# Trustworthy Agents for Electronic Health Records through Confidence Estimation

arXiv: https://arxiv.org/abs/2508.19096 · HTML: https://mlsanity.com/paper/2508.19096/

## Key facts

- Cited by 2 papers in the map (data through 14 Oct 2026).
- Placed in Medical and scientific domain agents, one of 16 directions in LLM agents and tool use.
- Builds on 16 of its 27 references that are in the map.
- First posted on arXiv 26 Aug 2025.

## Placed in

- LLM agents and tool use / [Medical and scientific domain agents](https://mlsanity.com/agents/medical-and-scientific-domain-agents/)

## Builds on (most cited first, 16 of 16)

- [ReAct: Synergizing Reasoning and Acting in Language Models](https://mlsanity.com/paper/2210.03629/) (2022)
- [Reflexion: Language Agents with Verbal Reinforcement Learning](https://mlsanity.com/paper/2303.11366/) (2023)
- [TruthfulQA: Measuring How Models Mimic Human Falsehoods](https://mlsanity.com/paper/2109.07958/) (2021)
- [G-Eval: NLG Evaluation using GPT-4 with Better Human Alignment](https://mlsanity.com/paper/2303.16634/) (2023)
- [Can LLMs Express Their Uncertainty? An Empirical Evaluation of Confidence Elicitation in LLMs](https://mlsanity.com/paper/2306.13063/) (2023)
- [DIN-SQL: Decomposed In-Context Learning of Text-to-SQL with Self-Correction](https://mlsanity.com/paper/2304.11015/) (2023)
- [How Can We Know When Language Models Know? On the Calibration of Language Models for Question Answering](https://mlsanity.com/paper/2012.00955/) (2020)
- [LLMs Know More Than They Show: On the Intrinsic Representation of LLM Hallucinations](https://mlsanity.com/paper/2410.02707/) (2024)
- [Quantifying Uncertainty in Answers from any Language Model and Enhancing their Trustworthiness](https://mlsanity.com/paper/2308.16175/) (2023)
- [On Verbalized Confidence Scores for LLMs](https://mlsanity.com/paper/2412.14737/) (2024)
- [Text-to-SQL Generation for Question Answering on Electronic Medical Records](https://mlsanity.com/paper/1908.01839/) (2019)
- [Factual Confidence of LLMs: on Reliability and Robustness of Current Estimators](https://mlsanity.com/paper/2406.13415/) (2024)
- [Creating Trustworthy LLMs: Dealing with Hallucinations in Healthcare AI](https://mlsanity.com/paper/2311.01463/) (2023)
- [MedHalu: Hallucinations in Responses to Healthcare Queries by Large Language Models](https://mlsanity.com/paper/2409.19492/) (2024)
- [Assessing the Reliability of Large Language Model Knowledge](https://mlsanity.com/paper/2310.09820/) (2023)
- [MedHal: a Synthetic Dataset for Medical Hallucination Detection](https://mlsanity.com/paper/2504.08596/) (2025)

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

- [EHR-RobustGym: Benchmarking and Training Agents for Robust Clinical Reasoning](https://mlsanity.com/paper/2609.39371/) (2026)
- [What Can Component-Replacement Evidence Establish? A Critical Scoping Review of Local Decisions in LLM Agents](https://mlsanity.com/paper/2609.39989/) (2026)

## Abstract (arXiv)

Large language models (LLMs) show promise for extracting information from Electronic Health Records (EHR) and supporting clinical decisions. However, deployment in clinical settings faces challenges due to hallucination risks. We propose Hallucination Controlled Accuracy at k% (HCAcc@k%), a novel metric quantifying the accuracy-reliability trade-off at varying confidence thresholds. We introduce TrustEHRAgent, a confidence-aware agent incorporating stepwise confidence estimation for clinical question answering. Experiments on MIMIC-III and eICU datasets show TrustEHRAgent outperforms baselines under strict reliability constraints, achieving improvements of 44.23%p and 25.34%p at HCAcc@70% while baseline methods fail at these thresholds. These results highlight limitations of traditional accuracy metrics in evaluating healthcare AI agents. Our work contributes to developing trustworthy clinical agents that deliver accurate information or transparently express uncertainty when confidence is low.