Daily Papers

EHR audit logs are a highly granular stream of events that capture clinician activities, and is a significant area of interest for research in characterizing clinician workflow on the electronic health record (EHR). Existing techniques to measure the complexity of workflow through EHR audit logs (audit logs) involve time- or frequency-based cross-sectional aggregations that are unable to capture the full complexity of a EHR session. We briefly evaluate the usage of transformer-based tabular language model (tabular LM) in measuring the entropy or disorderedness of action sequences within workflow and release the evaluated models publicly.

Electronic Health Records (EHRs) contain rich yet complex information, and their automated analysis is critical for clinical decision-making. Despite recent advances of large language models (LLMs) in clinical workflows, their ability to analyze EHRs remains limited due to narrow task coverage and lack of EHR-oriented reasoning capabilities. This paper aims to bridge the gap, specifically, we present EHR-Ins, a large-scale, comprehensive EHR reasoning instruction dataset, comprising 300k high-quality reasoning cases and 4M non-reasoning cases across 42 distinct EHR tasks. Its core innovation is a thinking-graph-driven framework that enables to generate high-quality reasoning data at scale. Based on it, we develop EHR-R1, a series of reasoning-enhanced LLMs with up to 72B parameters tailored for EHR analysis. Through a multi-stage training paradigm, including domain adaptation, reasoning enhancement, and reinforcement learning, EHR-R1 systematically acquires domain knowledge and diverse reasoning capabilities, enabling accurate and robust EHR analysis. Lastly, we introduce EHR-Bench, a new benchmark curated from MIMIC-IV, spanning 42 tasks, to comprehensively assess reasoning and prediction across EHR scenarios. In experiments, we show that the resulting EHR-R1 consistently outperforms state-of-the-art commercial and open-source LLMs (including DeepSeek-V3 and GPT-4o), surpassing GPT-4o by over 30 points on MIMIC-Bench and achieving a 10\% higher zero-shot AUROC on EHRSHOT. Collectively, EHR-Ins, EHR-R1, and EHR-Bench have significantly advanced the development for more reliable and clinically relevant EHR analysis.

Recruitment applications span diverse operations, from drafting job descriptions and interpreting queries to organizing profiles, assessing fit, and recommending candidates and jobs. Systematic LLM evaluation therefore requires task coverage that reflects this range of business needs. We introduce EHR-Bench, an open Chinese benchmark comprising twelve tasks across six capability families and five recruitment scenarios. The tasks cover generation, extraction, classification, retrieval, semantic similarity, and reciprocal ranking within one evaluation framework. An internal recruitment dataset guides task definitions, the occupation taxonomy and sampling targets, output requirements, and scoring protocols. Following these specifications, we construct 8,336 task instances from public materials and controlled augmentation, with source-aware expert review and documented provenance. We evaluate twelve LLMs through task-level, capability-level, and aggregate comparisons. Closely ranked models exhibit distinct task strengths, and performance varies across input sources, reference evidence, and candidate pools. Five shared models retain the same observed Overall ordering on a private operational reference, with variation in capability and task correspondence. EHR-Bench provides a reproducible foundation for systematic model assessment, task-specific model selection, and further research on LLMs for recruitment. The project repository is available at https://github.com/EhrBench/EHR-Bench.

We present a new text-to-SQL dataset for electronic health records (EHRs). The utterances were collected from 222 hospital staff members, including physicians, nurses, and insurance review and health records teams. To construct the QA dataset on structured EHR data, we conducted a poll at a university hospital and used the responses to create seed questions. We then manually linked these questions to two open-source EHR databases, MIMIC-III and eICU, and included various time expressions and held-out unanswerable questions in the dataset, which were also collected from the poll. Our dataset poses a unique set of challenges: the model needs to 1) generate SQL queries that reflect a wide range of needs in the hospital, including simple retrieval and complex operations such as calculating survival rate, 2) understand various time expressions to answer time-sensitive questions in healthcare, and 3) distinguish whether a given question is answerable or unanswerable. We believe our dataset, EHRSQL, can serve as a practical benchmark for developing and assessing QA models on structured EHR data and take a step further towards bridging the gap between text-to-SQL research and its real-life deployment in healthcare. EHRSQL is available at https://github.com/glee4810/EHRSQL.

Electronic Health Records (EHRs), which contain patients' medical histories in various multi-modal formats, often overlook the potential for joint reasoning across imaging and table modalities underexplored in current EHR Question Answering (QA) systems. In this paper, we introduce EHRXQA, a novel multi-modal question answering dataset combining structured EHRs and chest X-ray images. To develop our dataset, we first construct two uni-modal resources: 1) The MIMIC- CXR-VQA dataset, our newly created medical visual question answering (VQA) benchmark, specifically designed to augment the imaging modality in EHR QA, and 2) EHRSQL (MIMIC-IV), a refashioned version of a previously established table-based EHR QA dataset. By integrating these two uni-modal resources, we successfully construct a multi-modal EHR QA dataset that necessitates both uni-modal and cross-modal reasoning. To address the unique challenges of multi-modal questions within EHRs, we propose a NeuralSQL-based strategy equipped with an external VQA API. This pioneering endeavor enhances engagement with multi-modal EHR sources and we believe that our dataset can catalyze advances in real-world medical scenarios such as clinical decision-making and research. EHRXQA is available at https://github.com/baeseongsu/ehrxqa.

While the general machine learning (ML) community has benefited from public datasets, tasks, and models, the progress of ML in healthcare has been hampered by a lack of such shared assets. The success of foundation models creates new challenges for healthcare ML by requiring access to shared pretrained models to validate performance benefits. We help address these challenges through three contributions. First, we publish a new dataset, EHRSHOT, which contains deidentified structured data from the electronic health records (EHRs) of 6,739 patients from Stanford Medicine. Unlike MIMIC-III/IV and other popular EHR datasets, EHRSHOT is longitudinal and not restricted to ICU/ED patients. Second, we publish the weights of CLMBR-T-base, a 141M parameter clinical foundation model pretrained on the structured EHR data of 2.57M patients. We are one of the first to fully release such a model for coded EHR data; in contrast, most prior models released for clinical data (e.g. GatorTron, ClinicalBERT) only work with unstructured text and cannot process the rich, structured data within an EHR. We provide an end-to-end pipeline for the community to validate and build upon its performance. Third, we define 15 few-shot clinical prediction tasks, enabling evaluation of foundation models on benefits such as sample efficiency and task adaptation. Our model and dataset are available via a research data use agreement from the Stanford AIMI Center. Code to reproduce our results are available at our Github repo: https://github.com/som-shahlab/ehrshot-benchmark

In this study, we provide solutions to two practical yet overlooked scenarios in federated learning for electronic health records (EHRs): firstly, we introduce EHRFL, a framework that facilitates federated learning across healthcare institutions with distinct medical coding systems and database schemas using text-based linearization of EHRs. Secondly, we focus on a scenario where a single healthcare institution initiates federated learning to build a model tailored for itself, in which the number of clients must be optimized in order to reduce expenses incurred by the host. For selecting participating clients, we present a novel precision-based method, leveraging data latents to identify suitable participants for the institution. Our empirical results show that EHRFL effectively enables federated learning across hospitals with different EHR systems. Furthermore, our results demonstrate the efficacy of our precision-based method in selecting reduced number of participating clients without compromising model performance, resulting in lower operational costs when constructing institution-specific models. We believe this work lays a foundation for the broader adoption of federated learning on EHRs.

Transformers have significantly advanced the modeling of Electronic Health Records (EHR), yet their deployment in real-world healthcare is limited by several key challenges. Firstly, the quadratic computational cost and insufficient context length of these models pose significant obstacles for hospitals in processing the extensive medical histories typical in EHR data. Additionally, existing models employ separate finetuning for each clinical task, complicating maintenance in healthcare environments. Moreover, these models focus exclusively on either clinical prediction or EHR forecasting, lacking the flexibility to perform well across both. To overcome these limitations, we introduce EHRMamba, a robust foundation model built on the Mamba architecture. EHRMamba can process sequences up to four times longer than previous models due to its linear computational cost. We also introduce a novel approach to Multitask Prompted Finetuning (MTF) for EHR data, which enables EHRMamba to simultaneously learn multiple clinical tasks in a single finetuning phase, significantly enhancing deployment and cross-task generalization. Furthermore, our model leverages the HL7 FHIR data standard to simplify integration into existing hospital systems. Alongside EHRMamba, we open-source Odyssey, a toolkit designed to support the development and deployment of EHR foundation models, with an emphasis on data standardization and interpretability. Our evaluations on the MIMIC-IV dataset demonstrate that EHRMamba advances state-of-the-art performance across 6 major clinical tasks and excels in EHR forecasting, marking a significant leap forward in the field.

