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38 papers in the last four weeks, up 41% on the four weeks before. 0.3% of all new papers.

May 18, 2026

Bridging the Version Gap: Multi-version Training Improves ICD Code Prediction, Especially for Rare Codes

Clinical coding maps clinical documentation to standardized medical codes, an essential yet time-consuming administrative task that could benefit from automation. Current models on ICD coding are typically optimized for codes from a specific ICD version. However, in reality, ICD systems evolve continuously, and different versions are adopted across time periods and regions. Moreover, ICD coding suffers from the long-tail problem, and rare code performance can be a bottleneck for developing implementable models. We examine whether it is viable to train version-independent models by combining data annotated in different ICD versions, which may help address these challenges. We add ICD-9 data to the training of a modified label-wise attention model for ICD-10 prediction, and find that despite the version mismatch, adding ICD-9 yields a 27% increase in micro F1 for 18K rare ICD codes compared to training on ICD-10 alone. On 8K frequent ICD-10 codes, the multi-version training also substantially improves macro metrics, with far fewer model parameters.

Jinghui Liu, Anthony Nguyen

Australian e-Health Research Centre, CSIRO

Automated Medical Coding Healthcare

May 17, 2026

A World Model of Radiologist Reading for Medical Image Representation Learning

Radiologist eye-tracking data provide a rich record of how experts search, compare, and accumulate evidence during image reading; yet, existing methods exploit this signal only partially, either as a static spatial prior or as an auxiliary prediction target decoupled from diagnosis. We propose GazeWorld, a medical imaging world model that treats the image as the world and the radiologist's fixation sequence as a trajectory through it. GazeWorld autoregressively predicts the latent representation of the next fixated patch from all previously visited ones, while a spatial-completion branch covers unvisited regions. At inference, GazeWorld generates a sequence of patch representations from the image alone without requiring real gaze data. Frozen GazeWorld features achieve state-of-the-art diagnostic accuracy across all nine supervised settings on CheXpert, RSNA Pneumonia, and SIIM-ACR Pneumothorax, as well as the highest zero-shot accuracy on all three benchmarks. On the GazeSearch benchmark, a generic decoder trained on the same frozen features outperforms the purpose-built LogitGaze-Med by over 16% in ScanMatch and 22% in SED, despite not being explicitly trained to predict gaze. GazeWorld demonstrates that modeling how experts read, not just what they conclude, offers a promising pretraining paradigm for medical imaging AI.

Yiwei Li, Zihao Wu, Huaqin Zhao +5

University of Georgia · University of Texas at Arlington · New Jersey Institute of Technology

World Model Learning Healthcare Medical Image Classification Medical Image Representation Learning

May 17, 2026

Medical Context Distorts Decisions in Clinical Vision Language Models

Vision-language models (VLMs) are increasingly proposed for clinical decision support, yet their reliability in real-world scenarios that require integrating both visual and textual context from medical records remains poorly characterized. This paper identifies three failure modes: (1) modality over-reliance on text over images, (2) spurious reliance on irrelevant clinical history, and (3) prompt sensitivity across semantically equivalent inputs. We evaluate a diverse set of general-domain and medically-tuned open and closed VLMs on chest x-ray tasks using MIMIC-CXR. By systematically manipulating image-text alignment, clinical history, and prompt formulations, we found that VLM decisions are dominated by the text modality, even when visual evidence is available. Moreover, we observed that VLMs are heavily influenced by irrelevant reports, while minor prompt changes can reverse correct image-based predictions. Our findings underscore the need for explicit safeguards and stress-testing before considering the use of these models in clinical practice.

David Restrepo, Ira Ktena, Maria Vakalopoulou +2

1MICS, CentraleSup´elec - Universit´e Paris-Saclay, France · 2Cancer Data Science Unit, IHU PRISM, National Institute in Precision Oncology, University Paris-Saclay, CentraleSupelec, Gustave Roussy, INSERM, Gif-sur-Yvette · 3Ellison Institute of Technology (EIT), Oxford, UK +1

VLM Evaluation VLM Robustness Prompt Sensitivity Radiology VLMs Vision-Language Models Healthcare+1

May 17, 2026

BELIEF: Structured Evidence Modeling and Uncertainty-Aware Fusion for Biomedical Question Answering

Biomedical question answering often requires decisions from retrieved literature whose relevance, quality, and support for candidate answers are uneven. Most retrieval-augmented large language model (LLM) methods feed this literature to the model as flat text, leaving evidence reliability and remaining uncertainty largely implicit. We propose BELIEF, a structured evidence modeling and uncertainty-aware fusion framework for closed-set biomedical question answering. Rather than treating retrieved documents as undifferentiated context, BELIEF converts them into evidence objects that record clinical attributes, source quality, question relevance, support strength, and the associated candidate hypothesis. These evidence objects provide a shared basis for two complementary reasoning paths. The symbolic path constructs reliability-weighted basic probability assignments based on Dempster--Shafer (D-S) theory over a finite answer space and performs uncertainty-aware symbolic evidence fusion to estimate belief and residual uncertainty. The neural path uses the same structured evidence for LLM-based semantic inference, while a reliability-aware arbitration module reconciles the symbolic and neural outputs according to belief strength, uncertainty, evidence reliability, and semantic consistency. Experiments on PubMedQA, MedQA, and MedMCQA with five general-purpose LLM backbones show that BELIEF obtains the best result in 25 of 30 backbone--dataset--metric settings. Comparisons with biomedical-domain models indicate that BELIEF is competitive on MedQA and MedMCQA, while specialized biomedical pretraining remains advantageous on PubMedQA. Ablation, complementarity, uncertainty-stratified, and cost analyses further show that BELIEF improves retrieved-evidence utilization by making evidence structure, path disagreement, and decision uncertainty explicit.

