# From Conversation to Query Execution: Benchmarking User and Tool Interactions for EHR Database Agents

arXiv: https://arxiv.org/abs/2509.23415 · HTML: https://mlsanity.com/paper/2509.23415/

## Key facts

- Cited by 1 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 4 of its 30 references that are in the map.
- First posted on arXiv 27 Sep 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, 4 of 4)

- [Evaluating Large Language Models Trained on Code](https://mlsanity.com/paper/2107.03374/) (2021)
- [MedAgentBench: A Realistic Virtual EHR Environment to Benchmark Medical LLM Agents](https://mlsanity.com/paper/2501.14654/) (2025)
- [Reliable LLM-based User Simulator for Task-Oriented Dialogue Systems](https://mlsanity.com/paper/2402.13374/) (2024)
- [MedAgentGym: A Scalable Agentic Training Environment for Code-Centric Reasoning in Biomedical Data Science](https://mlsanity.com/paper/2506.04405/) (2025)

## Built on by (most cited first, 1 of 1)

- [Ascent: An Agentic System over the Model Context Protocol for Real-World Clinical Data Analysis](https://mlsanity.com/paper/2609.24620/) (2026)

## Abstract (arXiv)

Despite the impressive performance of LLM-powered agents, their adoption for Electronic Health Record (EHR) data access remains limited by the absence of benchmarks that adequately capture real-world clinical data access flows. In practice, two core challenges hinder deployment: query ambiguity from vague user questions and value mismatch between user terminology and database entries. To address this, we introduce EHR-ChatQA, an interactive database question answering benchmark that evaluates the end-to-end workflow of database agents: clarifying user questions, using tools to resolve value mismatches, and generating correct SQL to deliver accurate answers. To cover diverse patterns of query ambiguity and value mismatch, EHR-ChatQA assesses agents in a simulated environment with an LLM-based user across two interaction flows: Incremental Query Refinement (IncreQA), where users add constraints to existing queries, and Adaptive Query Refinement (AdaptQA), where users adjust their search goals mid-conversation. Experiments with state-of-the-art LLMs (e.g., o4-mini and Gemini-2.5-Flash) over five i.i.d. trials show that while the best-performing agents achieve Pass@5 of over 90% (at least one of five trials) on IncreQA and 60-70% on AdaptQA, their Pass^5 (consistent success across all five trials) is substantially lower, with gaps of up to about 60%. These results underscore the need to build agents that are not only performant but also robust for the safety-critical EHR domain. Finally, we provide diagnostic insights into common failure modes to guide future agent development. Our code and data are publicly available at https://github.com/glee4810/EHR-ChatQA.