Electronic Health Records (EHRs) are integral for storing comprehensive patient medical records, combining structured data (e.g., medications) with detailed clinical notes (e.g., physician notes). These elements are essential for straightforward data retrieval and provide deep, contextual insights into patient care. However, they often suffer from discrepancies due to unintuitive EHR system designs and human errors, posing serious risks to patient safety. To address this, we developed EHRCon, a new dataset and task specifically designed to ensure data consistency between structured tables and unstructured notes in EHRs. EHRCon was crafted in collaboration with healthcare professionals using the MIMIC-III EHR dataset, and includes manual annotations of 3,943 entities across 105 clinical notes checked against database entries for consistency. EHRCon has two versions, one using the original MIMIC-III schema, and another using the OMOP CDM schema, in order to increase its applicability and generalizability. Furthermore, leveraging the capabilities of large language models, we introduce CheckEHR, a novel framework for verifying the consistency between clinical notes and database tables. CheckEHR utilizes an eight-stage process and shows promising results in both few-shot and zero-shot settings. The code is available at https://github.com/dustn1259/EHRCon.

Electronic health records (EHRs) contain vast amounts of complex data, but harmonizing and processing this information remains a challenging and costly task requiring significant clinical expertise. While large language models (LLMs) have shown promise in various healthcare applications, their potential for abstracting medical concepts from EHRs remains largely unexplored. We introduce EHRmonize, a framework leveraging LLMs to abstract medical concepts from EHR data. Our study uses medication data from two real-world EHR databases to evaluate five LLMs on two free-text extraction and six binary classification tasks across various prompting strategies. GPT-4o's with 10-shot prompting achieved the highest performance in all tasks, accompanied by Claude-3.5-Sonnet in a subset of tasks. GPT-4o achieved an accuracy of 97% in identifying generic route names, 82% for generic drug names, and 100% in performing binary classification of antibiotics. While EHRmonize significantly enhances efficiency, reducing annotation time by an estimated 60%, we emphasize that clinician oversight remains essential. Our framework, available as a Python package, offers a promising tool to assist clinicians in EHR data abstraction, potentially accelerating healthcare research and improving data harmonization processes.

Discharge summaries in Electronic Health Records (EHRs) are crucial for clinical decision-making, but their length and complexity make information extraction challenging, especially when dealing with accumulated summaries across multiple patient admissions. Large Language Models (LLMs) show promise in addressing this challenge by efficiently analyzing vast and complex data. Existing benchmarks, however, fall short in properly evaluating LLMs' capabilities in this context, as they typically focus on single-note information or limited topics, failing to reflect the real-world inquiries required by clinicians. To bridge this gap, we introduce EHRNoteQA, a novel benchmark built on the MIMIC-IV EHR, comprising 962 different QA pairs each linked to distinct patients' discharge summaries. Every QA pair is initially generated using GPT-4 and then manually reviewed and refined by three clinicians to ensure clinical relevance. EHRNoteQA includes questions that require information across multiple discharge summaries and covers eight diverse topics, mirroring the complexity and diversity of real clinical inquiries. We offer EHRNoteQA in two formats: open-ended and multi-choice question answering, and propose a reliable evaluation method for each. We evaluate 27 LLMs using EHRNoteQA and examine various factors affecting the model performance (e.g., the length and number of discharge summaries). Furthermore, to validate EHRNoteQA as a reliable proxy for expert evaluations in clinical practice, we measure the correlation between the LLM performance on EHRNoteQA, and the LLM performance manually evaluated by clinicians. Results show that LLM performance on EHRNoteQA have higher correlation with clinician-evaluated performance (Spearman: 0.78, Kendall: 0.62) compared to other benchmarks, demonstrating its practical relevance in evaluating LLMs in clinical settings.

Clinical decision-making increasingly relies on timely and context-aware access to patient information within Electronic Health Records (EHRs), yet most existing natural language question-answering (QA) systems are evaluated solely on benchmark datasets, limiting their practical relevance. To overcome this limitation, we introduce EHRNavigator, a multi-agent framework that harnesses AI agents to perform patient-level question answering across heterogeneous and multimodal EHR data. We assessed its performance using both public benchmark and institutional datasets under realistic hospital conditions characterized by diverse schemas, temporal reasoning demands, and multimodal evidence integration. Through quantitative evaluation and clinician-validated chart review, EHRNavigator demonstrated strong generalization, achieving 86% accuracy on real-world cases while maintaining clinically acceptable response times. Overall, these findings confirm that EHRNavigator effectively bridges the gap between benchmark evaluation and clinical deployment, offering a robust, adaptive, and efficient solution for real-world EHR question answering.

Patient world models and clinical agents aim to predict changes in patients' health and support clinical work. Developing these systems requires reliable histories of patient conditions, treatments, and the information available at each decision. Electronic health records (EHRs) contain these histories, but differences in how events are recorded make them difficult to use consistently. We present EHR2Trace, a system that converts EHRs from different sources into traceable patient events for model training and evaluation. It links events to source records, separates event time from information availability, and distinguishes medication orders, dispensing, and administration. A shared event representation supports both OMOP and MEDS exports, with automated validation and reproducible builds. Across three clinical datasets, EHR2Trace converted 846.4 million events, with every applicable check passing except one unit-consistency check on MIMIC-IV, and detected all 28 injected faults. A controlled prediction experiment showed that assigning later diagnoses to admission time substantially inflated measured performance, and that a model trained on such data lost accuracy when deployed on histories filtered by availability. EHR2Trace provides a reusable data foundation for patient world models and clinical agents, helping researchers inspect patient histories, check conversion decisions, and evaluate models with explicit data rules.

Federated learning (FL) is the most practical multi-source learning method for electronic healthcare records (EHR). Despite its guarantee of privacy protection, the wide application of FL is restricted by two large challenges: the heterogeneous EHR systems, and the non-i.i.d. data characteristic. A recent research proposed a framework that unifies heterogeneous EHRs, named UniHPF. We attempt to address both the challenges simultaneously by combining UniHPF and FL. Our study is the first approach to unify heterogeneous EHRs into a single FL framework. This combination provides an average of 3.4% performance gain compared to local learning. We believe that our framework is practically applicable in the real-world FL.

Electronic Health Records (EHRs) contain rich, longitudinal patient information across structured (e.g., labs, vitals, and imaging) and unstructured (e.g., clinical notes) modalities. While deep learning models such as RNNs and Transformers have advanced single- and multimodal EHR analysis, existing methods often optimize for specific downstream tasks and overlook the creation of generalizable patient representations that can be reused across multiple tasks. To address this gap, we propose CAAT-EHR, a novel Cross-Attentional Autoregressive Transformer architecture that produces task-agnostic, longitudinal embeddings of multimodal EHR data. In CAAT-EHR, self-attention layers capture temporal dependencies within each modality, while cross-attention layers fuse information across modalities to model complex interrelationships. During pre-training, an autoregressive decoder predicts future time steps from the fused embeddings, enforcing temporal consistency and enriching the encoder output. Once trained, the encoder alone generates versatile multimodal EHR embeddings that can be applied directly to a variety of predictive tasks. CAAT-EHR demonstrates significant improvements on benchmark EHR datasets for mortality prediction, ICU length-of-stay estimation, and Alzheimer's disease diagnosis prediction. Models using EHR embeddings generated by CAAT-EHR outperform models trained on raw EHR data in eleven out of twelve comparisons for F1 score and AUC across all three downstream tasks. Ablation studies confirm the critical roles of cross-modality fusion and autoregressive refinement. Overall, CAAT-EHR provides a unified framework for learning generalizable, temporally consistent multimodal EHR representations that support more reliable clinical decision support systems.

Databases of electronic health records (EHRs) are increasingly used to inform clinical decisions. Machine learning methods can find patterns in EHRs that are predictive of future adverse outcomes. However, statistical models may be built upon patterns of health-seeking behavior that vary across patient subpopulations, leading to poor predictive performance when training on one patient population and predicting on another. This note proposes two tests to better measure and understand model generalization. We use these tests to compare models derived from two data sources: (i) historical medical records, and (ii) electrocardiogram (EKG) waveforms. In a predictive task, we show that EKG-based models can be more stable than EHR-based models across different patient populations.

Electronic Health Records (EHRs) hold immense potential for advancing healthcare, offering rich, longitudinal data that combines structured information with valuable insights from unstructured clinical notes. However, the unstructured nature of clinical text poses significant challenges for secondary applications. Traditional methods for structuring EHR free-text data, such as rule-based systems and multi-stage pipelines, are often limited by their time-consuming configurations and inability to adapt across clinical notes from diverse healthcare settings. Few systems provide a comprehensive attribute extraction for terminologies. While giant large language models (LLMs) like GPT-4 and LLaMA 405B excel at structuring tasks, they are slow, costly, and impractical for large-scale use. To overcome these limitations, we introduce GENIE, a Generative Note Information Extraction system that leverages LLMs to streamline the structuring of unstructured clinical text into usable data with standardized format. GENIE processes entire paragraphs in a single pass, extracting entities, assertion statuses, locations, modifiers, values, and purposes with high accuracy. Its unified, end-to-end approach simplifies workflows, reduces errors, and eliminates the need for extensive manual intervention. Using a robust data preparation pipeline and fine-tuned small scale LLMs, GENIE achieves competitive performance across multiple information extraction tasks, outperforming traditional tools like cTAKES and MetaMap and can handle extra attributes to be extracted. GENIE strongly enhances real-world applicability and scalability in healthcare systems. By open-sourcing the model and test data, we aim to encourage collaboration and drive further advancements in EHR structurization.