Chang Zong, Hao Ning, Siliang Tang +2

School of Computer Science and Technology, Zhejiang University of Science and Technology, Hangzhou 310023, China · College of Artificial Intelligence, Zhejiang University, Hangzhou 310027, China · Zhejiang Key Laboratory of Biomedical Intelligent Computing Technology, Zhejiang University of Science and Technology, Hangzhou 310023, China

Healthcare Evidence-Grounded Reasoning Dempster-Shafer Theory Biomedical QA LLM Uncertainty Estimation Medical LLMs+1

May 16, 2026

SEMA-RAG: A Self-Evolving Multi-Agent Retrieval-Augmented Generation Framework for Medical Reasoning

Retrieval-Augmented Generation (RAG) is widely employed to mitigate risks such as hallucinations and knowledge obsolescence in medical question answering, yet its predominantly single-round, static retrieval paradigm misaligns with the multi-stage process of clinical reasoning. This compressed workflow induces two structural deficiencies: question-to-query translation often lacks clinically grounded semantic interpretation, and retrieval lacks iterative sufficiency feedback, making it difficult to form reliable evidence chains. We argue that both issues stem from a deeper cause: overloading a single reasoning chain with heterogeneous tasks of interpretation, exploration, and adjudication. The remedy is to reconstruct the workflow via task decoupling and dynamic multi-round exploration. To this end, we propose SEMA-RAG, a Self-Evolving Multi-Agent RAG framework for medical question answering, which assigns these roles to three specialist agents: the Interpreter Agent for clinical schema interpretation, the Explorer Agent for sufficiency-driven self-evolving retrieval, and the Arbiter Agent for evidence adjudication and answer selection. Across five benchmarks and five LLM backbones, SEMA-RAG improves the strongest baseline by +6.46 accuracy points on average, measured per backbone.

Yongfeng Huang, Ruiying Chen, James Cheng

CSE, The Chinese University of Hong Kong · Wuhan University of Technology

Retrieval-Augmented Generation Healthcare Clinical QA Agentic RAG Medical Reasoning

May 16, 2026

Adversarial Fragility and Language Vulnerability in Clinical AI: A Systematic Audit of Diagnostic Collapse Under Imperceptible Perturbations and Cross-Lingual Drift in Low-Resource Healthcare Settings

Current clinical artificial intelligence (AI) systems are evaluated almost exclusively on clean, standardised, English-language inputs, conditions that do not reflect the realities of healthcare delivery in low-resource settings. This study presents the first systematic dual audit of two orthogonal safety vulnerabilities in clinical AI: adversarial image fragility and cross-lingual diagnostic drift. Using DenseNet121, the architecture underlying CheXNet, fine-tuned on the COVID-QU-Ex chest X-ray dataset (85,318 images; COVID-19, Non-COVID Pneumonia, Normal), we demonstrate that diagnostic accuracy collapses from 89.3% to 62.0% under a Fast Gradient Method (FGM) perturbation of epsilon=0.021, a magnitude imperceptible to the human eye. Standard defensive strategies including Gaussian smoothing and ensemble voting failed to restore clinical safety. In a parallel language fragility experiment, we tested Llama3.1:8b and NatLAS (N-ATLAS) on 20 COVID-19 clinical cases presented in Standard English, Nigerian Pidgin (Naija), and Yoruba-inflected English. Both models exhibited significant accuracy degradation: Llama3.1:8b dropped from 80.0% to 65.0% on Pidgin; NatLAS, an African-context model, collapsed from 85.0% to 55.0%, with diagnosis consistency falling to 50%. These findings establish a quantitative failure envelope for clinical AI under conditions representative of Primary Health Centre (PHC) deployment in Nigeria, and motivate urgent calls for adversarially hardened, linguistically inclusive clinical AI architectures.

Anthonio Oladimeji Gabriel, Ahmad Rufai Yusuf

Centre for Clinical Intelligence & Safety, Ìyàwó, Nigeria · Tomorrow University of Applied Sciences, Germany

Multilingual Language Model Evaluation Healthcare Adversarial Attacks Adversarial Robustness Clinical Language Model Evaluation

May 16, 2026

From Static Risk to Dynamic Trajectories: Toward World-Model-Inspired Clinical Prediction

Clinical decision-making is a feedback system where risk estimates influence treatment, which in turn changes disease trajectories, and both shape clinicians' measurement practices. Static prediction often fails clinically: models trained on observational care logs conflate disease biology with clinician behavior, particularly under treatment confounder feedback and irregular or informative observation. This Review focuses on intervention-aware disease trajectory modeling in clinical AI--methods estimating patient-specific longitudinal disease evolution and assessing trajectory changes under alternative treatments. We organize the field around six linked components: three decision tasks (factual forecasting, counterfactual estimation, policy evaluation) and three data-generating mechanisms (disease evolution, treatment assignment, observation process) that determine identifiability. We present the first unified framework bridging forecasting, counterfactual trajectories, and policy evaluation across discrete/continuous time, explicitly addressing treatment assignment, time-varying confounding, and observation bias. We synthesize key method families (multistate/joint models, temporal point-process, deep sequence architectures, longitudinal causal inference), map them to relevant components, and align evaluation with claim strength via overlap diagnostics, uncertainty quantification, off-policy robustness, and target-trial validation. This synthesis advances benchmark prediction to decision-grade clinical evidence, enabling treatment-sensitive individualized futures, pre-deployment policy stress-testing, and safer closed-loop learning health systems that adapt/abstain when evidence is insufficient.

