# LLMD: A Large Language Model for Interpreting Longitudinal Medical Records

arXiv: https://arxiv.org/abs/2410.12860 · HTML: https://mlsanity.com/paper/2410.12860/

## Key facts

- Cited by 2 papers in the map (data through 14 Oct 2026).
- Builds on 11 of its 28 references that are in the map.
- First posted on arXiv 11 Oct 2024.

## Builds on (most cited first, 11 of 11)

- [LLaMA: Open and Efficient Foundation Language Models](https://mlsanity.com/paper/2302.13971/) (2023)
- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks](https://mlsanity.com/paper/2005.11401/) (2020)
- [Finetuned Language Models Are Zero-Shot Learners](https://mlsanity.com/paper/2109.01652/) (2021)
- [REALM: Retrieval-Augmented Language Model Pre-Training](https://mlsanity.com/paper/2002.08909/) (2020)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [A Survey on Evaluation of Large Language Models](https://mlsanity.com/paper/2307.03109/) (2023)
- [Capabilities of GPT-4 on Medical Challenge Problems](https://mlsanity.com/paper/2303.13375/) (2023)
- [Efficient and Effective Text Encoding for Chinese LLaMA and Alpaca](https://mlsanity.com/paper/2304.08177/) (2023)
- [Scalable and accurate deep learning for electronic health records](https://mlsanity.com/paper/1801.07860/) (2018)
- [Delving Deep into Label Smoothing](https://mlsanity.com/paper/2011.12562/) (2020)

## Built on by (most cited first, 2 of 2)

- [HARMON-E: Hierarchical Agentic Reasoning for Multimodal Oncology Notes to Extract Structured Data](https://mlsanity.com/paper/2512.19864/) (2025)
- [PredAct-Bench: Benchmarking Tool-Augmented Dialogue under Controlled Tool Noise](https://mlsanity.com/paper/2608.02372/) (2026)

## Abstract (arXiv)

We introduce LLMD, a large language model designed to analyze a patient's medical history based on their medical records. Along with domain knowledge, LLMD is trained on a large corpus of records collected over time and across facilities, as well as tasks and labels that make nuanced connections among them. This approach is critical to an accurate picture of patient health, and has distinctive advantages over models trained on knowledge alone, unlabeled records, structured EHR data, or records from a single health system. The recipe for LLMD continues pretraining a foundational model on both domain knowledge and the contents of millions of records. These span an average of 10 years of care and as many as 140 care sites per patient. LLMD is then instruction fine-tuned on structuring and abstraction tasks. The former jointly identify and normalize document metadata, provenance information, clinical named-entities, and ontology mappings, while the latter roll these into higher-level representations, such a continuous era of time a patient was on a medication. LLMD is deployed within a layered validation system that includes continual random audits and review by experts, e.g. based on uncertainty, disease-specific rules, or use-case. LLMD exhibits large gains over both more-powerful generalized models and domain-specific models. On medical knowledge benchmarks, LLMD-8B achieves state of the art accuracy on PubMedQA text responses, besting orders-of-magnitude larger models. On production tasks, we show that LLMD significantly outperforms all other models evaluated, and among alternatives, large general purpose LLMs like GPT-4o are more accurate than models emphasizing medical knowledge. We find strong evidence that accuracy on today's medical benchmarks is not the most significant factor when analyzing real-world patient data, an insight with implications for future medical LLMs.'