arXiv:2608.27856cs.LGcs.AI2026-08

让医院的医疗模型代理共享经验,不传数据也能提升诊疗预测效果。

FedEHR-Agents: Federated Agentic Optimization for Automated EHR Modeling

论文配图:FedEHR-Agents: Federated Agentic Optimization for Automated EHR Modeling
图 1 · 摘自论文原文
  • 以临床建模经验为核心,而非仅共享模型参数。
  • 在多医院真实数据上表现优于本地与传统联邦学习基线。
  • 适合需要隐私保护的跨机构医疗智能协作场景。

大语言模型正推动自主临床代理执行复杂的电子健康记录(EHR)建模任务。然而,各医院部署的代理受限于本地数据与环境,跨院合作又受患者级数据敏感性制约。尽管联邦学习(FL)为隐私保护协作提供基础,现有方法仍以模型为中心,仅聚焦预测模型或其更新,忽视了自主代理积累的丰富建模经验。为此,我们提出 FedEHR-Agents,一种面向自动化EHR建模的经验中心联邦代理优化框架。每家医院部署一个自主临床代理,通过历史记忆、任务评估和TextGrad提示优化,持续改进本地建模经验。联邦服务器则基于证据引导的经验聚合,整合异构医院间的可靠互补经验,并提炼为全局元提示用于后续本地优化。在真实世界多医院EHR基准上的大量实验表明,FedEHR-Agents在多种临床预测任务中持续优于本地及联邦基线,且对不同联邦规模和大模型骨干具有鲁棒性。结果证明,临床建模经验是超越传统参数中心联邦学习的有前景协作对象,指向联邦自主临床智能的发展方向。

原文摘要 · Abstract (English)

Recent advances in large language models are enabling autonomous clinical agents to perform increasingly complex electronic health record (EHR) modeling workflows. However, agents deployed at individual hospitals remain constrained by institution-specific data and modeling environments, while direct cross-hospital collaboration is restricted by the sensitivity of patient-level EHR data. Although federated learning (FL) provides a natural foundation for privacy-preserving collaboration, existing approaches remain predominantly model-centric, limiting federation to prediction models or their updates while overlooking the richer modeling experience accumulated by autonomous agents. To address this limitation, we propose FedEHR-Agents, an experience-centric federated agentic optimization framework for automated EHR modeling. Each hospital deploys an autonomous clinical EHR agent that performs data preprocessing and model development while refining local clinical modeling experience through historical memory, task-specific evaluation, and TextGrad-based prompt refinement. The federated server performs evidence-guided experience aggregation to integrate reliable and complementary modeling experience across heterogeneous hospitals and distills the aggregated experience into global meta-prompts for subsequent local refinement. Extensive experiments on real-world multi-hospital EHR benchmarks demonstrate that FedEHR-Agents consistently outperforms local and federated baselines across diverse clinical prediction tasks and remains robust across different federation scales and LLM backbones. These results establish clinical modeling experience as a promising collaborative object beyond conventional parameter-centric FL and point toward federated autonomous clinical intelligence.

联邦学习医疗AI大模型应用

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