Pujun Feng, Xiaoyu Guo, Seyed Ehsan Saffari +10

Faculty of Applied Sciences, Macao Polytechnic University, Macao SAR 999078, China. · Medin.ai, Beijing 100871, China. · School of Software & Microelectronics, Peking University, Beijing 100871, China. +8

Causal Effect Estimation Off-Policy Evaluation Healthcare Clinical Outcome Prediction Counterfactual Prediction Causal Inference+2

May 15, 2026

CHI-Bench: Can AI Agents Automate End-to-End, Long-Horizon, Policy-Rich Healthcare Workflows?

End-to-end automation of realistic healthcare operations stresses three capabilities underrepresented in current benchmarks: policy density, decisions must be grounded in a large library of medical, insurance, and operational rules; Multi-role composition: a single task requires the agent to play multiple roles with handoffs; and multilateral interaction: intermediate workflow steps are multi-turn dialogs, such as peer-to-peer review and patient outreach. We introduce

χ

-Bench, a benchmark of long-horizon healthcare workflows across three domains: provider prior authorization, payer utilization management, and care management. Each task hands the agent a clinical case in a high-fidelity simulator of 20 healthcare apps exposed via 87 MCP tools, which it must drive to a terminal status through tool calls and writing the role's artifacts, guided by a 1,290+ document managed-care operations handbook skill. Across 30 agent harness/models configurations, the best agent resolves only 28.0% of tasks, no agent clears 20% on strict pass^3, and executing all tasks in a single session slumps the performance to 3.8%. These results raise the hypothesis that similar gaps are likely to surface in other policy-dense, role-composed, irreversible enterprise domains.

Haolin Chen, Deon Metelski, Leon Qi +30

Johns Hopkins Medicine · Wellstar Health System · Stanford University +16

Healthcare Long-Horizon Agent Evaluation AI Agent Benchmarks Tool-Using Agents Workflow Automation

May 15, 2026

MedMIX: Modality-Internal Expert Fusion for Multimodal Medical Diagnosis

Multimodal clinical prediction faces three challenges: multiple foundation models (FMs) with complementary strengths per modality, pervasive missing modalities at training and test time, and sample-specific variation in modality contributions. We introduce MedMIX, a multimodal framework that combines intra-modality expert fusion, learned inter-modality fusion, and training-only large--small model collaboration for robust medical prediction under incomplete modalities. Within each modality, MedMIX aggregates complementary embeddings from multiple small expert models; across modalities, it performs learned fusion over available modalities; and during training, it leverages large teacher models to improve deployed representations without additional inference cost. Across three heterogeneous benchmarks (OpenI, MIMIC-IV-MM, and MMIST-ccRCC), MedMIX achieves consistently strong performance while remaining robust under controlled missing-modality perturbations, and further demonstrates sustained robustness under cross-cohort shift on MIMIC-III. These results highlight MedMIX as a practical framework that unifies within-modality expert collaboration, sample-specific cross-modality fusion, and efficient large--small model collaboration while remaining robust to incomplete modalities.

Seungik Cho, Anqi Li, Wei Qiu

Department of Electrical and Computer Engineering Rice University Houston, TX 77005

Missing-Modality Learning Multimodal Robustness Healthcare Medical Diagnosis Multimodal Fusion

May 15, 2026

Symphony for Speech-to-Text: Supporting Real-Time Medical Voice Interfaces

After decades of use in dictation and, more recently, ambient documentation, speech is emerging as a primary modality for interacting with technology and AI in healthcare. Yet medical speech recognition remains difficult: systems must capture specialized terminology, resolve contextual ambiguity, and render measurements, abbreviations, and clinical shorthand precisely. Existing solutions are typically optimized either for general-purpose transcription or narrow dictation workflows, limiting their reliability in safety-critical settings and their usefulness for broader clinical workflows. We introduce Symphony for Speech-to-Text, a medical-grade speech recognition system for real-time streaming and batch file-based clinical use. Symphony decomposes the transcription process into specialized components for recognition, formatting, and contextual correction to optimize medical term recall while producing clinically structured text in real time and adapting across use cases. Evaluations on public benchmark and medical speech datasets show that Symphony substantially outperforms state-of-the-art systems in clinical settings while matching or exceeding them in general-domain settings, suggesting robust generalization rather than overfitting. We release a clinical benchmark dataset to support reliable validation and further progress in medical speech recognition. Symphony is available through a production-grade API for live dictation, conversational transcription, and batch audio file processing.

Arne Nix, Robert James, Lasse Borgholt +6

Corti

Healthcare Streaming ASR Automatic Speech Recognition Clinical Speech Processing

May 15, 2026

Fully Open Meditron: An Auditable Pipeline for Clinical LLMs

Clinical decision support systems (CDSS) require scrutable, auditable pipelines that enable rigorous, reproducible validation. Yet current LLM-based CDSS remain largely opaque. Most "open" models are open-weight only, releasing parameters while withholding the data provenance, curation procedures, and generation pipelines that determine model behavior. Fully Open (FO) models, which expose the complete training stack end-to-end, do not currently exist in medicine. We introduce Fully Open Meditron, the first fully open pipeline for building LLM-CDSS, comprising a clinician-audited training corpus, a reproducible data construction and training framework, and a use-aligned evaluation protocol. The corpus unifies eight public medical QA datasets into a normalized conversational format and expands coverage with three clinician-vetted synthetic extensions: exam-style QA, guideline-grounded QA derived from 46,469 clinical practice guidelines, and clinical vignettes. The pipeline enforces system-wide decontamination, gold-label resampling of teacher generations, and end-to-end validation by a four-physician panel. We evaluate using an LLM-as-a-judge protocol over expert-written clinical vignettes, calibrated against 204 human raters. We apply the recipe to five FO base models (Apertus-70B/8B-Instruct, OLMo-2-32B-SFT, EuroLLM-22B/9B-Instruct). All MeditronFO variants are preferred over their bases. Apertus-70B-MeditronFO improves +6.6 points over its base (47.2% to 53.8%) on aggregate medical benchmarks, establishing a new FO SoTA. Gemma-3-27B-MeditronFO is preferred over MedGemma in 58.6% of LLM-as-a-judge comparisons and outperforms it on HealthBench (58% vs 55.9%). These results show that fully open pipelines can achieve state-of-the-art domain-specific performance without sacrificing auditability or reproducibility.

