EHR-RAG: Bridging Long-Horizon Structured Electronic Health Records and Large Language Models via Enhanced Retrieval-Augmented Generation
This addresses the challenge of accurate medical decision-making from complex EHR data for healthcare practitioners, representing a domain-specific advancement with incremental improvements in retrieval methods.
The paper tackles the problem of using large language models (LLMs) for clinical prediction with long-horizon electronic health records (EHRs) that exceed context limits, proposing EHR-RAG, a retrieval-augmented framework that improves accuracy by preserving clinical structure and temporal dynamics. It achieves an average Macro-F1 improvement of 10.76% across four EHR prediction tasks compared to strong LLM-based baselines.
Electronic Health Records (EHRs) provide rich longitudinal clinical evidence that is central to medical decision-making, motivating the use of retrieval-augmented generation (RAG) to ground large language model (LLM) predictions. However, long-horizon EHRs often exceed LLM context limits, and existing approaches commonly rely on truncation or vanilla retrieval strategies that discard clinically relevant events and temporal dependencies. To address these challenges, we propose EHR-RAG, a retrieval-augmented framework designed for accurate interpretation of long-horizon structured EHR data. EHR-RAG introduces three components tailored to longitudinal clinical prediction tasks: Event- and Time-Aware Hybrid EHR Retrieval to preserve clinical structure and temporal dynamics, Adaptive Iterative Retrieval to progressively refine queries in order to expand broad evidence coverage, and Dual-Path Evidence Retrieval and Reasoning to jointly retrieves and reasons over both factual and counterfactual evidence. Experiments across four long-horizon EHR prediction tasks show that EHR-RAG consistently outperforms the strongest LLM-based baselines, achieving an average Macro-F1 improvement of 10.76%. Overall, our work highlights the potential of retrieval-augmented LLMs to advance clinical prediction on structured EHR data in practice.