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arXiv · 2510.25628

EHR-R1: A Reasoning-Enhanced Foundational Language Model for Electronic Health Record Analysis

Yusheng Liao·Chaoyi Wu·Junwei Liu·Shuyang Jiang·Pengcheng Qiu·Haowen Wang·Yun Yue·Shuai Zhen·Jian Wang·Qianrui Fan·Jinjie Gu·Ya Zhang·Yanfeng Wang·Yu Wang·Weidi Xie
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Abstract

Electronic Health Records (EHRs) contain rich yet complex information, and their automated analysis is critical for clinical decision-making. Despite recent advances of large language models (LLMs) in clinical workflows, their ability to analyze EHRs remains limited due to narrow task coverage and lack of EHR-oriented reasoning capabilities. This paper aims to bridge the gap, specifically, we present EHR-Ins, a large-scale, comprehensive EHR reasoning instruction dataset, comprising 300k high-quality reasoning cases and 4M non-reasoning cases across 42 distinct EHR tasks. Its core innovation is a thinking-graph-driven framework that enables to generate high-quality reasoning data at scale. Based on it, we develop EHR-R1, a series of reasoning-enhanced LLMs with up to 72B parameters tailored for EHR analysis. Through a multi-stage training paradigm, including domain adaptation, reasoning enhancement, and reinforcement learning, EHR-R1 systematically acquires domain knowledge and diverse reasoning capabilities, enabling accurate and robust EHR analysis. Lastly, we introduce EHR-Bench, a new benchmark curated from MIMIC-IV, spanning 42 tasks, to comprehensively assess reasoning and prediction across EHR scenarios. In experiments, we show that the resulting EHR-R1 consistently outperforms state-of-the-art commercial and open-source LLMs (including DeepSeek-V3 and GPT-4o), surpassing GPT-4o by over 30 points on MIMIC-Bench and achieving a 10\% higher zero-shot AUROC on EHRSHOT. Collectively, EHR-Ins, EHR-R1, and EHR-Bench have significantly advanced the development for more reliable and clinically relevant EHR analysis.

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Yusheng Liao, Chaoyi Wu, Junwei Liu, Shuyang Jiang, Pengcheng Qiu, Haowen Wang, Yun Yue, Shuai Zhen, Jian Wang, Qianrui Fan, Jinjie Gu, Ya Zhang, Yanfeng Wang, Yu Wang, Weidi Xie. 2025-11-25. EHR-R1: A Reasoning-Enhanced Foundational Language Model for Electronic Health Record Analysis. https://arxiv.org/abs/2510.25628

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