Recent large language models (LLMs) have demonstrated significant advancements, particularly in their ability to serve as agents thereby surpassing their traditional role as chatbots. These agents can leverage their planning and tool utilization capabilities to address tasks specified at a high level. However, a standardized dataset to benchmark the agent capabilities of LLMs in medical applications is currently lacking, making the evaluation of LLMs on complex tasks in interactive healthcare environments challenging. To address this gap, we introduce MedAgentBench, a broad evaluation suite designed to assess the agent capabilities of large language models within medical records contexts. MedAgentBench encompasses 300 patient-specific clinically-derived tasks from 10 categories written by human physicians, realistic profiles of 100 patients with over 700,000 data elements, a FHIR-compliant interactive environment, and an accompanying codebase. The environment uses the standard APIs and communication infrastructure used in modern EMR systems, so it can be easily migrated into live EMR systems. MedAgentBench presents an unsaturated agent-oriented benchmark that current state-of-the-art LLMs exhibit some ability to succeed at. The best model (Claude 3.5 Sonnet v2) achieves a success rate of 69.67%. However, there is still substantial space for improvement which gives the community a next direction to optimize. Furthermore, there is significant variation in performance across task categories. MedAgentBench establishes this and is publicly available at https://github.com/stanfordmlgroup/MedAgentBench , offering a valuable framework for model developers to track progress and drive continuous improvements in the agent capabilities of large language models within the medical domain.

Improving large language models (LLMs) for electronic health record (EHR) reasoning is essential for enabling accurate and generalizable clinical predictions. While LLMs excel at medical text understanding, they underperform on EHR-based prediction tasks due to challenges in modeling temporally structured, high-dimensional data. Existing approaches often rely on hybrid paradigms, where LLMs serve merely as frozen prior retrievers while downstream deep learning (DL) models handle prediction, failing to improve the LLM's intrinsic reasoning capacity and inheriting the generalization limitations of DL models. To this end, we propose EAG-RL, a novel two-stage training framework designed to intrinsically enhance LLMs' EHR reasoning ability through expert attention guidance, where expert EHR models refer to task-specific DL models trained on EHR data. Concretely, EAG-RL first constructs high-quality, stepwise reasoning trajectories using expert-guided Monte Carlo Tree Search to effectively initialize the LLM's policy. Then, EAG-RL further optimizes the policy via reinforcement learning by aligning the LLM's attention with clinically salient features identified by expert EHR models. Extensive experiments on two real-world EHR datasets show that EAG-RL improves the intrinsic EHR reasoning ability of LLMs by an average of 14.62%, while also enhancing robustness to feature perturbations and generalization to unseen clinical domains. These results demonstrate the practical potential of EAG-RL for real-world deployment in clinical prediction tasks. Our code have been available at https://github.com/devilran6/EAG-RL.

Introduction: Electronic health records (EHR) are a critical medium through which patient stigmatization is perpetuated among healthcare teams. Methods: We identified linguistic features of doubt markers and stigmatizing labels in MIMIC-III EHR via expanded lexicon matching and supervised learning classifiers. Predictors of rates of linguistic features were assessed using Poisson regression models. Results: We found higher rates of stigmatizing labels per chart among patients who were Black or African American (RR: 1.16), patients with Medicare/Medicaid or government-run insurance (RR: 2.46), self-pay (RR: 2.12), and patients with a variety of stigmatizing disease and mental health conditions. Patterns among doubt markers were similar, though male patients had higher rates of doubt markers (RR: 1.25). We found increased stigmatizing labels used by nurses (RR: 1.40), and social workers (RR: 2.25), with similar patterns of doubt markers. Discussion: Stigmatizing language occurred at higher rates among historically stigmatized patients, perpetuated by multiple provider types.

Electronic health records (EHRs) are multimodal by nature, consisting of structured tabular features like lab tests and unstructured clinical notes. In real-life clinical practice, doctors use complementary multimodal EHR data sources to get a clearer picture of patients' health and support clinical decision-making. However, most EHR predictive models do not reflect these procedures, as they either focus on a single modality or overlook the inter-modality interactions/redundancy. In this work, we propose MEDFuse, a Multimodal EHR Data Fusion framework that incorporates masked lab-test modeling and large language models (LLMs) to effectively integrate structured and unstructured medical data. MEDFuse leverages multimodal embeddings extracted from two sources: LLMs fine-tuned on free clinical text and masked tabular transformers trained on structured lab test results. We design a disentangled transformer module, optimized by a mutual information loss to 1) decouple modality-specific and modality-shared information and 2) extract useful joint representation from the noise and redundancy present in clinical notes. Through comprehensive validation on the public MIMIC-III dataset and the in-house FEMH dataset, MEDFuse demonstrates great potential in advancing clinical predictions, achieving over 90% F1 score in the 10-disease multi-label classification task.

Electronic Health Records (EHRs) contain rich temporal dynamics that conventional encoding approaches fail to adequately capture. While Large Language Models (LLMs) show promise for EHR modeling, they struggle to reason about sequential clinical events and temporal dependencies. We propose Next Event Prediction (NEP), a framework that enhances LLMs' temporal reasoning through autoregressive fine-tuning on clinical event sequences. By reformulating EHRs as timestamped event chains and predicting future medical events, NEP explicitly models disease progression patterns and causal relationships. Extensive evaluations across oncology survival prediction and clinical diagnosis tasks demonstrate NEP's superiority, outperforming specialized EHR models by 4.6% AUROC and general-purpose LLMs by 7.2% C-index in temporal reasoning tasks. Our analyses reveal dual benefits: state-of-the-art prediction accuracy combined with clinically interpretable attention patterns that align with known disease pathways.

Frontier language models are rarely used in clinical workflows because the realistic, longitudinal benchmarks needed to develop them are scarce. Real electronic health record (EHR) data cannot be openly shared due to privacy, ethics or data use issues and it does not contain verifiable ground truth since the chart records only reflect what clinicians documented. We introduce Synthetic Hospital, an open, fully synthetic, fact-grounded longitudinal EHR benchmark that resolves the open sharing and verifiable ground truth barriers. Built entirely from public medical-education material with no protected health information, it comprises 1,268 longitudinal patients and 5,602 encounters, where every diagnosis, finding, and temporal relation is grounded in standard ontologies (ICD-10-CM, SNOMED CT, LOINC) and with a complete provenance chain back to its source medical education material. Synthetic Hospital is served through a simulated hospital record system that mirrors real EHR infrastructure (standard interoperability APIs, role-based access and function-calling interface). In a blinded review, physicians distinguished its records from real patient charts at near-chance rates (53\%). Across 10 frontier and open models, none approaches ceiling: the best model reconstructs a patient's longitudinal problem list with a severity-weighted F1 of 0.73, level with the mean of seven physicians on a matched subset but well below the best of them (0.89), and misses roughly half of clinically relevant findings when summarizing a chart. Overall, these results highlight that Synthetic Hospital is a difficult and realistic test of clinical AI performance.

Electronic health record (EHR) foundation models trained on longitudinal patient trajectories have demonstrated strong performance across diverse clinical prediction tasks. However, their clinical reasoning capabilities remain constrained by next-token prediction on limited and incomplete EHR data. To address this, we propose a reinforcement learning (RL) fine-tuning framework that treats EHR foundation models as generative policies over patient trajectories. We formulate common clinical prediction problems (e.g., hospital readmission) as event-conditioned, time-windowed reasoning tasks. We then design time-aware, rollout-sensitive rewards to account for finite rollout lengths and temporally inconclusive outcomes. We find that RL fine-tuning consistently improves over pre-trained backbones and strong baselines. Notably, it enables smaller models to surpass larger pre-trained models in data-limited regimes and induces positive transfer across tasks. Further analysis shows that RL fine-tuned models generate trajectories with stronger structural and semantic alignment to ground truth and greater downstream utility.

Recently, deep learning-based language models have significantly enhanced text-to-SQL tasks, with promising applications in retrieving patient records within the medical domain. One notable challenge in such applications is discerning unanswerable queries. Through fine-tuning model, we demonstrate the feasibility of converting medical record inquiries into SQL queries. Additionally, we introduce an entropy-based method to identify and filter out unanswerable results. We further enhance result quality by filtering low-confidence SQL through log probability-based distribution, while grammatical and schema errors are mitigated by executing queries on the actual database. We experimentally verified that our method can filter unanswerable questions, which can be widely utilized even when the parameters of the model are not accessible, and that it can be effectively utilized in practice.

