TRACE: Temporal Reasoning via Agentic Context Evolution for Streaming Electronic Health Records (EHRs)

2026-02-13

Technology Category

• Machine Learning: Large Multimodal Models (LMMs)
• Cognitive Modeling & Cognitive Systems: Conceptual Inference and Reasoning
• Natural Language Processing: (Large) Language Models

Application Category

• Semantics and Knowledge: Data modeling to support human-machine intelligence, including LLMs agents, intelligent system behavior, explanations, and user-friendly interactions
• Search and Retrieval-Augmented AI: Large language models for search
• User Modeling, Personalization and Recommendation: Large Language Models (LLM) for user modeling and recommendation

Abstract

Large Language Models (LLMs) encode extensive medical knowledge but struggle to apply it reliably to longitudinal patient trajectories, where evolving clinical states, irregular timing, and heterogeneous events degrade performance over time. Existing adaptation strategies rely on fine-tuning or retrieval-based augmentation, which introduce computational overhead, privacy constraints, or instability under long contexts. We introduce TRACE (Temporal Reasoning via Agentic Context Evolution), a framework that enables temporal clinical reasoning with frozen LLMs by explicitly structuring and maintaining context rather than extending context windows or updating parameters. TRACE operates over a dual-memory architecture consisting of a static Global Protocol encoding institutional clinical rules and a dynamic Individual Protocol tracking patient-specific state. Four agentic components, Router, Reasoner, Auditor, and Steward, coordinate over this structured memory to support temporal inference and state evolution. The framework maintains bounded inference cost via structured state compression and selectively audits safety-critical clinical decisions. Evaluated on longitudinal clinical event streams from MIMIC-IV, TRACE significantly improves next-event prediction accuracy, protocol adherence, and clinical safety over long-context and retrieval-augmented baselines, while producing interpretable and auditable reasoning traces.

Problem

• Temporal Reasoning
• Streaming EHRs
• Longitudinal Patient Trajectories
• Clinical State Evolution
• Large Language Models

Innovation

• Temporal Reasoning
• Agentic Architecture
• Structured Context Compression
• Frozen LLMs
• Clinical Safety