Retrieval-Augmented Generation systems are essential for providing fact-based guidance from Malaysian Clinical Practice Guidelines. However, their effectiveness with image-based queries is limited, as general Vision-Language Model captions often lack clinical specificity and factual grounding. This study proposes and validates a framework to specialize the MedGemma model for generating high-fidelity captions that serve as superior queries. To overcome data scarcity, we employ a knowledge distillation pipeline to create a synthetic dataset across dermatology, fundus, and chest radiography domains, and fine-tune MedGemma using the parameter-efficient QLoRA method. Performance was rigorously assessed through a dual framework measuring both classification accuracy and, via a novel application of the RAGAS framework, caption faithfulness, relevancy, and correctness. The fine-tuned model demonstrated substantial improvements in classification performance, while RAGAS evaluation confirmed significant gains in caption faithfulness and correctness, validating the models ability to produce reliable, factually grounded descriptions. This work establishes a robust pipeline for specializing medical VLMs and validates the resulting model as a high-quality query generator, laying the groundwork for enhancing multimodal RAG systems in evidence-based clinical decision support.

Clinicians face growing information overload from biomedical literature and guidelines, hindering evidence-based care. Retrieval-augmented generation (RAG) with large language models may provide fast, provenance-linked answers, but requires real-world evaluation. We describe iatroX, a UK-centred RAG-based clinical reference platform, and report early adoption, usability, and perceived clinical value from a formative implementation evaluation. Methods comprised a retrospective analysis of usage across web, iOS, and Android over 16 weeks (8 April-31 July 2025) and an in-product intercept survey. Usage metrics were drawn from web and app analytics with bot filtering. A client-side script randomized single-item prompts to approx. 10% of web sessions from a predefined battery assessing usefulness, reliability, and adoption intent. Proportions were summarized with Wilson 95% confidence intervals; free-text comments underwent thematic content analysis. iatroX reached 19,269 unique web users, 202,660 engagement events, and approx. 40,000 clinical queries. Mobile uptake included 1,960 iOS downloads and Android growth (peak >750 daily active users). The survey yielded 1,223 item-level responses: perceived usefulness 86.2% (95% CI 74.8-93.9%; 50/58); would use again 93.3% (95% CI 68.1-99.8%; 14/15); recommend to a colleague 88.4% (95% CI 75.1-95.9%; 38/43); perceived accuracy 75.0% (95% CI 58.8-87.3%; 30/40); reliability 79.4% (95% CI 62.1-91.3%; 27/34). Themes highlighted speed, guideline-linked answers, and UK specificity. Early real-world use suggests iatroX can mitigate information overload and support timely answers for UK clinicians. Limitations include small per-item samples and early-adopter bias; future work will include accuracy audits and prospective studies on workflow and care quality.

In recent years, the field of medical informatics has seen significant advancements with the introduction of medical large language models (LLMs). These models, powered by artificial intelligence, have demonstrated remarkable capabilities in understanding and generating medical text, providing valuable assistance in clinical decision - making, diagnostics, and patient care. Prom inent examples include models such as Meditron [1], BioMistral [2] and OpenBioLLM [3], which have shown considerable promise in various medical applications. However, despite these advancements, the inherent limitations of medical LLMs highlight the need for more robust solutions.

