# Detecting Clinical Discrepancies in Health Coaching Agents: A Dual-Stream Memory and Reconciliation Architecture

arXiv: https://arxiv.org/abs/2604.27045 · HTML: https://mlsanity.com/paper/2604.27045/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical and scientific domain agents, one of 16 directions in LLM agents and tool use.
- Builds on 15 of its 37 references that are in the map.
- First posted on arXiv 29 Apr 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, 15 of 15)

- [Generative Agents: Interactive Simulacra of Human Behavior](https://mlsanity.com/paper/2304.03442/) (2023)
- [MemGPT: Towards LLMs as Operating Systems](https://mlsanity.com/paper/2310.08560/) (2023)
- [Publicly Available Clinical BERT Embeddings](https://mlsanity.com/paper/1904.03323/) (2019)
- [Evaluating Very Long-Term Conversational Memory of LLM Agents](https://mlsanity.com/paper/2402.17753/) (2024)
- [Mem0: Building Production-Ready AI Agents with Scalable Long-Term Memory](https://mlsanity.com/paper/2504.19413/) (2025)
- [LongMemEval: Benchmarking Chat Assistants on Long-Term Interactive Memory](https://mlsanity.com/paper/2410.10813/) (2024)
- [Zep: A Temporal Knowledge Graph Architecture for Agent Memory](https://mlsanity.com/paper/2501.13956/) (2025)
- [Med-BERT: pre-trained contextualized embeddings on large-scale structured electronic health records for disease prediction](https://mlsanity.com/paper/2005.12833/) (2020)
- [Evaluating Memory in LLM Agents via Incremental Multi-Turn Interactions](https://mlsanity.com/paper/2507.05257/) (2025)
- [MemoryBench: A Benchmark for Memory and Continual Learning in LLM Systems](https://mlsanity.com/paper/2510.17281/) (2025)
- [FHIR-AgentBench: Benchmarking LLM Agents for Realistic Interoperable EHR Question Answering](https://mlsanity.com/paper/2509.19319/) (2025)
- [BeliefShift: Benchmarking Temporal Belief Consistency and Opinion Drift in LLM Agents](https://mlsanity.com/paper/2603.23848/) (2026)
- [AI Agents for Conversational Patient Triage: Preliminary Simulation-Based Evaluation with Real-World EHR Data](https://mlsanity.com/paper/2506.04032/) (2025)
- [PrecLLM: A Privacy-Preserving Framework for Efficient Clinical Annotation Extraction from Unstructured EHRs using Small-Scale LLMs](https://mlsanity.com/paper/2412.02868/) (2024)
- [Data Quality Challenges in Retrieval-Augmented Generation](https://mlsanity.com/paper/2510.00552/) (2025)

## Abstract (arXiv)

As Large Language Model (LLM) agents transition from single-session tools to persistent systems managing longitudinal healthcare journeys, their memory architectures face a critical challenge: reconciling two imperfect sources of truth. The patient's evolving self-report is current but prone to recall bias, while the Electronic Health Record (EHR) is medically validated but frequently stale. General-purpose agent memory systems optimize for coherence by overwriting older facts with the user's latest statement, a pattern that risks safety failures when applied to clinical data. We introduce a Dual-Stream Memory Architecture that strictly separates the patient narrative from the structured clinical record (FHIR), governed by a dedicated Reconciliation Engine that evaluates every extracted memory against the patient's FHIR profile and classifies discrepancies by type, severity, and the specific FHIR resources involved. We evaluate this architecture on 26 patients across 675 longitudinal wellness coaching sessions, using a hybrid dataset that interleaves real provider-patient transcripts with synthetic, FHIR-grounded clinical scenarios. In isolated testing, the engine detects 84.4% of designed clinical discrepancies with 86.7% safety-critical recall. By coupling extraction and reconciliation evaluation on the same data, we directly quantify a 13.6% error cascade, tracing the degradation to clinical details lost during memory extraction from unstructured conversation rather than to downstream classification errors. These findings establish that validating patient-reported memories against clinical records is both feasible and necessary for safe deployment of longitudinal health agents.