Qingyu Chen
Publications
EHR-RAG: Bridging Long-Horizon Structured Electronic Health Records and Large Language Models via Enhanced Retrieval-Augmented Generation
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.
AI-generated data contamination erodes pathological variability and diagnostic reliability
Generative artificial intelligence (AI) is rapidly populating medical records with synthetic content, creating a feedback loop where future models are increasingly at risk of training on uncurated AI-generated data. However, the clinical consequences of this AI-generated data contamination remain unexplored. Here, we show that in the absence of mandatory human verification, this self-referential cycle drives a rapid erosion of pathological variability and diagnostic reliability. By analysing more than 800,000 synthetic data points across clinical text generation, vision-language reporting, and medical image synthesis, we find that models progressively converge toward generic phenotypes regardless of the model architecture. Specifically, rare but critical findings, including pneumothorax and effusions, vanish from the synthetic content generated by AI models, while demographic representations skew heavily toward middle-aged male phenotypes. Crucially, this degradation is masked by false diagnostic confidence; models continue to issue reassuring reports while failing to detect life-threatening pathology, with false reassurance rates tripling to 40%. Blinded physician evaluation confirms that this decoupling of confidence and accuracy renders AI-generated documentation clinically useless after just two generations. We systematically evaluate three mitigation strategies, finding that while synthetic volume scaling fails to prevent collapse, mixing real data with quality-aware filtering effectively preserves diversity. Ultimately, our results suggest that without policy-mandated human oversight, the deployment of generative AI threatens to degrade the very healthcare data ecosystems it relies upon.