Xavier Theimer-Lienhard, Mushtaha El-Amin, Fay Elhassan +5

LiGHT, EPFL

Healthcare LLM Auditing Clinical Decision Support Medical LLMs LLM Training

May 15, 2026

BiomedAP: A Vision-Informed Dual-Anchor Framework with Gated Cross-Modal Fusion for Robust Medical Vision-Language Adaptation

Biomedical Vision--Language Models (VLMs) have shown remarkable promise in few-shot medical diagnosis but face a critical bottleneck: \textit{fragility to prompt variations}.Existing adaptation frameworks typically optimize visual and textual prompts as independent streams, relying on ideal ``Golden Prompts''. In clinical reality, where descriptions are often noisy and heterogeneous, this modality isolation leads to unstable cross-modal alignment. To address this, we propose BiomedAP, a vision-informed dual-anchor framework with gated cross-modal fusion.BiomedAP enforces synergistic alignment through two mechanisms: (1) Gated Cross-Modal Fusion, which enables layer-wise interaction between modalities, acting as a dynamic noise regulator to suppress irrelevant textual cues; and (2) a Dual-Anchor Constraint that regularizes learnable prompts toward stable semantic centroids derived from both expert templates (High Anchors) and few-shot visual prototypes (Low Anchors). Extensive experiments across 11 benchmarks demonstrate that BiomedAP consistently surpasses baselines, achieving competitive few-shot accuracy and markedly enhanced robustness under prompt perturbations. Our code is available at: https://github.com/tongdiedie/BiomedAP. Keywords: Vision-Language Models; Prompt Learning; Parameter-Efficient Fine-Tuning; Few-shot Learning

Huanyang Tong, Kai Liu, Fangjun Kuang +1

Wenzhou University · Wenzhou Business College

VLM Robustness Prompt Learning Healthcare VLM Adaptation Medical VLMs Vision-Language Alignment

May 15, 2026

Few-Shot Large Language Models for Actionable Triage Categorization of Online Patient Inquiries

Online patient inquiries are often informal, incomplete, and written before professional assessment, yet they must still be routed to an appropriate level of clinical follow-up. We study this as a four-class actionable triage task -- self-care, schedule-visit, urgent-clinician-review, or emergency-referral, and ask whether prompted large language models (LLMs) can support such routing under low-resource labeling conditions. Using the public HealthCareMagic-100K corpus, we construct a 300-example human calibrated gold evaluation set, a 700-example auto-labeled silver training set, and a 40-example few-shot pool. We compare Term Frequency-Inverse Document Frequency (TF-IDF) and Bidirectional Encoder Representations from Transformers for Biomedical Text Mining (BioBERT) baselines train on silver labels against six prompted LLMs under 0-shot, 4-shot, and 12-shot conditions respectively. Accordingly, we evaluate with macro-

F_1

alongside safety-aware metrics, including emergency-recall, under-triage rate, and severe under-triage rate. The strongest LLM (Claude Haiku 4.5, 12-shot) reaches macro-

F_1

0.475, exceeding the best supervised baseline (BioBERT, 0.378) on point estimate, with overlapping confidence intervals. Few-shot prompting and two-model agreement help in label-dependent ways: self-care agreement is reliable, urgent-clinician-review is not. We conclude that LLMs can support triage prioritization and selective human review, but not autonomous deployment.

Liqi Zhou, Jiafu Li

Healthcare Clinical Triage Few-Shot Prompting Clinical Decision-Making Classification Clinical Language Model Evaluation+1

May 15, 2026

MHGraphBench: Knowledge Graph-Grounded Benchmarking of Mental Health Knowledge in Large Language Models

Large language models (LLMs) are increasingly used in the mental health domain, yet it remains unclear how well they capture related biomedical knowledge and how reliably they apply it to clinically salient structured judgments. Here, we present a knowledge-graph (KG)-grounded benchmark for assessing LLMs on mental-health entity recognition, relation judgment, and two-hop reasoning. The benchmark is derived from PrimeKG and comprises nine task families with KG-supported answers and controlled negative options. Experiments across 15 closed- and open-source LLMs reveal a persistent recognition-to-judgment gap: leading models achieve near-ceiling performance on entity typing and on the small relation-typing subset, yet they still struggle with relation prediction and two-hop reasoning. Additionally, short KG-derived snippets benefit some models but degrade performance for others. Moreover, output-format reliability can substantially influence measured performance under constrained multiple-choice settings, highlighting the critical role of response validity in benchmark-based evaluation. MHGraphBench should therefore be interpreted as evaluating agreement with a curated mental-health slice of PrimeKG under a constrained multiple-choice interface, rather than as a direct assessment of real-world clinical safety.