Foundation Models (FMs) trained on Electronic Health Records (EHRs) have achieved state-of-the-art results on numerous clinical prediction tasks. However, most existing EHR FMs have context windows of <1k tokens. This prevents them from modeling full patient EHRs which can exceed 10k's of events. Recent advancements in subquadratic long-context architectures (e.g., Mamba) offer a promising solution. However, their application to EHR data has not been well-studied. We address this gap by presenting the first systematic evaluation of the effect of context length on modeling EHR data. We find that longer context models improve predictive performance -- our Mamba-based model surpasses the prior state-of-the-art on 9/14 tasks on the EHRSHOT prediction benchmark. For clinical applications, however, model performance alone is insufficient -- robustness to the unique properties of EHR is crucial. Thus, we also evaluate models across three previously underexplored properties of EHR data: (1) the prevalence of "copy-forwarded" diagnoses which creates artificial repetition of tokens within EHR sequences; (2) the irregular time intervals between EHR events which can lead to a wide range of timespans within a context window; and (3) the natural increase in disease complexity over time which makes later tokens in the EHR harder to predict than earlier ones. Stratifying our EHRSHOT results, we find that higher levels of each property correlate negatively with model performance, but that longer context models are more robust to more extreme levels of these properties. Our work highlights the potential for using long-context architectures to model EHR data, and offers a case study for identifying new challenges in modeling sequential data motivated by domains outside of natural language. We release our models and code at: https://github.com/som-shahlab/long_context_clues

A promising application of AI to healthcare is the retrieval of information from electronic health records (EHRs), e.g. to aid clinicians in finding relevant information for a consultation or to recruit suitable patients for a study. This requires search capabilities far beyond simple string matching, including the retrieval of concepts (diagnoses, symptoms, medications, etc.) related to the one in question. The suitability of AI methods for such applications is tested by predicting the relatedness of concepts with known relatedness scores. However, all existing biomedical concept relatedness datasets are notoriously small and consist of hand-picked concept pairs. We open-source a novel concept relatedness benchmark overcoming these issues: it is six times larger than existing datasets and concept pairs are chosen based on co-occurrence in EHRs, ensuring their relevance for the application of interest. We present an in-depth analysis of our new dataset and compare it to existing ones, highlighting that it is not only larger but also complements existing datasets in terms of the types of concepts included. Initial experiments with state-of-the-art embedding methods show that our dataset is a challenging new benchmark for testing concept relatedness models.

Clinical question answering over electronic health records (EHRs) can help clinicians and patients access relevant medical information more efficiently. However, many recent approaches rely on large cloud-based models, which are difficult to deploy in clinical environments due to privacy constraints and computational requirements. In this work, we investigate how far grounded EHR question answering can be pushed when restricted to a single notebook. We participate in all four subtasks of the ArchEHR-QA 2026 shared task and evaluate several approaches designed to run on commodity hardware. All experiments are conducted locally without external APIs or cloud infrastructure. Our results show that such systems can achieve competitive performance on the shared task leaderboards. In particular, our submissions perform above average in two subtasks, and we observe that smaller models can approach the performance of much larger systems when properly configured. These findings suggest that privacy-preserving EHR QA systems running fully locally are feasible with current models and commodity hardware. The source code is available at https://github.com/ibrahimey/ArchEHR-QA-2026.

Generative models trained using self-supervision of tokenized electronic health record (EHR) timelines show promise for clinical outcome prediction. This is typically done using Monte Carlo simulation for future patient trajectories. However, existing approaches suffer from three key limitations: sparse estimate distributions that poorly differentiate patient risk levels, extreme computational costs, and high sampling variance. We propose two new estimators: the Sum of Conditional Outcome Probability Estimator (SCOPE) and Risk Estimation from Anticipated Conditional Hazards (REACH), that leverage next-token probability distributions discarded by standard Monte Carlo. We prove both estimators are unbiased and that REACH guarantees variance reduction over Monte Carlo sampling for any model and outcome. Empirically, on hospital mortality prediction in MIMIC-IV using the ETHOS-ARES framework, SCOPE and REACH match 100-sample Monte Carlo performance using only 10-11 samples (95% CI: [9,11]), representing a ~10x reduction in inference cost without degrading calibration. For ICU admission prediction, efficiency gains are more modest (~1.2x), which we attribute to the outcome's lower "spontaneity," a property we characterize theoretically and empirically. These methods substantially improve the feasibility of deploying generative EHR models in resource-constrained clinical settings.

Large Language Models (LLMs) have shown strong promise for mining Electronic Health Records (EHRs) by reasoning over longitudinal clinical information to capture context-rich patient trajectories. However, leveraging LLMs for structured EHRs (e.g., standardized diagnosis and medication codes) presents two key challenges. First, translating time-stamped EHR sequences into plain text can obscure both temporal structure and code identities, weakening the ability to capture code co-occurrence and longitudinal regularities. Second, unlike cohort-trained predictive models that learn a shared, task-aligned representation space across patients, LLMs are often applied in a case-isolated inference setting where each patient is processed independently without leveraging population-level patterns. To address these challenges, we introduce RePrompT, a time-aware LLM framework that integrates structured EHR encoders through prompt tuning, without modifying underlying architectures. Specifically, RePrompT recurrently incorporates latent states from prior visits to preserve longitudinal information, and injects population-level information through trainable prompt tokens derived from a cohort-trained, task-aligned EHR encoder. Experiments on MIMIC-III and MIMIC-IV demonstrate that RePrompT consistently outperforms both EHR-based and LLM-based baselines across multiple clinical prediction tasks.

We introduce PhysicianBench, a benchmark for evaluating LLM agents on physician tasks grounded in real clinical setting within electronic health record (EHR) environments. Existing medical agent benchmarks primarily focus on static knowledge recall, single-step atomic actions, or action intent without verifiable execution against the environment. As a result, they fail to capture the long-horizon, composite workflows that characterize real clinical systems. PhysicianBench comprises 100 long-horizon tasks adapted from real consultation cases between primary care and subspecialty physicians, with each task independently reviewed by a separate panel of physicians. Tasks are instantiated in an EHR environment with real patient records and accessed through the same standard APIs used by commercial EHR vendors. Tasks span 21 specialties (e.g., cardiology, endocrinology, oncology, psychiatry) and diverse workflow types (e.g., diagnosis interpretation, medication prescribing, treatment planning), requiring an average of 27 tool calls per task. Solving each task requires retrieving data across encounters, reasoning over heterogeneous clinical information, executing consequential clinical actions, and producing clinical documentation. Each task is decomposed into structured checkpoints (670 in total across the benchmark) capturing distinct stages of completion graded by task-specific scripts with execution-grounded verification. Across 13 proprietary and open-source LLM agents, the best-performing model achieves only 46% success rate (pass@1), while open-source models reach at most 19%, revealing a substantial gap between current agent capabilities and the demands of real-world clinical workflows. PhysicianBench provides a realistic and execution-grounded benchmark for measuring progress toward autonomous clinical agents.

Clinical LLM assistants must reason over multi-visit patient trajectories, yet whether the compact history representations used to scale them---retrieval, structured timelines, LLM summaries, agentic memory---preserve the longitudinal signal clinical reasoning needs has not been measured. We introduce ClinTraceBench: 385 MIMIC-IV-derived verified dialogues with event-ID provenance, a nine-task taxonomy (T1--T9), and L0--L4 deterministic + L5 human-audit validation (98.92\% agreement). We evaluate eight history representation strategies---a no-context floor, last-visit-only, full-context, BGE-M3 dense-retrieval, two compression schemes, and two agentic-memory systems (Mem0, A-Mem)---across four backbones (DeepSeek-V3, GPT-4o-mini, Haiku~4.5, Sonnet~4.6) on 6{,}271 questions: 32 cells, 200{,}672 predictions. Four findings: (SP4) a controlled T3 injection probe isolates compression-induced relation loss---with the attribution sentence present before construction, Mem0, A-Mem and llm-summary still recover only 0--5.3\% of the injected positives; (SP1) compressed strategies pay an aggregation tax on multi-visit trends and cross-patient comparisons; (SP2) the blind-to-full gap spans +29.8~pp (GPT-4o-mini) to +62.7~pp (Haiku); (SP3) abstention scales non-monotonically with context length. On the Pareto frontier Haiku dominates Sonnet under full-context (\25.76 vs. 106.21), inverting the ``biggest backbone wins'' heuristic.

Masked autoencoders (MAEs) are increasingly applied to electronic health records (EHR) for learning general-purpose representations that support diverse clinical tasks. However, existing approaches typically rely on uniform random masking, implicitly assuming all features are equally predictable. In reality, laboratory tests exhibit substantial heterogeneity in volatility: some biomarkers (e.g., sodium) remain stable, while others (e.g., lactate) fluctuate considerably and are more difficult to model. Clinically, volatile biomarkers often signal acute pathophysiology and require more sophisticated modeling to capture their complex temporal patterns. We propose a volatility-aware pretraining strategy, Coefficient of Variation Masking (CV-Masking), that adaptively adjusts masking probabilities according to the intrinsic variability of each feature. Combined with a value-only masking objective aligned with clinical workflows, CV-Masking yields systematic improvements over random and variance-based strategies. Experiments on a large panel of laboratory tests show that CV-Masking enhances reconstruction, improves downstream predictive performance, and accelerates convergence, producing more robust and clinically meaningful EHR representations.

