动态检索病史关键片段,提升电子病历预测准确性
EHR-RAGp: Retrieval-Augmented Prototype-Guided Foundation Model for Electronic Health Records

- 用原型引导检索机制,自动找最相关的过往病历
- 在多个临床任务中超越现有顶尖模型表现
- 适合需要长时序病历分析的医疗AI研究者
电子健康记录(EHR)包含丰富的纵向患者信息,广泛应用于预测建模。然而,由于病程长、事件异质、时间不规则及历史背景重要性差异,有效利用历史数据仍具挑战。现有方法多依赖固定窗口或统一聚合,易掩盖关键临床信号。本文提出EHR-RAGp,一种增强型基础模型,可动态整合多种临床事件类型的最相关历史信息。其提出的原型引导检索模块作为对齐机制,评估历史片段与当前预测任务的相关性,引导模型聚焦于最具信息量的上下文。在多个临床预测任务中,EHR-RAGp持续优于现有最先进的EHR基础模型和Transformer基线模型。此外,将其集成至已有临床基础模型可带来显著性能提升。整体而言,EHR-RAGp为利用长时序临床上下文提升下游任务表现提供了一个可扩展、高效的框架。
原文摘要 · Abstract (English)
Electronic Health Records (EHR) contain rich longitudinal patient information and are widely used in predictive modeling applications. However, effectively leveraging historical data remains challenging due to long trajectories, heterogeneous events, temporal irregularity, and the varying relevance of past clinical context. Existing approaches often rely on fixed windows or uniform aggregation, which can obscure clinically important signals. In this work, we introduce EHR-RAGp, a retrieval-augmented foundation model that dynamically integrates the most relevant patient history across diverse clinical event types. We propose a prototype-guided retrieval module that acts as an alignment mechanism and estimates the relevance of retrieved historical chunks with respect to a given prediction task, guiding the model towards the most informative context. Across multiple clinical prediction tasks, EHR-RAGp consistently outperforms state-of-the-art EHR foundation models and transformer-based baselines. Furthermore, integrating EHR-RAGp with existing clinical foundation models yields substantial performance gains. Overall, EHR-RAGp provides a scalable and efficient framework for leveraging long-range clinical context to improve downstream performance.
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