Weixin Liu, Congning Ni, Shelagh A. Mulvaney +4

Vanderbilt University, Nashville, TN, USA · Vanderbilt University Medical Center, Nashville, TN, USA · Virginia Tech, Blacksburg, VA, USA

LLM Evaluation Healthcare Mental Health Clinical Language Model Evaluation Knowledge Graphs LLM Reasoning+1

May 15, 2026

MI-CXR: A Benchmark for Longitudinal Reasoning over Multi-Interval Chest X-rays

Longitudinal chest X-ray (CXR) interpretation requires reasoning over disease evolution across multiple patient visits, yet most existing medical VQA benchmarks focus on single images or short-horizon image pairs. We introduce MI-CXR, a benchmark for standardized evaluation of Multi-Interval longitudinal reasoning over multi-visit CXR sequences, without requiring free-form report generation or additional clinical context. MI-CXR comprises five-way multiple-choice questions over five-visit patient timelines and instantiates three complementary task families: Temporal Event Localization, Interval-wise Change Reasoning, and Global Trajectory Summarization, which assess clinically grounded visual reasoning over time. Evaluating 14 state-of-the-art vision-language models (VLMs) shows low overall performance, with an average accuracy of 29.3%, only modestly above random guessing. Using stage-wise diagnostic probing, we find that models often produce locally plausible interval descriptions but fail to enforce temporal constraints or compose evidence into globally consistent decisions over the full timeline. These findings reveal key limitations of current VLMs and establish MI-CXR as a principled benchmark for longitudinal medical reasoning. The benchmark is available at https://github.com/AIDASLab/MI-CXR

Sunghwan Steve Cho, Yunseok Han, Jaeyoung Do

AIDAS Laboratory, 1ECE & 2IPAI, Seoul National University

VLM Evaluation Healthcare Longitudinal Medical Image Analysis Medical VQA Medical Image Benchmarks

May 15, 2026

RoiMAM: Region-of-Interest Medical Attention Model for Efficient Vision-Language Understanding

Vision-Language Models (VLMs) facilitate medical visual question answering (MedVQA) by jointly interpreting images and text. However, existing models typically depend on large architectures and closed-set answers, which limits their efficiency and potential clinical applicability. To overcome these shortcomings, we introduce RoiMAM, an efficient VLM. It integrates a training-free ROI Generation Module with Semantic Selective Suppression to focus on lesion-relevant regions, alongside a Text Prompt Enhancer module that provides modality-specific context without introducing training parameters. Compared to the widely used MedVInT-TD model, our design achieves efficient and accurate diagnosis at less than 20% of the model size, while improving accuracy by approximately 2% on SLAKE and 4.6% on PMC-VQA.

Jiayan Yang, Zhuoyu Wu, Wenqi Fang

Shenzhen Institutes of Advanced Technology, Chinese Academy of Science · CyPhi(ΨΦ) AI Research Lab, School of IT, Monash University, Malaysia Campus

Healthcare Efficient VLM Inference Medical VQA Medical VLMs

May 14, 2026

Retrieval-Augmented Large Language Models for Schema-Constrained Clinical Information Extraction

Conversational nurse-patient transcripts contain actionable observations, but converting these transcripts into structured representations at scale remains challenging. Documentation burden is substantial, with prior studies showing clinicians spend large portions of their workday on documentation and related desk work rather than direct patient care. MEDIQA-SYNUR focuses on observation extraction from conversational nurse-patient transcripts, requiring systems to normalize these narratives into a predefined schema with value-type constraints. We propose a modular retrieval-augmented generation (RAG) pipeline that uses the training set as an exemplar corpus, combines schema-constrained prompting (full schema vs. pruned candidate schema), deterministic schema-based postprocessing, and a second-pass audit, with two LLM backbones: Llama-4-Scout-17B-16E-Instruct and GPT-5.2 with corresponding embedding models for RAG. Our best configuration uses GPT-5.2 with full schema, RAG, and a second-pass auditing, achieving 80.36% F1 score. Overall, our results show that RAG consistently improves performance, while the optimal degree of schema constraint depends on the model, and second-pass auditing yields modest additional gains by correcting residual schema-adherence errors.

A H M Rezaul Karim, Ozlem Uzuner

George Mason University, VA, USA

Retrieval-Augmented Generation Healthcare Clinical Information Extraction LLM Information Extraction Text Generation

May 14, 2026

Text Knows What, Tables Know When: Clinical Timeline Reconstruction via Retrieval-Augmented Multimodal Alignment

Clinical language models increasingly operate over electronic health records (EHRs), yet patient records are not stored as temporally grounded trajectories. Clinical notes describe symptoms, assessments, and disease progression, but often compress or narratively reorder events. Structured EHR rows provide timestamps for labs, medications, vitals, and procedures, but capture only part of the clinical story. We formulate clinical timeline reconstruction as retrieval-augmented temporal grounding: constructing a patient trajectory by using narrative text for event semantics and structured rows as partial temporal evidence. We introduce a scaffolded workflow that extracts central narrative events, builds an initial temporal scaffold, attaches non-central events, and calibrates timestamps using retrieved structured EHR rows. We evaluate on 40 discharge summaries, including 15 i2b2-derived and 25 MIMIC-IV summaries, each with manual gold-standard timelines and aligned structured EHR data. Across models, multimodal calibration left event match rates largely unchanged and generally improved temporal performance: mean paired case-level multimodal-unimodal differences were positive in 7 of 12 model-metric comparisons across concordance and AULTC, with none negative. However, uncertainty was substantial given the 40-case sample; paired case-level bootstrap intervals excluded zero only for the DeepSeek V3.2 AULTC improvement. A gap analysis shows that 35.1% of text-derived events have no structured counterpart. These findings support treating structured EHR data as partial temporal evidence for narrative-derived patient trajectories.

Sayantan Kumar, Shahriar Noroozizadeh, Juyong Kim +1

Division of Intramural Research National Library of Medicine, National Institutes of Health Bethesda, MD, USA

Multimodal RAG Healthcare Cross-Modal Alignment Longitudinal EHR Modeling Electronic Health Records

May 14, 2026

COTCAgent: Preventive Consultation via Probabilistic Chain-of-Thought Completion

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/.

