arXiv subjects

Carlos Morato

Publications and source records attributed to Carlos Morato.

7 recordsLinked to original sources

arXiv2026

LearnActCoder: Role-Aware Error Memory for Adaptive Clinical Coding Agents

Clinical coding agents repeatedly encounter the same failure modes, including unsupported codes, missed documented conditions, specificity errors, and procedure-coding convention mismatches. We introduce Learn-Then-Act, an inference-time adaptation framework that converts errors from a small labeled LEARN batch into a structured Mistake Knowledge Database (MistakeKDB). False-negative lessons are routed to a recall-oriented Coder, while false-positive lessons are routed to a precision-oriented Judge. We instantiate the framework in LearnActCoder, a Coder-Judge clinical coding pipeline with lookup-table grounding where available. On 150 matched MIMIC-III notes, structured MistakeKDB improves CPT F1 by 5.9 percentage points, while raw-example and reflection-style memories remain near the no-memory baseline; the ICD-9 improvement is not significant. On a matched MIMIC-IV cohort, memory shifts ICD-10 coding toward higher precision at a recall cost, leaving F1 statistically unchanged. Applying the same memory to 1,000 held-out MIMIC-III notes maintains a stable ICD operating point, providing scale/stability evidence. Overall, the results are consistent with structured, feedback-derived error memory being useful for adapting clinical coding behavior across cases without weight updates or changes to the underlying workflow. Absolute CPT/HCPCS performance remains low, and the system is evaluated retrospectively rather than in clinical deployment.

cs.AI↗

arXiv2026

A Multi-Agent Pipeline for Source-Grounded Synthetic Note Generation from Longitudinal Structured EHR

Structured EHR is abundant but sparse, coded, and difficult to use directly for note-centric clinical modeling. We present MedNotes, a multi-agent synthetic data generation pipeline that converts longitudinal structured EHR into source-grounded clinical note representations under explicit quality control. MedNotes treats structured-data-to-text synthesis as a closed-loop agentic process: a generator proposes a note, evaluator agents diagnose factual, coverage, structural, and hallucination-related failures, and a router accepts, revises, or rejects the draft. On 1,485 EHRSHOT encounters, MedNotes achieves a 91.4% pass rate, with mean factual accuracy of 0.980, completeness of 99.1%, structural fidelity of 0.761, and 0.028 critical hallucinations per encounter. Iterative refinement improves acceptance from 69.4% to 91.4%. The resulting synthetic corpus improves downstream CPT prediction and paragraph-level section prediction when combined with limited real data.

cs.CL↗

arXiv2026

Structured Evidence Routing for Incident Risk Prediction from Multimodal Longitudinal EHRs

Incident risk prediction from longitudinal electronic health records (EHRs) is challenging because relevant signals are multimodal, weak in isolation, and distributed across irregular patient histories. We propose structured evidence routing, a router-predictor-reviewer workflow that separates full-record access from disease-specific assessment. The router organizes the complete pre-index EHR into a compact summary and targeted evidence slices; the predictor uses this evidence to form an evidence-linked risk assessment, which the reviewer critiques. For comparison with supervised EHRSHOT baselines, we pair the routed evidence summaries with a supervised classifier readout. Across five 1-year incident diagnosis tasks, our method reaches the AUROC range of established supervised EHRSHOT baselines and remains competitive on AUPRC, while exposing a patient-specific evidence trail. Internal pre-readout ablations further suggest that routing, laboratory evidence, task guidance, and review each contribute to performance.

cs.AI↗

arXiv2026

Foundation Agents Meet Agentic Deep Research: Evidence-Grounded Clinical Code Forecasting

Next-encounter ICD forecasting predicts which standardized diagnosis codes will be documented at a future visit from the longitudinal record available beforehand. The task is prospective and multi-label: the target note does not yet exist, and several codes may be correct. Structured EHR foundation models capture recurrence and temporal progression, whereas language foundation models generate flexible diagnostic hypotheses. We introduce ICD-Deepresearch, a DeepResearch workflow that composes these predictive foundation models with medical search and ICD dictionaries. Because no source reveals the future code set, research evaluates candidate transitions by linking patient evidence, external clinical relations, and exact code semantics under a fixed top-K budget. Candidate Generation uses SparseEHR to produce an EHR Prior that initializes two bounded Research Expansion rounds; an independent GPT-5 Direct Forecast supplies complementary candidates. Final Selection validates, deduplicates, and jointly ranks both paths, after which a separate module writes rationales without changing predictions. Finally ICD-Deepresearch achieves patient-averaged precision/recall of 24.60/35.09% on MIMIC-III and 25.14/48.32% on MIMIC-IV. Physicians rate 51% and 68% of its retrieved documents useful, compared with 22% and 39% for standalone GPT-5 web search and 32% and 41% for Medical Deep Research. ICD-Deepresearch therefore improves over the registered local comparators while retrieving evidence with higher physician-rated usefulness than the standalone research systems