Accurate clinical prognosis requires synthesizing structured Electronic Health Records (EHRs) with real-time physiological signals like the Electrocardiogram (ECG). Large Language Models (LLMs) offer a powerful reasoning engine for this task but struggle to natively process these heterogeneous, non-textual data types. To address this, we propose UniPACT (Unified Prognostic Question Answering for Clinical Time-series), a unified framework for prognostic question answering that bridges this modality gap. UniPACT's core contribution is a structured prompting mechanism that converts numerical EHR data into semantically rich text. This textualized patient context is then fused with representations learned directly from raw ECG waveforms, enabling an LLM to reason over both modalities holistically. We evaluate UniPACT on the comprehensive MDS-ED benchmark, it achieves a state-of-the-art mean AUROC of 89.37% across a diverse set of prognostic tasks including diagnosis, deterioration, ICU admission, and mortality, outperforming specialized baselines. Further analysis demonstrates that our multimodal, multi-task approach is critical for performance and provides robustness in missing data scenarios.

Automated clinical diagnosis remains a core challenge in medical AI, which usually requires models to integrate multi-modal data and reason across complex, case-specific contexts. Although recent methods have advanced medical report generation (MRG) and visual question answering (VQA) with medical vision-language models (VLMs), these methods, however, predominantly operate under a sample-isolated inference paradigm, as such processing cases independently without access to longitudinal electronic health records (EHRs) or structurally related patient examples. This paradigm limits reasoning to image-derived information alone, which ignores external complementary medical evidence for potentially more accurate diagnosis. To overcome this limitation, we propose HyperWalker, a Deep Diagnosis framework that reformulates clinical reasoning via dynamic hypergraphs and test-time training. First, we construct a dynamic hypergraph, termed iBrochure, to model the structural heterogeneity of EHR data and implicit high-order associations among multimodal clinical information. Within this hypergraph, a reinforcement learning agent, Walker, navigates to and identifies optimal diagnostic paths. To ensure comprehensive coverage of diverse clinical characteristics in test samples, we incorporate a linger mechanism, a multi-hop orthogonal retrieval strategy that iteratively selects clinically complementary neighborhood cases reflecting distinct clinical attributes. Experiments on MRG with MIMIC and medical VQA on EHRXQA demonstrate that HyperWalker achieves state-of-the-art performance. Code is available at: https://github.com/Bean-Young/HyperWalker

Background: Electronic Health Records hold detailed longitudinal information about each patient's health status and general clinical history, a large portion of which is stored within the unstructured text. Existing approaches focus mostly on structured data and a subset of single-domain outcomes. We explore how temporal modelling of patients from free text and structured data, using deep generative transformers can be used to forecast a wide range of future disorders, substances, procedures or findings. Methods: We present Foresight, a novel transformer-based pipeline that uses named entity recognition and linking tools to convert document text into structured, coded concepts, followed by providing probabilistic forecasts for future medical events such as disorders, substances, procedures and findings. We processed the entire free-text portion from three different hospital datasets totalling 811336 patients covering both physical and mental health. Findings: On tests in two UK hospitals (King's College Hospital, South London and Maudsley) and the US MIMIC-III dataset precision@10 0.68, 0.76 and 0.88 was achieved for forecasting the next disorder in a patient timeline, while precision@10 of 0.80, 0.81 and 0.91 was achieved for forecasting the next biomedical concept. Foresight was also validated on 34 synthetic patient timelines by five clinicians and achieved relevancy of 97% for the top forecasted candidate disorder. As a generative model, it can forecast follow-on biomedical concepts for as many steps as required. Interpretation: Foresight is a general-purpose model for biomedical concept modelling that can be used for real-world risk forecasting, virtual trials and clinical research to study the progression of disorders, simulate interventions and counterfactuals, and educational purposes.

In this work, we introduce Multiple Embedding Model for EHR (MEME), an approach that views Electronic Health Records (EHR) as multimodal data. This approach incorporates "pseudo-notes", textual representations of tabular EHR concepts such as diagnoses and medications, and allows us to effectively employ Large Language Models (LLMs) for EHR representation. This framework also adopts a multimodal approach, embedding each EHR modality separately. We demonstrate the effectiveness of MEME by applying it to several tasks within the Emergency Department across multiple hospital systems. Our findings show that MEME surpasses the performance of both single modality embedding methods and traditional machine learning approaches. However, we also observe notable limitations in generalizability across hospital institutions for all tested models.

Accurately predicting the criticalness of ICU patients (such as in-ICU mortality risk) is vital for early intervention in critical care. However, conventional models often treat each patient in isolation and struggle to exploit the relational structure in Electronic Health Records (EHR). We propose a Similarity-Based Self-Construct Graph Model (SBSCGM) that dynamically builds a patient similarity graph from multi-modal EHR data, and a HybridGraphMedGNN architecture that operates on this graph to predict patient mortality and a continuous criticalness score. SBSCGM uses a hybrid similarity measure (combining feature-based and structural similarities) to connect patients with analogous clinical profiles in real-time. The HybridGraphMedGNN integrates Graph Convolutional Network (GCN), GraphSAGE, and Graph Attention Network (GAT) layers to learn robust patient representations, leveraging both local and global graph patterns. In experiments on 6,000 ICU stays from the MIMIC-III dataset, our model achieves state-of-the-art performance (AUC-ROC 0.94) outperforming baseline classifiers and single-type GNN models. We also demonstrate improved precision/recall and show that the attention mechanism provides interpretable insights into model predictions. Our framework offers a scalable and interpretable solution for critical care risk prediction, with potential to support clinicians in real-world ICU deployment.

Conventional medical cancer screening methods are costly, labor-intensive, and extremely difficult to scale. Although AI can improve cancer detection, most systems rely on complex or specialized medical data, making them impractical for large-scale screening. We introduce Can-SAVE, a lightweight AI system that ranks population-wide cancer risks solely based on medical history events. By integrating survival model outputs into a gradient-boosting framework, our approach detects subtle, long-term patient risk patterns - often well before clinical symptoms manifest. Can-SAVE was rigorously evaluated on a real-world dataset of 2.5 million adults spanning five Russian regions, marking the study as one of the largest and most comprehensive deployments of AI-driven cancer risk assessment. In a retrospective oncologist-supervised study over 1.9M patients, Can-SAVE achieves a 4-10x higher detection rate at identical screening volumes and an Average Precision (AP) of 0.228 vs. 0.193 for the best baseline (LoRA-tuned Qwen3-Embeddings via DeepSeek-R1 summarization). In a year-long prospective pilot (426K patients), our method almost doubled the cancer detection rate (+91%) and increased population coverage by 36% over the national screening protocol. The system demonstrates practical scalability: a city-wide population of 1 million patients can be processed in under three hours using standard hardware, enabling seamless clinical integration. This work proves that Can-SAVE achieves nationally significant cancer detection improvements while adhering to real-world public healthcare constraints, offering immediate clinical utility and a replicable framework for population-wide screening. Code for training and feature engineering is available at https://github.com/sb-ai-lab/Can-SAVE.

Large language models (LLMs) trained with next-word-prediction have achieved success as clinical foundation models. Representations from these language backbones yield strong linear probe performance across biomedical tasks, suggesting that patient semantics emerge from next-token prediction at scale. However, this paradigm treats patients as a document to be summarized rather than a dynamical system to be simulated; a patient's trajectory emerges from their state evolving under interventions and time, requiring models that simulate dynamics rather than predict tokens. To address this, we introduce SMB-Structure, a world model for structured EHR that grounds a joint-embedding prediction architecture (JEPA) with next-token prediction (SFT). SFT grounds our model to reconstruct future patient states in token space, while JEPA predicts those futures in latent space from the initial patient representation alone, forcing trajectory dynamics to be encoded before the next state is observed. We validate across two large-scale cohorts: Memorial Sloan Kettering (23,319 oncology patients; 323,000+ patient-years) and INSPECT (19,402 pulmonary embolism patients). Using a linear probe evaluated at multiple points along the disease trajectory, we demonstrate that our training paradigm learns embeddings that capture disease dynamics not recoverable by autoregressive baselines, enabling SMB-Structure to achieve competitive performance on complex tasks characterized by high patient heterogeneity. Model weights are available at https://huggingface.co/standardmodelbio/SMB-v1-1.7B-Structure.