Zihan Deng, Xiaozhen Zhong, Chuanzhi Xu

School of Computing and Data Science, The University of Hong Kong · 2Shenzhen Institute for Advanced Study, University of Electronic Science and Technology of China · School of Computer Science, The University of Sydney

Healthcare Clinical Decision Support CoT Reasoning Longitudinal EHR Modeling Medical LLMs Clinical Risk Prediction

May 14, 2026

Quantifying and Mitigating Premature Closure in Frontier LLMs

Premature closure, or committing to a conclusion before sufficient information is available, is a recognized contributor to diagnostic error but remains underexamined in large language models (LLMs). We define LLM premature closure as inappropriate commitment under uncertainty: providing an answer, recommendation, or clinical guidance when the safer response would be clarification, abstention, escalation, or refusal. We evaluated five frontier LLMs across structured and open-ended medical tasks. In MedQA (n = 500) and AfriMed-QA (n = 490) questions where the correct choice had been removed, models still selected an answer at high rates, with baseline false-action rates of 55-81% and 53-82%, respectively. In open-ended evaluation, models gave inappropriate answers on an average of 30% of 861 HealthBench questions and 78% of 191 physician-authored adversarial queries. Safety-oriented prompting reduced premature closure across models, but residual failure persisted, highlighting the need to evaluate whether medical LLMs know when not to answer.

Rebecca Handler, Suhana Bedi, Nigam Shah

Department of Medicine, Stanford University · Department of Biomedical Data Science, Stanford University

Healthcare LLM Prompting LLM Safety Clinical Language Model Evaluation Medical LLMs LLM Abstention

May 14, 2026

RxEval: A Prescription-Level Benchmark for Evaluating LLM Medication Recommendation

Inpatient medication recommendation requires clinicians to repeatedly select specific medications, doses, and routes as a patient's condition evolves. Existing benchmarks formulate this task as admission-level prediction over coarse drug codes with multi-hot diagnostic and procedure code inputs, failing to capture the per-timepoint, information-rich nature of real prescribing. We propose RxEval, a prescription-level benchmark that evaluates LLM prescribing capability by multiple-choice questions: each question presents a detailed patient profile and time-ordered clinical trajectory, requiring selection of specific medication-dose-route triples from real prescriptions and patient-specific distractors generated via reasoning-chain perturbation. RxEval comprises 1,547 questions spanning 584 patients, 18 diagnostic categories, and 969 unique medications. Evaluation of 16 LLMs shows that RxEval is both challenging and discriminative: F1 ranges from 45.18 to 77.10 across models, and the best Exact Match is only 46.10%. Error analysis reveals that even frontier models may overlook stated patient information and fail to derive clinical conclusions.

Shuhao Chen, Weisen Jiang, Changmiao Wang +4

The Hong Kong University of Science and Technology · Southern University of Science and Technology · The Chinese University of Hong Kong +2

Healthcare Clinical Decision Support Clinical Decision-Making Large Language Model-Based Recommendation Clinical Language Model Evaluation

May 14, 2026

Logical Grammar Induction via Graph Kolmogorov Complexity: A Neuro-Symbolic Framework for Self-Healing Clinical Data Integrity

The reliability of Healthcare Information Systems (HIS) is frequently compromised by human-induced data entry errors, which existing statistical anomaly detection methods fail to distinguish from legitimate clinical extremes. This paper proposes Logic-GNN, a novel neuro-symbolic framework that treats clinical records as a structured

private language'' governed by latent logical games. By integrating Temporal Graph Neural Networks (TGNN) with Graph Kolmogorov Complexity, we induce a symbolic grammar that represents the underlying logic of medical interactions. We define anomalies as

grammatical violations'' that cause a significant expansion in the Minimum Description Length (MDL) of the clinical graph. Evaluated on the Sina System dataset (2M+ records), Logic-GNN achieves an F1-score of 0.94, outperforming state-of-the-art baselines by 12% in distinguishing between life-threatening medical outliers and data corruption. Our approach introduces a self-healing mechanism that suggests logical corrections to maintain data integrity in real-time HIS environments.

Abolfazl Zarghani, Amir Malekesfandiari

Department of Computer Engineering, Ferdowsi University of Mashhad, Mashhad, Iran

Healthcare Neuro-Symbolic Reasoning Anomaly Detection

May 14, 2026

DT-Transformer: A Foundation Model for Disease Trajectory Prediction on a Real-world Health System

Accurate disease trajectory prediction is critical for early intervention, resource allocation, and improving long-term outcomes. While electronic health records (EHRs) provide a rich longitudinal view of patient health in clinical environments, models trained on curated research cohorts may not reflect routine deployment settings, and those trained on single-hospital datasets capture only fragments of each patient's trajectory. This highlights the importance of leveraging large, multi-hospital health systems for training and validation to better reflect real-world clinical complexity. In this work, we develop DT-Transformer, a foundation model trained on 57.1M structured EHR entries over 1.7M patients from Mass General Brigham (MGB), spanning 11 hospitals and a broad network of outpatient clinics. DT-Transformer achieves strong discrimination in both held-out and prospective validation settings. Next-event prediction achieves a median age- and sex-stratified AUC of 0.871 across 896 disease categories, with all categories exceeding AUC 0.5. These results support health system-scale training as a path toward foundation models suited to real-world clinical forecasting.

