VirtualTrialHarness: Coordinating Agentic Operationalization of Virtual Trial Protocols Across Complex Clinical Schemas

Healthcare agents must transform longitudinal clinical evidence into reliable actions through heterogeneous tools and stateful workflows, conditions under which model-centric systems may lose context, misuse tools, fail to verify consequential transitions, or cross authorization boundaries. Existing medical-agent benchmarks primarily emphasize terminal task outcomes, making it difficult to determine whether execution failures arise from the agent model, the runtime harness, or their interaction. We present the Medical Harness Protocol, an outcome-preserving framework that independently evaluates seven healthcare-specific process dimensions: Care Action Fulfillment, Clinical Resource Competence, Patient-Evidence Alignment, Clinical Workflow Continuity, Clinical Auditability, Closed-Loop Verification, and Clinical Conduct Boundaries. A normalized intervention trace further tracks whether runtime support is available, activated, delivered, adopted by the agent, and propagated into subsequent behavior. We instantiate the protocol as MedHarnessBench, comprising 342 executable tasks across FHIR/EHR operations, healthcare-administration interfaces, and multimodal clinical tools. Across more than 16,000 controlled task executions, MedHarness yields broad improvements in terminal task success, intermediate subtask completion, and healthcare-specific process quality. We further evaluate MedHarness against multiple general-purpose harnesses and use controlled single-fault perturbations to verify the sensitivity and discrimination of the seven-dimensional evaluation. These results demonstrate that healthcare-specific runtime support can substantially improve both task completion and execution quality, while revealing failures that terminal outcomes alone cannot capture. Code and resources are available at https://github.com/Tomry1114/Awesome-Agent-Harness-for-Healthcare.

Completing complex tasks with language-model agents requires coordinating planning, execution, and review so the final result addresses the user's original objective. We present an agent execution harness that keeps the original objective separate from a revisable plan and an execution record. A planner assigns scoped tasks, workers produce outputs and artifacts, and a reviewer examines results against the original request before submitting or requesting additional work. Reusable domain-specific instructions guide these roles and are refined during construction using task inputs and execution trajectories, without official grading feedback. We evaluate complete harness configurations across terminal tasks, clinical responses, application building, and scientific questions. On Terminal-Bench 2.1, the harness passes 83 of 89 instances (93.26%); on HealthBench Professional, a Fable-configured system achieves a length-adjusted rubric score of 69.63 across 525 tasks. In a 53-task paired HealthBench comparison, the Fable-configured harness achieves an aggregate score 19.89 points higher than direct completion, despite a $-1.46$-point median task-level change; mean inference cost rises from $0.29 to $2.13 per task. We combine these outcomes with latency, documented instruction revisions, and reviewer decisions. Evaluating outcomes alongside execution trajectories and resource use clarifies how coordination supports task completion, where it introduces regressions, and at what cost.

An agent harness controls how a language model accesses information, uses tools, preserves memory, and checks its work. Improving this software is costly when each evaluation requires a long interaction with an environment. We introduce Vestrum, a framework that turns failures in execution traces into scoped harness changes without training the task model. Its organizing overhypothesis is that tasks of a shared kind may exhibit recurring failures whose remedies transfer within that kind. Vestrum expresses failures as recognizable classes, proposes changes across verification, retrieval, decomposition, and knowledge synthesis, and screens their scope before evaluating them as a bundle. A persistent lessons file informs subsequent proposals. Across five settings and two baseline harnesses, the frozen harnesses improve held-out performance: UltraHorizon rises from 47.6 to 59.8 over GAM, Terminal-Bench 4 Hard from 63.7% to 70.3% of checks passed over Claude Code on eight held-out tasks at 1.03x test cost, and cell-type annotation agreement from 67.5% to 77.8% on held-out sections of one slide, alongside gains on LoCoMo and AMA-Bench. Across our searches, verification grounded in evidence helped both intermediate steps and final answers, at lower cost at intermediate steps, while critics asked to rebuild finished answers broke more than they repaired. On the three memory benchmarks, Vestrum also scores above the evaluated GEPA configurations in every paired evaluation.