Large language models (LLMs) show promise for clinical reasoning and decision support, but evaluation in realistic, electronic health record-congruent settings remains limited. Existing benchmarks often rely on static datasets or unstructured inputs that do not reflect the structured, interoperable data formats used in clinical systems. We introduce a pipeline for generating clinically realistic HL7 FHIR R4 bundles from unstructured text, enabling controllable evaluation of clinical decision support systems. The pipeline combines staged LLM generation with terminology-grounded validation and repair to reduce hallucinated codes and enforce structural and semantic consistency. Applying this approach to MedCaseReasoning, we construct MedCase-Structured, a synthetic dataset aligned with clinician-authored diagnostic cases, achieving valid FHIR generation for 82.5% of cases. Evaluation on MedCase-Structured reveals consistently lower diagnostic accuracy for LLMs on structured FHIR inputs than with plain text, highlighting the importance of deployment-aligned benchmarking.

We present Clin-JEPA, a multi-phase co-training framework for joint-embedding predictive (JEPA) pretraining on EHR patient trajectories. JEPA architectures have enabled latent-space planning in robotics and high-quality representation learning in vision, but extending the paradigm to EHR data -- to obtain a single backbone that simultaneously forecasts patient trajectories and serves diverse downstream risk-prediction tasks without per-task fine-tuning -- remains an open challenge. Existing JEPA frameworks either discard the predictor after pretraining (I-JEPA, V-JEPA) or train it on a frozen pretrained encoder (V-JEPA 2-AC), leaving the encoder unaware of the rollout signal that the retained predictor must use at inference; co-training the encoder and predictor under a shared JEPA prediction objective would supply this grounding, but naïve co-training is unstable, with representation collapse and online/target drift causing autoregressive rollout to diverge. Clin-JEPA's five-phase pretraining curriculum -- predictor warmup, joint refinement, EMA target alignment, hard sync, and predictor finalization -- addresses each failure mode by phase, stably co-training a Qwen3-8B-based encoder and a 92M-parameter latent trajectory predictor. On MIMIC-IV ICU data, three independent evaluations support the framework: (1) latent ell_1 rollout drift uniquely converges (-15.7%) over 48-hour horizons while baselines and ablations diverge (+3% to +4951%); (2) the encoder learns a clinically discriminative latent geometry (deteriorating-patient cohorts displace 4.83times further than stable patients in latent space, vs leq2.62times for baseline encoders); (3) a single backbone outperforms strong tabular and sequence baselines on multi-task downstream evaluation. Clin-JEPA achieves mean AUROC 0.851 on ICareFM EEP and 0.883 on 8 binary risk tasks (+0.038 and +0.041 vs baseline average).

After decades of massive digitisation, an unprecedented amount of historical documents is available in digital format, along with their machine-readable texts. While this represents a major step forward with respect to preservation and accessibility, it also opens up new opportunities in terms of content mining and the next fundamental challenge is to develop appropriate technologies to efficiently search, retrieve and explore information from this 'big data of the past'. Among semantic indexing opportunities, the recognition and classification of named entities are in great demand among humanities scholars. Yet, named entity recognition (NER) systems are heavily challenged with diverse, historical and noisy inputs. In this survey, we present the array of challenges posed by historical documents to NER, inventory existing resources, describe the main approaches deployed so far, and identify key priorities for future developments.

Scaling test-time compute is a promising axis for improving LLM capabilities. However, test-time compute can be scaled in a variety of ways, and effectively combining different approaches remains an active area of research. Here, we explore this problem in the context of solving real-world GitHub issues from the SWE-bench dataset. Our system, named CodeMonkeys, allows models to iteratively edit a codebase by jointly generating and running a testing script alongside their draft edit. We sample many of these multi-turn trajectories for every issue to generate a collection of candidate edits. This approach lets us scale "serial" test-time compute by increasing the number of iterations per trajectory and "parallel" test-time compute by increasing the number of trajectories per problem. With parallel scaling, we can amortize up-front costs across multiple downstream samples, allowing us to identify relevant codebase context using the simple method of letting an LLM read every file. In order to select between candidate edits, we combine voting using model-generated tests with a final multi-turn trajectory dedicated to selection. Overall, CodeMonkeys resolves 57.4% of issues from SWE-bench Verified using a budget of approximately 2300 USD. Our selection method can also be used to combine candidates from different sources. Selecting over an ensemble of edits from existing top SWE-bench Verified submissions obtains a score of 66.2% and outperforms the best member of the ensemble on its own. We fully release our code and data at https://scalingintelligence.stanford.edu/pubs/codemonkeys.

We present the first simulations of core-collapse supernovae in axial symmetry with feedback from fast neutrino flavor conversion (FFC). Our schematic treatment of FFCs assumes instantaneous flavor equilibration under the constraint of lepton-number conservation individually for each flavor. Systematically varying the spatial domain where FFCs are assumed to occur, we find that they facilitate SN explosions in low-mass (9-12 solar masses) progenitors that otherwise explode with longer time delays, whereas FFCs weaken the tendency to explode of higher-mass (around 20 solar masses) progenitors.

Despite the prominence of decoder-only language models, encoders remain crucial for resource-constrained applications. We introduce ModernGBERT (134M, 1B), a fully transparent family of German encoder models trained from scratch, incorporating architectural innovations from ModernBERT. To evaluate the practical trade-offs of training encoders from scratch, we also present LL\"aMmlein2Vec (120M, 1B, 7B), a family of encoders derived from German decoder-only models via LLM2Vec. We benchmark all models on natural language understanding, text embedding, and long-context reasoning tasks, enabling a controlled comparison between dedicated encoders and converted decoders. Our results show that ModernGBERT 1B outperforms prior state-of-the-art German encoders as well as encoders adapted via LLM2Vec, with regard to performance and parameter-efficiency. All models, training data, checkpoints and code are publicly available, advancing the German NLP ecosystem with transparent, high-performance encoder models.

Wikipedia plays a key role in shaping public understanding of science, and its openly accessible revision history is a unique record of how scientific knowledge evolves over time. Yet scientifically meaningful revisions are obscured by the sheer volume of routine edits, leaving each article's scientific history hidden. We present WikiSTAR (Scientific Tracking of Article Revisions), an interactive system for exploring scientifically meaningful changes across an article's revision history. Using an LLM classifier with an expert-designed multi-label taxonomy, WikiSTAR first tags edit types such as the addition of technical terms, new research findings, and changes in scientific narrative. Then, through interactive views, an article's full revision history can be traced at any granularity - from aggregate trends that reveal when and in which sections scientific content was added or refined, down to individual edits - showing how scientific knowledge develops at a scale previously impossible. In a user study, experts from three domains found that WikiSTAR surfaced new patterns and research questions and enabled previously impractical analyses. We release our system, code and a human-annotated benchmark.

We present the results of HIPE-OCRepair-2026, an ICDAR competition on LLM-assisted OCR post-correction of historical documents. OCR post-correction remains a long-standing challenge in digital heritage: large-scale collections of digitized documents are affected by legacy OCR errors, while re-digitization at scale remains impractical. Large language models (LLMs) offers a major opportunity to revisit this challenge, yet their effectiveness across languages, document types, and noise conditions - and their tendency to hallucinate - remains insufficiently understood. HIPE-OCRepair-2026 pursues two objectives: (i) to evaluate the capabilities of modern OCR post-correction systems, and (ii) to provide a reproducible evaluation framework anchored in the HIPE-OCRepair-2026 dataset, a harmonized multilingual resource consolidating existing and newly curated historical datasets. Participants were tasked with correcting noisy OCR transcripts from historical newspapers and printed works in English, French, and German (17th-20th century), working at the level of coherent transcription units (paragraphs or articles) without access to source images. The evaluation adopts a retrieval-oriented rather than diplomatic scoring approach, reflecting the practical use case of search and access over digitized collections. Four teams submitted systems ranging from zero-shot prompting to continued pre-training and fine-tuning, offering insights into the merits of different adaptation strategies. Results show that modern LLM-assisted systems can significantly improve OCR quality, but performance varies across datasets, languages, and noise levels. Over-correction on low-noise inputs emerges as a recurring challenge, highlighting the importance of evaluation beyond character error reduction. The dataset, scorer, and evaluation pipeline are publicly released to support future research.

Employing a machine learning approach we predict, up to 24 hours prior, a diagnosis of severe sepsis. Strongly predictive models are possible that use only text reports from the Electronic Health Record (EHR), and omit structured numerical data. Unstructured text alone gives slightly better performance than structured data alone, and the combination further improves performance. We also discuss advantages of using unstructured EHR text for modeling, as compared to structured EHR data.