Yunying Zhu, Andrew R Weckstein, Kueiyu Joshua Lin +1

Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA · Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA · Kempner Institute for the Study of Natural and Artificial Intelligence, Harvard University, MA, USA +2

Healthcare Clinical Prediction Longitudinal EHR Modeling Time Series Transformers Time-Series Foundation Models

May 13, 2026

Reinforcement Learning for Tool-Calling Agents in Fast Healthcare Interoperability Resources (FHIR)

Fast Healthcare Interoperability Resources (FHIR) is the dominant standard for interoperable exchange of healthcare data. In FHIR, electronic health records form a directed graph of resources. Answering clinically meaningful questions over FHIR requires agents to perform multi-step reasoning, filtering, and aggregation across multiple resource types. Prior work shows that even tool-augmented LLM agents (retrieval, code execution, multi-turn planning) often select the wrong resources or violate traversal constraints. We study this problem in the context of FHIR-AgentBench, a benchmark for realistic question answering over real-world hospital data, and frame reasoning on FHIR as a sequential decision-making problem over a queryable structured graph. We implement a multi-turn CodeAct agent and post-train it with reinforcement learning using a custom harness and tools. A LLM Judge provides execution-grounded rewards. Compared to prompt-based, closed-model baselines, RL post-training improves performance while enforcing data-integrity constraints. Empirically, our approach improves answer correctness from 50% (o4-mini) to 77% on FHIR-AgentBench using a smaller and cheaper Qwen3-8B model. We present an end-to-end post-training pipeline (environment building, harness construction, model training and custom evaluation) that reliably improves multi-turn reasoning over structured clinical graphs.

Marius S. Knorr, Robert Müller, Jan P. Bremer +1

IDM gGmbH, University Medical Center Hamburg-Eppendorf, Hamburg, Germany · Aganthos

Healthcare RL for Language Model Reasoning AI Agent Benchmarks LLM Agent Training RL for Tool Use

May 13, 2026

When Evidence Conflicts: Uncertainty and Order Effects in Retrieval-Augmented Biomedical Question Answering

Biomedical retrieval-augmented large language models (LLMs) often face evidence that is incomplete, misleading, or internally contradictory, yet evaluation usually emphasizes answer accuracy under helpful context rather than reliability under conflict. Using HealthContradict, we evaluate six open-weight LLMs under five controlled evidence conditions: no retrieved context, correct-only context, incorrect-only context, and two mixed conditions containing both correct and contradictory documents in opposite orders. In this conflicting-evidence order contrast, where the same two documents are both present and only their order is reversed, accuracy drops for every model and 11.4%--25.2% of predictions flip. To support abstention in these difficult cases, we also evaluate a conflict-aware abstention score that combines model confidence with a detector of evidence conflict. In the two hardest conditions, this score improves selective accuracy over confidence-only, with mean gains of 7.2--33.4 points in incorrect-only (IC') and 3.6--14.4 points in incorrect-first conflicting (ICC') conditions across 75%, 50%, and 25% coverage. These results show that conflicting biomedical evidence is both an uncertainty and robustness problem and motivate evaluation and abstention methods that explicitly account for evidence disagreement.

Yikun Han, Mengfei Lan, Halil Kilicoglu

University of Illinois Urbana-Champaign

Selective Prediction Healthcare Knowledge Conflicts in Language Models Biomedical QA LLM Uncertainty Estimation Biomedical IR+2

May 13, 2026

ProtoMedAgent: Multimodal Clinical Interpretability via Privacy-Aware Agentic Workflows

While interpretable prototype networks offer compelling case-based reasoning for clinical diagnostics, their raw continuous outputs lack the semantic structure required for medical documentation. Bridging this gap via standard Retrieval-Augmented Generation (RAG) routinely triggers ``retrieval sycophancy,'' where Large Language Models (LLMs) hallucinate post-hoc rationalizations to align with visual predictions. We introduce ProtoMedAgent, a framework that formalizes multimodal clinical reporting as an iterative, zero-gradient test-time optimization problem over a strict neuro-symbolic bottleneck. Operating on a frozen prototype backbone, we distill latent visual and tabular features into a discrete semantic memory. Online generation is strictly constrained by exact set-theoretic differentials and a reflective Scribe-Critic loop, mathematically precluding unsupported narrative claims. To safely bound data disclosure, we introduce a semantic privacy gate governed by

k

-anonymity and

\ell

-diversity. Evaluated on a 4,160-patient clinical cohort, ProtoMedAgent achieves 91.2% Comparison Set Faithfulness where it fundamentally outperforms standard RAG (46.2%). ProtoMedAgent additionally leverages a binding

\ell

-diversity phase transition to systematically reduce artifact-level membership inference risks by an absolute 9.8%.

Alvaro Lopez Pellicer, Plamen Angelov, Marwan Bukhari +3

School of Computing and Communications, Lancaster University · Lancaster Medical School, Lancaster University · PUC-Rio, Puc-Behring Institute for AI

LLM Hallucination Mitigation Healthcare Interpretable ML Explainable Medical Image Analysis Multimodal Model Interpretability Multimodal Agents

May 13, 2026

JANUS: Anatomy-Conditioned Gating for Robust CT Triage Under Distribution Shift

Automated CT triage requires models that are simultaneously accurate across diverse pathologies and reliable under institutional shift. While Vision Transformers provide strong visual representations, many clinically significant findings are defined by quantitative imaging biomarkers rather than appearance alone. We introduce JANUS, a physiology-guided dual-stream architecture that conditions visual embeddings on macro-radiomic priors via Anatomically Guided Gating. On the MERLIN test set (N=5082), JANUS attains macro-AUROC 0.88 and AUPRC 0.74, outperforming all reproduced baselines. It generalizes to an external dataset N=2000; AUROC 0.87), with the largest gains on findings defined by size and attenuation as well as improved calibration on both datasets. We further quantify prediction suppression using the Physiological Veto Rate (PVR), showing that under domain shift JANUS reduces high-confidence false positives substantially more often than true positives. Together, these results are consistent with physically grounded conditioning that improves both discrimination and reliability in CT triage. Code is made publicly available at github repository https://github.com/lavsendahal/janus and model weights are at https://huggingface.co/lavsendahal/janus.