This study evaluated Sherpa Rx, an artificial intelligence tool leveraging large language models and retrieval-augmented generation (RAG) for pharmacogenomics, to validate its performance on key response metrics. Sherpa Rx integrated Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines with Pharmacogenomics Knowledgebase (PharmGKB) data to generate contextually relevant responses. A dataset (N=260 queries) spanning 26 CPIC guidelines was used to evaluate drug-gene interactions, dosing recommendations, and therapeutic implications. In Phase 1, only CPIC data was embedded. Phase 2 additionally incorporated PharmGKB content. Responses were scored on accuracy, relevance, clarity, completeness (5-point Likert scale), and recall. Wilcoxon signed-rank tests compared accuracy between Phase 1 and Phase 2, and between Phase 2 and ChatGPT-4omini. A 20-question quiz assessed the tool's real-world applicability against other models. In Phase 1 (N=260), Sherpa Rx demonstrated high performance of accuracy 4.9, relevance 5.0, clarity 5.0, completeness 4.8, and recall 0.99. The subset analysis (N=20) showed improvements in accuracy (4.6 vs. 4.4, Phase 2 vs. Phase 1 subset) and completeness (5.0 vs. 4.8). ChatGPT-4omini performed comparably in relevance (5.0) and clarity (4.9) but lagged in accuracy (3.9) and completeness (4.2). Differences in accuracy between Phase 1 and Phase 2 was not statistically significant. However, Phase 2 significantly outperformed ChatGPT-4omini. On the 20-question quiz, Sherpa Rx achieved 90% accuracy, outperforming other models. Integrating additional resources like CPIC and PharmGKB with RAG enhances AI accuracy and performance. This study highlights the transformative potential of generative AI like Sherpa Rx in pharmacogenomics, improving decision-making with accurate, personalized responses.

Artificial intelligence (AI) has demonstrated significant potential in transforming healthcare through the analysis and modeling of electronic health records (EHRs). However, the inherent heterogeneity, temporal irregularity, and domain-specific nature of EHR data present unique challenges that differ fundamentally from those in vision and natural language tasks. This survey offers a comprehensive overview of recent advancements at the intersection of deep learning, large language models (LLMs), and EHR modeling. We introduce a unified taxonomy that spans five key design dimensions: data-centric approaches, neural architecture design, learning-focused strategies, multimodal learning, and LLM-based modeling systems. Within each dimension, we review representative methods addressing data quality enhancement, structural and temporal representation, self-supervised learning, and integration with clinical knowledge. We further highlight emerging trends such as foundation models, LLM-driven clinical agents, and EHR-to-text translation for downstream reasoning. Finally, we discuss open challenges in benchmarking, explainability, clinical alignment, and generalization across diverse clinical settings. This survey aims to provide a structured roadmap for advancing AI-driven EHR modeling and clinical decision support. For a comprehensive list of EHR-related methods, kindly refer to https://survey-on-tabular-data.github.io/.

Large language models (LLMs) show promise for supporting clinical decision-making in complex fields such as rheumatology. Our evaluation shows that smaller language models (SLMs), combined with retrieval-augmented generation (RAG), achieve higher diagnostic and therapeutic performance than larger models, while requiring substantially less energy and enabling cost-efficient, local deployment. These features are attractive for resource-limited healthcare. However, expert oversight remains essential, as no model consistently reached specialist-level accuracy in rheumatology.

Enhancing clinical decision support (CDS), reducing documentation burdens, and improving patient health literacy remain persistent challenges in digital health. This paper presents an open-source, agent-based framework that integrates Large Language Models (LLMs) with HL7 FHIR data via the Model Context Protocol (MCP) for dynamic extraction and reasoning over electronic health records (EHRs). Built on the established MCP-FHIR implementation, the framework enables declarative access to diverse FHIR resources through JSON-based configurations, supporting real-time summarization, interpretation, and personalized communication across multiple user personas, including clinicians, caregivers, and patients. To ensure privacy and reproducibility, the framework is evaluated using synthetic EHR data from the SMART Health IT sandbox (https://r4.smarthealthit.org/), which conforms to the FHIR R4 standard. Unlike traditional approaches that rely on hardcoded retrieval and static workflows, the proposed method delivers scalable, explainable, and interoperable AI-powered EHR applications. The agentic architecture further supports multiple FHIR formats, laying a robust foundation for advancing personalized digital health solutions.