Large language models are often used to answer queries grounded in large text corpora (e.g. codebases, legal documents, or chat histories) by placing the entire corpus in the context window and leveraging in-context learning (ICL). Although current models support contexts of 100K-1M tokens, this setup is costly to serve because the memory consumption of the KV cache scales with input length. We explore an alternative: training a smaller KV cache offline on each corpus. At inference time, we load this trained KV cache, which we call a Cartridge, and decode a response. Critically, the cost of training a Cartridge can be amortized across all the queries referencing the same corpus. However, we find that the naive approach of training the Cartridge with next-token prediction on the corpus is not competitive with ICL. Instead, we propose self-study, a training recipe in which we generate synthetic conversations about the corpus and train the Cartridge with a context-distillation objective. We find that Cartridges trained with self-study replicate the functionality of ICL, while being significantly cheaper to serve. On challenging long-context benchmarks, Cartridges trained with self-study match ICL performance while using 38.6x less memory and enabling 26.4x higher throughput. Self-study also extends the model's effective context length (e.g. from 128k to 484k tokens on MTOB) and surprisingly, leads to Cartridges that can be composed at inference time without retraining.

We present and test the largest benchmark for vericoding, LLM-generation of formally verified code from formal specifications - in contrast to vibe coding, which generates potentially buggy code from a natural language description. Our benchmark contains 12,504 formal specifications, with 3,029 in Dafny, 2,334 in Verus/Rust and 7,141 in Lean. Of these, 6,174 are new unseen problems. We find vericoding success rates of 27% in Lean, 44% in Verus/Rust and 82% in Dafny using off-the-shelf LLMs. Adding natural-language descriptions does not significantly improve performance. We also find that LLM progress has improved progress on pure Dafny verification from 68% to 96% over the past year. The benchmark and vericoding results are shared at https://github.com/Beneficial-AI-Foundation/vericoding-benchmark

Knowledge graphs have become a key resource for integrating heterogeneous data and powering downstream tasks such as question answering, entity linking, and semantic search. They are built and maintained incrementally, either (i) fully automated, e.g., YAGO, (ii) semiautomatically with community oversight, e.g., DBpedia, or (iii) manually through collaborative editing, e.g., Wikidata. Understanding the evolution of knowledge graphs is essential as changes may reflect real-world updates, error corrections, or noise introduced by vandalism, all of which affect the reliability of downstream applications. Among openly available knowledge graphs, Wikidata is the most challenging case to study evolution, with over 120 million entities edited by humans and bots and an edit history spanning more than a decade. Although Wikidata exposes change data in various formats (e.g., periodic dumps and real-time event streams), none support analytical queries over the complete edit history. Therefore, we present WiDiff, a tool that extracts changes from Wikidata's complete edit history and provides a unified interface for large-scale analytical queries over it.

Implicit Neural Representations (INR) have recently shown to be powerful tool for high-quality video compression. However, existing works are limiting as they do not explicitly exploit the temporal redundancy in videos, leading to a long encoding time. Additionally, these methods have fixed architectures which do not scale to longer videos or higher resolutions. To address these issues, we propose NIRVANA, which treats videos as groups of frames and fits separate networks to each group performing patch-wise prediction. This design shares computation within each group, in the spatial and temporal dimensions, resulting in reduced encoding time of the video. The video representation is modeled autoregressively, with networks fit on a current group initialized using weights from the previous group's model. To further enhance efficiency, we perform quantization of the network parameters during training, requiring no post-hoc pruning or quantization. When compared with previous works on the benchmark UVG dataset, NIRVANA improves encoding quality from 37.36 to 37.70 (in terms of PSNR) and the encoding speed by 12X, while maintaining the same compression rate. In contrast to prior video INR works which struggle with larger resolution and longer videos, we show that our algorithm is highly flexible and scales naturally due to its patch-wise and autoregressive designs. Moreover, our method achieves variable bitrate compression by adapting to videos with varying inter-frame motion. NIRVANA achieves 6X decoding speed and scales well with more GPUs, making it practical for various deployment scenarios.

Transformer-based large language models (LLMs) are now deployed to hundreds of millions of users. LLM inference is commonly performed on batches of sequences that share a prefix, such as few-shot examples or a chatbot system prompt. Decoding in this large-batch setting can be bottlenecked by the attention operation, which reads large key-value (KV) caches from memory and computes inefficient matrix-vector products for every sequence in the batch. In this work, we introduce Hydragen, a hardware-aware exact implementation of attention with shared prefixes. Hydragen computes attention over the shared prefix and unique suffixes separately. This decomposition enables efficient prefix attention by batching queries together across sequences, reducing redundant memory reads and enabling the use of hardware-friendly matrix multiplications. Our method can improve end-to-end LLM throughput by up to 32x against competitive baselines, with speedup growing with the batch size and shared prefix length. Hydragen also enables the use of very long shared contexts: with a high batch size, increasing the prefix length from 1K to 16K tokens decreases Hydragen throughput by less than 15%, while the throughput of baselines drops by over 90%. Hydragen generalizes beyond simple prefix-suffix decomposition and can be applied to tree-based prompt sharing patterns, allowing us to further reduce inference time on competitive programming problems by 55%.

Scaling the amount of compute used to train language models has dramatically improved their capabilities. However, when it comes to inference, we often limit the amount of compute to only one attempt per problem. Here, we explore inference compute as another axis for scaling by increasing the number of generated samples. Across multiple tasks and models, we observe that coverage - the fraction of problems solved by any attempt - scales with the number of samples over four orders of magnitude. In domains like coding and formal proofs, where all answers can be automatically verified, these increases in coverage directly translate into improved performance. When we apply repeated sampling to SWE-bench Lite, the fraction of issues solved with DeepSeek-V2-Coder-Instruct increases from 15.9% with one sample to 56% with 250 samples, outperforming the single-attempt state-of-the-art of 43% which uses more capable frontier models. Moreover, using current API pricing, amplifying the cheaper DeepSeek model with five samples is more cost-effective and solves more issues than paying a premium for one sample from GPT-4o or Claude 3.5 Sonnet. Interestingly, the relationship between coverage and the number of samples is often log-linear and can be modelled with an exponentiated power law, suggesting the existence of inference-time scaling laws. Finally, we find that identifying correct samples out of many generations remains an important direction for future research in domains without automatic verifiers. When solving math word problems from GSM8K and MATH, coverage with Llama-3 models grows to over 95% with 10,000 samples. However, common methods to pick correct solutions from a sample collection, such as majority voting or reward models, plateau beyond several hundred samples and fail to fully scale with the sample budget.

We present Voxtral Mini and Voxtral Small, two multimodal audio chat models. Voxtral is trained to comprehend both spoken audio and text documents, achieving state-of-the-art performance across a diverse range of audio benchmarks, while preserving strong text capabilities. Voxtral Small outperforms a number of closed-source models, while being small enough to run locally. A 32K context window enables the model to handle audio files up to 40 minutes in duration and long multi-turn conversations. We also contribute three benchmarks for evaluating speech understanding models on knowledge and trivia. Both Voxtral models are released under Apache 2.0 license.

We introduce Voxtral Realtime, a natively streaming automatic speech recognition model that matches offline transcription quality at sub-second latency. Unlike approaches that adapt offline models through chunking or sliding windows, Voxtral Realtime is trained end-to-end for streaming, with explicit alignment between audio and text streams. Our architecture builds on the Delayed Streams Modeling framework, introducing a new causal audio encoder and Ada RMS-Norm for improved delay conditioning. We scale pretraining to a large-scale dataset spanning 13 languages. At a delay of 480ms, Voxtral Realtime achieves performance on par with Whisper, the most widely deployed offline transcription system. We release the model weights under the Apache 2.0 license.

Implicit Neural Representations (INRs) offer exceptional fidelity for video compression by learning per-video optimized functions, but their adoption is crippled by impractically slow encoding times. Existing attempts to accelerate INR encoding often sacrifice reconstruction quality or crucial coordinate-level control essential for adaptive streaming and transcoding. We introduce SIEDD (Shared-Implicit Encoder with Discrete Decoders), a novel architecture that fundamentally accelerates INR encoding without these compromises. SIEDD first rapidly trains a shared, coordinate-based encoder on sparse anchor frames to efficiently capture global, low-frequency video features. This encoder is then frozen, enabling massively parallel training of lightweight, discrete decoders for individual frame groups, further expedited by aggressive coordinate-space sampling. This synergistic design delivers a remarkable 20-30X encoding speed-up over state-of-the-art INR codecs on HD and 4K benchmarks, while maintaining competitive reconstruction quality and compression ratios. Critically, SIEDD retains full coordinate-based control, enabling continuous resolution decoding and eliminating costly transcoding. Our approach significantly advances the practicality of high-fidelity neural video compression, demonstrating a scalable and efficient path towards real-world deployment. Our codebase is available at https://github.com/VikramRangarajan/SIEDD .

