# Empowering Locally Deployable Medical Agent via State Enhanced Logical Skills for FHIR-based Clinical Tasks

arXiv: https://arxiv.org/abs/2603.06902 · HTML: https://mlsanity.com/paper/2603.06902/

## 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 12 of its 30 references that are in the map.
- First posted on arXiv 6 Mar 2026.

## 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, 12 of 12)

- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [A-MEM: Agentic Memory for LLM Agents](https://mlsanity.com/paper/2502.12110/) (2025)
- [ExpeL: LLM Agents Are Experiential Learners](https://mlsanity.com/paper/2308.10144/) (2023)
- [Reinforcement Learning in Healthcare: A Survey](https://mlsanity.com/paper/1908.08796/) (2019)
- [Med-R1: Reinforcement Learning for Generalizable Medical Reasoning in Vision-Language Models](https://mlsanity.com/paper/2503.13939/) (2025)
- [A Survey of LLM-based Agents in Medicine: How far are we from Baymax?](https://mlsanity.com/paper/2502.11211/) (2025)
- [Scalable Deep Learning on Distributed Infrastructures: Challenges, Techniques and Tools](https://mlsanity.com/paper/1903.11314/) (2019)
- [Large Language Model Inference Acceleration: A Comprehensive Hardware Perspective](https://mlsanity.com/paper/2410.04466/) (2024)
- [FHIR-AgentBench: Benchmarking LLM Agents for Realistic Interoperable EHR Question Answering](https://mlsanity.com/paper/2509.19319/) (2025)
- [Training LLMs for EHR-Based Reasoning Tasks via Reinforcement Learning](https://mlsanity.com/paper/2505.24105/) (2025)
- [Almanac Copilot: Towards Autonomous Electronic Health Record Navigation](https://mlsanity.com/paper/2405.07896/) (2024)
- [The Inherent Limits of Pretrained LLMs: The Unexpected Convergence of Instruction Tuning and In-Context Learning Capabilities](https://mlsanity.com/paper/2501.08716/) (2025)

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

- [From Single Chatbots to Governed Agent Ecosystems: An Agentic AI Pattern Catalogue and Orchestration Framework for Mission-Critical Hospital Information Management Systems](https://mlsanity.com/paper/2608.07627/) (2026)

## Abstract (arXiv)

While Large Language Models demonstrate immense potential as proactive Medical Agents, their real-world deployment is severely bottlenecked by data scarcity under privacy constraints. To overcome this, we propose State-Enhanced Logical-Skill Memory (SELSM), a training-free framework that distills simulated clinical trajectories into entity-agnostic operational rules within an abstract skill space. During inference, a Query-Anchored Two-Stage Retrieval mechanism dynamically fetches these entity-agnostic logical priors to guide the agent's step-by-step reasoning, effectively resolving the state polysemy problem. Evaluated on MedAgentBench -- the only authoritative high-fidelity virtual EHR sandbox benchmarked with real clinical data -- SELSM substantially elevates the zero-shot capabilities of locally deployable foundation models (30B--32B parameters). Notably, on the Qwen3-30B-A3B backbone, our framework completely eliminates task chain breakdowns to achieve a 100% completion rate, boosting the overall success rate by an absolute 22.67% and significantly outperforming existing memory-augmented baselines. This study demonstrates that equipping models with a dynamically updatable, state-enhanced cognitive scaffold is a privacy-preserving and computationally efficient pathway for local adaptation of AI agents to clinical information systems. While currently validated on FHIR-based EHR interactions as an initial step, the entity-agnostic design of SELSM provides a principled foundation toward broader clinical deployment.