Lavsen Dahal, Yubraj Bhandari, Geoffrey Rubin +1

Center for Virtual Imaging Trials, RAI Labs, Department of Radiology, Duke University, Durham NC 27708, USA · Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC 27708, USA · Department of Mathematics, Trinity College of Arts & Sciences, Duke University,2026 Durham, NC 27708, USA +1

Distribution Shift Robustness Healthcare Clinical Triage Medical Image Classification Radiomics Computed Tomography

May 13, 2026

MILM: Large Language Models for Multimodal Irregular Time Series with Informative Sampling

Multimodal irregular time series (MITS) consist of asynchronous and irregularly sampled observations from heterogeneous numerical and textual channels. In healthcare, for example, patients' electronic health records (EHR) include irregular lab measurements and clinical notes. The irregular timing and channel patterns of observations carry predictive signal alongside the numerical values and textual content. LLMs are natural candidates for processing such heterogeneous data, given their extensive pretrained knowledge spanning textual and numerical domains. We introduce MILM (Multimodal Irregular time series Language Model), which represents MITS as time-ordered triplets in Extensible Markup Language (XML) format and fine-tunes an LLM through a two-stage strategy for MITS classification. The first stage trains on value-redacted MITS to predict from sampling patterns alone, and the second stage trains on full MITS to jointly model sampling patterns and observed values. Our two-stage model (MILM-2S) and its single-stage counterpart (MILM-Direct) achieve the best and second-best average performance on multiple EHR datasets. Further value redaction evaluations confirm that sampling patterns carry predictive signal and that MILM-2S learns to exploit them. In the value pending evaluation we introduce, where some values are unavailable at prediction time, MILM-2S outperforms MILM-Direct by a larger margin compared to standard evaluation. For MILM-2S, preserving the time and channel of value-pending observations as additional sampling information further improves in-hospital mortality prediction.

Hsing-Huan Chung, Shijun Li, Yoav Wald +3

University of Texas at Austin · Technion-IIT · Johns Hopkins University

Irregular Time-Series Modeling Healthcare Time Series Classification Multimodal Large Language Models Clinical Outcome Prediction

May 13, 2026

MedCore: Boundary-Preserving Medical Core Pruning for MedSAM

Medical segmentation foundation models such as SAM and MedSAM provide strong prompt-driven segmentation, but their image encoders are still too large for many clinical settings. Compression is also risky in medicine because a model can keep high Dice while losing boundary fidelity. We propose MedCore, a structured pruning framework for MedSAM. The main idea is to preserve two kinds of structures: structures that became important during SAM-to-MedSAM adaptation, and structures that have high boundary leverage. We identify the first type by a dual-intervention score that compares zeroing a group with resetting it to its original SAM weight. We identify the second type by boundary-aware Fisher estimation. We also introduce a boundary leverage principle, which shows that compression-induced boundary displacement is controlled by logit perturbation on the boundary divided by the logit spatial gradient. This principle explains why boundary metrics can degrade even when Dice remains high. On polyp segmentation benchmarks, MedCore reduces parameters by 60.0% and FLOPs by 58.4% while achieving Dice 0.9549, Boundary F1 0.6388, and HD95 5.14 after recovery fine-tuning. It also reaches 86.6% parameter reduction and 90.4G FLOPs with strong boundary quality. Our analysis further shows that MedSAM lies in a head-fragile boundary regime: head-pruning steps have 2.887 times larger 95th-percentile boundary leverage than MLP-pruning steps, and this logit-level effect is consistent with BF1 and HD95 degradation. Our code is available at https://github.com/cenweizhang/MedCore.

Cenwei Zhang, Suncheng Xiang, Lei You

Shanghai Jiao Tong University Shanghai, China · Technical University of Denmark Ballerup, Denmark

Model Compression Image Segmentation Medical Imaging Foundation Models Healthcare Medical Image Segmentation Structured Pruning+1

May 13, 2026

RealICU: Do LLM Agents Understand Long-Context ICU Data? A Benchmark Beyond Behavior Imitation

Intensive care units (ICU) generate long, dense and evolving streams of clinical information, where physicians must repeatedly reassess patient states under time pressure, underscoring a clear need for reliable AI decision support. Existing ICU benchmarks typically treat historical clinician actions as ground truth. However, these actions are made under incomplete information and limited temporal context of the underlying patient state, and may therefore be suboptimal, making it difficult to assess the true reasoning capabilities of AI systems. We introduce RealICU, a hindsight-annotated benchmark for evaluating large language models (LLMs) under realistic ICU conditions, where labels are created after senior physicians review the full patient trajectory. We formulate four physician-motivated tasks: assess Patient Status, Acute Problems, Recommended Actions, and Red Flag actions that risk unsafe outcomes. We partition each trajectory with 30-min windows and release two datasets: RealICU-Gold with 930-window annotations from 94 MIMIC-IV patients, and RealICU-Scale with 11,862 windows extended by Oracle, a physician-validated LLM hindsight labeler. Existing LLMs including memory-augmented ones performed poorly on RealICU, exposing two failure modes: a recall-safety tradeoff for clinical recommendations, and an anchoring bias to early interpretations of the patient. We further introduce ICU-Evo to study structured-memory agents that improves long-horizon reasoning but does not fully eliminate safety failures. Together, RealICU provides a clinically grounded testbed for measuring and improving AI sequential decision-support in high-stakes care. Project page: https://chengzhi-leo.github.io/RealICU-Bench/

Chengzhi Shen, Weixiang Shen, Tobias Susetzky +8

Cherise · Technical University of Munich (TUM) · TUM University Hospital +8

Healthcare Clinical Decision-Making Clinical Reasoning Clinical Language Model Evaluation Memory-Augmented Language Model Agents