Prompt Tuning is emerging as a scalable and cost-effective method to fine-tune Pretrained Language Models (PLMs), which are often referred to as Large Language Models (LLMs). This study benchmarks the performance and computational efficiency of Prompt Tuning and baselines for multi-label text classification. This is applied to the challenging task of classifying companies into an investment firm's proprietary industry taxonomy, supporting their thematic investment strategy. Text-to-text classification is frequently reported to outperform task-specific classification heads, but has several limitations when applied to a multi-label classification problem where each label consists of multiple tokens: (a) Generated labels may not match any label in the label taxonomy; (b) The fine-tuning process lacks permutation invariance and is sensitive to the order of the provided labels; (c) The model provides binary decisions rather than appropriate confidence scores. Limitation (a) is addressed by applying constrained decoding using Trie Search, which slightly improves classification performance. All limitations (a), (b), and (c) are addressed by replacing the PLM's language head with a classification head, which is referred to as Prompt Tuned Embedding Classification (PTEC). This improves performance significantly, while also reducing computational costs during inference. In our industrial application, the training data is skewed towards well-known companies. We confirm that the model's performance is consistent across both well-known and less-known companies. Our overall results indicate the continuing need to adapt state-of-the-art methods to domain-specific tasks, even in the era of PLMs with strong generalization abilities. We release our codebase and a benchmarking dataset at https://github.com/EQTPartners/PTEC.

The aim of this article is to introduce a new methodology for constructing morphings between shapes that have identical topology. This morphing is obtained by deforming a reference shape, through the resolution of a sequence of linear elasticity equations, onto the target shape. In particular, our approach does not assume any knowledge of a boundary parametrization. Furthermore, we demonstrate how constraints can be imposed on specific points, lines and surfaces in the reference domain to ensure alignment with their counterparts in the target domain after morphing. Additionally, we show how the proposed methodology can be integrated in an offline and online paradigm, which is useful in reduced-order modeling scenarii involving variable shapes. This framework facilitates the efficient computation of the morphings in various geometric configurations, thus improving the versatility and applicability of the approach. The methodology is illustrated on the regression problem of the drag and lift coefficients of airfoils of non-parameterized variable shapes.

We address the computational challenges of solving parametric PDEs with non parametrized geometric variations and non-reducible problems, such as those involving shocks and discontinuities of variable positions. Traditional dimensionality reduction methods like POD struggle with these scenarios due to slowly decaying Kolmogorov widths. To overcome this, we propose a novel non-linear dimensionality reduction technique to reduce the required modes for representation. The non-linear reduction is obtained through a POD after applying a transformation on the fields, which we call optimal mappings, and is a solution to an optimization problem in infinite dimension. The proposed learning framework combines morphing techniques, non-linear dimensionality reduction, and Gaussian Process Regression (GPR). The problem is reformulated on a reference geometry before applying the dimensionality reduction. Our method learns both the optimal mapping, and the solution fields, using a series of GPR models, enabling efficient and accurate modeling of complex parametric PDEs with geometrical variability. The results obtained concur with current state-of-the-art models. We mainly compare our method with the winning solution of the ML4CFD NeurIPS 2024 competition.

The knowledge of city exploration trails of people is in short supply because of the complexity in defining meaningful trails representative of individual behaviours and in the access to actionable data. Existing datasets have only recorded isolated check-ins of activities featured by opaque venue types. In this paper, we fill the gaps in defining what is a semantic trail of city exploration and how it can be generated by integrating different data sources. Furthermore, we publicly release two datasets holding millions of semantic trails each and we discuss their most salient characteristics. We finally present an application using these datasets to build a recommender system meant to guide tourists while exploring a city.

Various tasks in data science are modeled utilizing the variational regularization approach, where manually selecting regularization parameters presents a challenge. The difficulty gets exacerbated when employing regularizers involving a large number of hyperparameters. To overcome this challenge, bilevel learning can be employed to learn such parameters from data. However, neither exact function values nor exact gradients with respect to the hyperparameters are attainable, necessitating methods that only rely on inexact evaluation of such quantities. State-of-the-art inexact gradient-based methods a priori select a sequence of the required accuracies and cannot identify an appropriate step size since the Lipschitz constant of the hypergradient is unknown. In this work, we propose an algorithm with backtracking line search that only relies on inexact function evaluations and hypergradients and show convergence to a stationary point. Furthermore, the proposed algorithm determines the required accuracy dynamically rather than manually selected before running it. Our numerical experiments demonstrate the efficiency and feasibility of our approach for hyperparameter estimation on a range of relevant problems in imaging and data science such as total variation and field of experts denoising and multinomial logistic regression. Particularly, the results show that the algorithm is robust to its own hyperparameters such as the initial accuracies and step size.

Semantic change detection in remote sensing aims to identify land cover changes between bi-temporal image pairs. Progress in this area has been limited by the scarcity of annotated datasets, as pixel-level annotation is costly and time-consuming. To address this, recent methods leverage synthetic data or generate artificial change pairs, but out-of-domain generalization remains limited. In this work, we introduce a weak temporal supervision strategy that leverages additional temporal observations of existing single-temporal datasets, without requiring any new annotations. Specifically, we extend single-date remote sensing datasets with new observations acquired at different times and train a change detection model by assuming that real bi-temporal pairs mostly contain no change, while pairing images from different locations to generate change examples. To handle the inherent noise in these weak labels, we employ an object-aware change map generation and an iterative refinement process. We validate our approach on extended versions of the FLAIR and IAILD aerial datasets, achieving strong zero-shot and low-data regime performance across different benchmarks. Lastly, we showcase results over large areas in France, highlighting the scalability potential of our method.

We introduce Voxtral TTS, an expressive multilingual text-to-speech model that generates natural speech from as little as 3 seconds of reference audio. Voxtral TTS adopts a hybrid architecture that combines auto-regressive generation of semantic speech tokens with flow-matching for acoustic tokens. These tokens are encoded and decoded with Voxtral Codec, a speech tokenizer trained from scratch with a hybrid VQ-FSQ quantization scheme. In human evaluations conducted by native speakers, Voxtral TTS is preferred for multilingual voice cloning due to its naturalness and expressivity, achieving a 68.4\% win rate over ElevenLabs Flash v2.5. We release the model weights under a CC BY-NC license.

Language models trained with reinforcement learning may learn to optimize the grader's judgment rather than the intended objective. This "reward-seeking" is difficult to measure because a model that pursues the grader's judgment and one that pursues the intended objective behave identically whenever the grader rewards the intended behavior. We measure reward-seeking using Contrastive Synthetic Document Finetuning to change a model's beliefs about what the grader rewards, putting those beliefs in conflict with what users or developers want, and measuring the rate at which the model adopts each party's preferred behavior. Applied to intermediate checkpoints of a capabilities-focused OpenAI o3 RL run, without safety training, we find that these checkpoints often side with grader preferences over those of users or developers on coding and alignment tasks. This tendency to side with the grader trends upward throughout RL training. For example, in an environment that forces a choice between keeping a promise to a supervisor and breaking it to complete the task, a late capabilities-focused o3 checkpoint breaks the promise 87% of the time when SDF documents say the grader rewards task completion, versus 9% when they say it rewards honesty (a choice its chain-of-thought often makes explicit). An earlier checkpoint is far less sensitive (40% vs. 24%). Our method also generalizes to reward-hacking models. A model organism trained to reward-hack (gpt-oss-120b) is more than twice as sensitive to grader preferences as the unmodified model, with the mean behavioral shift in favor of the grader rising from 33% to 86%. These results indicate that RL can increase reward-seeking over the course of training, producing models that may act against their developers' intentions when they believe that doing so leads to higher reward.

A myriad of algorithms for the automatic analysis of brain MR images is available to support clinicians in their decision-making. For brain tumor patients, the image acquisition time series typically starts with an already pathological scan. This poses problems, as many algorithms are designed to analyze healthy brains and provide no guarantee for images featuring lesions. Examples include, but are not limited to, algorithms for brain anatomy parcellation, tissue segmentation, and brain extraction. To solve this dilemma, we introduce the BraTS inpainting challenge. Here, the participants explore inpainting techniques to synthesize healthy brain scans from lesioned ones. The following manuscript contains the task formulation, dataset, and submission procedure. Later, it will be updated to summarize the findings of the challenge. The challenge is organized as part of the ASNR-BraTS MICCAI challenge.

We propose Wolf, a WOrLd summarization Framework for accurate video captioning. Wolf is an automated captioning framework that adopts a mixture-of-experts approach, leveraging complementary strengths of Vision Language Models (VLMs). By utilizing both image and video models, our framework captures different levels of information and summarizes them efficiently. Our approach can be applied to enhance video understanding, auto-labeling, and captioning. To evaluate caption quality, we introduce CapScore, an LLM-based metric to assess the similarity and quality of generated captions compared to the ground truth captions. We further build four human-annotated datasets in three domains: autonomous driving, general scenes, and robotics, to facilitate comprehensive comparisons. We show that Wolf achieves superior captioning performance compared to state-of-the-art approaches from the research community (VILA1.5, CogAgent) and commercial solutions (Gemini-Pro-1.5, GPT-4V). For instance, in comparison with GPT-4V, Wolf improves CapScore both quality-wise by 55.6% and similarity-wise by 77.4% on challenging driving videos. Finally, we establish a benchmark for video captioning and introduce a leaderboard, aiming to accelerate advancements in video understanding, captioning, and data alignment. Leaderboard: https://wolfv0.github.io/leaderboard.html.