--We introduce PRISM (Predictive Reasoning in Sequential Medicine), a transformer-based architecture designed to model the sequential progression of clinical decision-making processes. Unlike traditional approaches that rely on isolated diagnostic classification, PRISM frames clinical trajectories as tokenized sequences of events -- including diagnostic tests, laboratory results, and diagnoses -- and learns to predict the most probable next steps in the patient diagnostic journey. Leveraging a large custom clinical vocabulary and an autoregressive training objective, PRISM demonstrates the ability to capture complex dependencies across longitudinal patient timelines. Experimental results show substantial improvements over random baselines in next-token prediction tasks, with generated sequences reflecting realistic diagnostic pathways, laboratory result progressions, and clinician ordering behaviors. These findings highlight the feasibility of applying generative language modeling techniques to structured medical event data, enabling applications in clinical decision support, simulation, and education. PRISM establishes a foundation for future advancements in sequence-based healthcare modeling, bridging the gap between machine learning architectures and real-world diagnostic reasoning. Accurate and timely clinical decision-making is fundamental to high-quality patient care.

While large language models (LLMs) achieve near-perfect scores on medical licensing exams, these evaluations inadequately reflect the complexity and diversity of real-world clinical practice. We introduce MedHELM, an extensible evaluation framework for assessing LLM performance for medical tasks with three key contributions. First, a clinician-validated taxonomy spanning 5 categories, 22 subcategories, and 121 tasks developed with 29 clinicians. Second, a comprehensive benchmark suite comprising 35 benchmarks (17 existing, 18 newly formulated) providing complete coverage of all categories and subcategories in the taxonomy. Third, a systematic comparison of LLMs with improved evaluation methods (using an LLM-jury) and a cost-performance analysis. Evaluation of 9 frontier LLMs, using the 35 benchmarks, revealed significant performance variation. Advanced reasoning models (DeepSeek R1: 66% win-rate; o3-mini: 64% win-rate) demonstrated superior performance, though Claude 3.5 Sonnet achieved comparable results at 40% lower estimated computational cost. On a normalized accuracy scale (0-1), most models performed strongly in Clinical Note Generation (0.73-0.85) and Patient Communication & Education (0.78-0.83), moderately in Medical Research Assistance (0.65-0.75), and generally lower in Clinical Decision Support (0.56-0.72) and Administration & Workflow (0.53-0.63). Our LLM-jury evaluation method achieved good agreement with clinician ratings (ICC = 0.47), surpassing both average clinician-clinician agreement (ICC = 0.43) and automated baselines including ROUGE-L (0.36) and BERTScore-F1 (0.44). Claude 3.5 Sonnet achieved comparable performance to top models at lower estimated cost. These findings highlight the importance of real-world, task-specific evaluation for medical use of LLMs and provides an open source framework to enable this.

The use of Large language models (LLMs) to augment clinical decision support systems is a topic with rapidly growing interest, but current shortcomings such as hallucinations and lack of clear source citations make them unreliable for use in the clinical environment. This study evaluates Ask Avo, an LLM-derived software by AvoMD that incorporates a proprietary Language Model Augmented Retrieval (LMAR) system, in-built visual citation cues, and prompt engineering designed for interactions with physicians, against ChatGPT-4 in end-user experience for physicians in a simulated clinical scenario environment. Eight clinical questions derived from medical guideline documents in various specialties were prompted to both models by 62 study participants, with each response rated on trustworthiness, actionability, relevancy, comprehensiveness, and friendly format from 1 to 5. Ask Avo significantly outperformed ChatGPT-4 in all criteria: trustworthiness (4.52 vs. 3.34, p<0.001), actionability (4.41 vs. 3.19, p<0.001), relevancy (4.55 vs. 3.49, p<0.001), comprehensiveness (4.50 vs. 3.37, p<0.001), and friendly format (4.52 vs. 3.60, p<0.001). Our findings suggest that specialized LLMs designed with the needs of clinicians in mind can offer substantial improvements in user experience over general-purpose LLMs. Ask Avo's evidence-based approach tailored to clinician needs shows promise in the adoption of LLM-augmented clinical decision support software.