | Whether an operative procedure will be coded for a patient with constipation and normal electrolytes. |
| Lesson | No operative procedure is typically coded for uncomplicated constipation with normal electrolytes and no evidence of obstruction or perforation. Routine medical management is expected unless a specific procedure like an enema or manual disimpaction is explicitly documented. |
| Setting | Gemma 4 12B | Granite-4.2-8B |
|---|---|---|
| LoRA / dropout | 64 / 0 | 64 / 0 |
| Rollout temperature | 1 | 1 |
| LoRA target modules | attention and MLP projections | attention and MLP projections |
| Optimizer | AdamW, weight decay 0.01 | AdamW, weight decay 0.01 |
| Learning-rate schedule | 10-step warmup, linear decay | 10-step warmup, linear decay |
| Training steps | 200 | 120 |
| Per visit | Linked | ||||||
| Reward | Accuracy | Leak | Ident. | Med. | Med. | ||
| Anonymity per visit or linked (test set) | |||||||
| Per-visit anonymity | 0.583 | 0.0% | 3.36 | 730 | 13% | 3 | 61% |
| Linked anonymity | 0.584 | 0.0% | 6.34 | 9 | 55% | 1 | 96% |
| Privacy terms or accuracy alone (training episodes) | |||||||
| Full reward | 0.502 | 6.6% | 3.55 | 1,954 | – | – | – |
| Task | Prompt | Answer |
|---|---|---|
| Disposition | Predict the recorded final ED disposition for this visit. | home, admitted, transfer |
| Diagnosis | Give the single ICD code for the primary ED diagnosis that will be recorded for this visit. Answer with the code only, in either ICD-9-CM or ICD-10-CM. | free text |
| Procedure | This patient is admitted. Predict whether any procedure will be coded for the hospital stay. | yes, no |