cs.CL↗

arXiv2026

Context Poisoning as Extreme-Value Attention Interference in Long-Context Language Models

Large language models can process increasingly long prompts, yet their ability to locate and use decisive evidence may degrade as irrelevant or confusable context is added. We formulate this phenomenon, which we call context poisoning, as extreme-value interference in attention: the decisive-evidence score is upper-bounded, while the maximum score among effective distractors grows with their number. Under a softmax retrieval abstraction, we derive a finite-sample upper bound showing that maintaining a fixed accuracy target above base rate requires the evidence margin to scale as $Ω(\sqrt{\log N})$, where N denotes the effective distractor count rather than necessarily the raw context length. The analysis connects long-context degradation to score aliasing, positional aliasing, and softmax dilution. Controlled experiments show that retrieval accuracy decreases as total context grows in the presence of embedded hard negatives, that the same-format condition produces the largest observed accuracy drop among the tested distractor constructions at fixed context length, and that retrieval gating can improve evidence use while its net benefit depends on preserving evidence recall. These results motivate evidence bottlenecks, alias-resistant representations, retrieve-then-reason architectures, verifier-mediated memory, and contrastive anti-poison training.

cs.CL↗

arXiv2026

Text Over Image: Auditing Multimodal Robustness in Synthetic Medical Image Detection

With the rapid adoption of generative AI, synthetic medical images pose growing risks, including diagnostic deception and insurance fraud. Although prior work has explored vision-language model (VLM)-based synthetic image detection, these evaluations typically consider images in isolation. In clinical practice, however, images are interpreted alongside structured records and metadata, and VLMs are increasingly deployed under joint image-record inputs. We uncover a previously underexamined multimodal vulnerability: when given both modalities, VLMs may overweight record context in authenticity judgments, such that the same image receives different predictions solely due to changes in its accompanying text. This raises concerns about robustness in real-world deployment. To systematically characterize this effect, we reformulate synthetic medical image detection as an audit of multimodal robustness at the image-record interface and introduce a paired benchmark that holds the image fixed while swapping controlled metadata variants. Across multiple imaging modalities, we evaluate diverse open-weight and frontier API VLMs and find that changing the metadata context alone can flip authenticity judgments, with accuracy on authentic images dropping by 61.1% on average under an explicit AI-origin tag. We further propose an inference-time mitigation pipeline that detects and neutralizes provenance shortcuts without model retraining, substantially outperforming direct prompt-based suppression on the affected subset. Our benchmark provides a standardized tool for assessing and improving multimodal robustness beyond image-only settings. Code and data will be released upon acceptance.

cs.CV↗

arXiv2026

Reasoning Quality Emerges Early: Data Curation for Reasoning Models

Supervised fine-tuning (SFT) on a small, high-quality set of long reasoning traces is an effective approach for eliciting strong reasoning capabilities in Large Language Models (LLMs). However, existing methods for curating high-quality SFT data rely heavily on strong reasoning models to filter examples based on diversity and difficulty, making the curation process costly while often yielding suboptimal data quality. In this work, we show that diverse and challenging reasoning examples can be identified using only the initial reasoning tokens. Specifically, we demonstrate that difficult problems can be reliably detected based on the loss of the first 100 reasoning tokens evaluated at a randomly perturbed checkpoint of the pretrained model. We further show that examples exhibiting similar loss patterns over their first 1k reasoning tokens across a small number of perturbed checkpoints extrapolating along the fine-tuning trajectory provably induce similar gradients. We validate our approach through extensive experiments on fine-tuning Qwen2.5-7B and Llama3.1-8B models on the M23K medical reasoning and OpenThoughts-Math datasets. Our method outperforms existing baselines by up to 1.7% while being 91% more token efficient.

cs.LG↗