# EHRBench: An Automated and Reliable EHR-based Benchmark for Clinical Decision Making with LLMs

arXiv: https://arxiv.org/abs/2605.30637 · HTML: https://mlsanity.com/paper/2605.30637/

## Key facts

- Cited by 2 papers in the map (data through 14 Oct 2026).
- Builds on 58 of its 118 references that are in the map.
- First posted on arXiv 28 May 2026.

## Builds on (most cited first, 30 of 58)

- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [Qwen2.5 Technical Report](https://mlsanity.com/paper/2412.15115/) (2024)
- [MMMU: A Massive Multi-discipline Multimodal Understanding and Reasoning Benchmark for Expert AGI](https://mlsanity.com/paper/2311.16502/) (2023)
- [A Survey on Hallucination in Large Language Models: Principles, Taxonomy, Challenges, and Open Questions](https://mlsanity.com/paper/2311.05232/) (2023)
- [gpt-oss-120b & gpt-oss-20b Model Card](https://mlsanity.com/paper/2508.10925/) (2025)
- [What Disease does this Patient Have? A Large-scale Open Domain Question Answering Dataset from Medical Exams](https://mlsanity.com/paper/2009.13081/) (2020)
- [ChatGLM: A Family of Large Language Models from GLM-130B to GLM-4 All Tools](https://mlsanity.com/paper/2406.12793/) (2024)
- [HealthBench: Evaluating Large Language Models Towards Improved Human Health](https://mlsanity.com/paper/2505.08775/) (2025)
- [RAGTruth: A Hallucination Corpus for Developing Trustworthy Retrieval-Augmented Language Models](https://mlsanity.com/paper/2401.00396/) (2023)
- [HuatuoGPT-o1, Towards Medical Complex Reasoning with LLMs](https://mlsanity.com/paper/2412.18925/) (2024)
- [On LLMs-Driven Synthetic Data Generation, Curation, and Evaluation: A Survey](https://mlsanity.com/paper/2406.15126/) (2024)
- [AgentClinic: a multimodal agent benchmark to evaluate AI in simulated clinical environments](https://mlsanity.com/paper/2405.07960/) (2024)
- [MedXpertQA: Benchmarking Expert-Level Medical Reasoning and Understanding](https://mlsanity.com/paper/2501.18362/) (2025)
- [OmniMedVQA: A New Large-Scale Comprehensive Evaluation Benchmark for Medical LVLM](https://mlsanity.com/paper/2402.09181/) (2024)
- [MediQ: Question-Asking LLMs and a Benchmark for Reliable Interactive Clinical Reasoning](https://mlsanity.com/paper/2406.00922/) (2024)
- [emrQA: A Large Corpus for Question Answering on Electronic Medical Records](https://mlsanity.com/paper/1809.00732/) (2018)
- [CMB: A Comprehensive Medical Benchmark in Chinese](https://mlsanity.com/paper/2308.08833/) (2023)
- [EHRSHOT: An EHR Benchmark for Few-Shot Evaluation of Foundation Models](https://mlsanity.com/paper/2307.02028/) (2023)
- [AI Hospital: Benchmarking Large Language Models in a Multi-agent Medical Interaction Simulator](https://mlsanity.com/paper/2402.09742/) (2024)
- [ExpertQA: Expert-Curated Questions and Attributed Answers](https://mlsanity.com/paper/2309.07852/) (2023)
- [Med42-v2: A Suite of Clinical LLMs](https://mlsanity.com/paper/2408.06142/) (2024)
- [Text-to-SQL Generation for Question Answering on Electronic Medical Records](https://mlsanity.com/paper/1908.01839/) (2019)
- [UltraMedical: Building Specialized Generalists in Biomedicine](https://mlsanity.com/paper/2406.03949/) (2024)
- [MedExQA: Medical Question Answering Benchmark with Multiple Explanations](https://mlsanity.com/paper/2406.06331/) (2024)
- [Sequential Diagnosis with Language Models](https://mlsanity.com/paper/2506.22405/) (2025)
- [MedAlign: A Clinician-Generated Dataset for Instruction Following with Electronic Medical Records](https://mlsanity.com/paper/2308.14089/) (2023)
- [Towards Evaluating and Building Versatile Large Language Models for Medicine](https://mlsanity.com/paper/2408.12547/) (2024)
- [Apollo: A Lightweight Multilingual Medical LLM towards Democratizing Medical AI to 6B People](https://mlsanity.com/paper/2403.03640/) (2024)
- [EHRNoteQA: An LLM Benchmark for Real-World Clinical Practice Using Discharge Summaries](https://mlsanity.com/paper/2402.16040/) (2024)
- [TIMER: Temporal Instruction Modeling and Evaluation for Longitudinal Clinical Records](https://mlsanity.com/paper/2503.04176/) (2025)

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

- [The Path to Self-Evolving Clinical Systems: Scaling Medical Agents from Assistance to Autonomy](https://mlsanity.com/paper/2607.11175/) (2026)
- [Toward Workflow-Aware Benchmarking for Healthcare NLP Agents](https://mlsanity.com/paper/2609.00296/) (2026)

## Abstract (arXiv)

Clinical decision-making (CDM) is central to real-world clinical workflows, where clinicians infer diagnoses, select treatments, or anticipate future health outcomes under incomplete evidence. LLMs are increasingly used to support these decisions due to strong language capabilities, broad biomedical knowledge, and efficiency, yet the reliability of LLMs on real-world clinical decision tasks remains insufficiently understood. To evaluate CDM models, especially LLM-based models, an ideal and practical medical decision benchmark should be constructed via an automated yet reliable pipeline to ensure both scale and quality. Moreover, the grounding of a CDM benchmark in real patient EHRs can better support evaluation on practical CDM tasks that require substantive biomedical knowledge and clinical inference. To fill the gaps, we introduce EHRBench, an automated and reliable EHR-grounded benchmark for evaluating LLM-based clinical decision-making at scale. To ensure scalability and reliability, EHRBench is constructed through an EHR-LLM-KB(knowledge-base) interaction pipeline. For efficiency, we use a specialized LLM to automatically convert encounter-level EHR trajectories into structured templates and deterministically instantiate the templates into QA items. In parallel, we apply systematic KB-based verification and enrichment to filter hallucinated or ambiguous relations and to improve reliability. Using this pipeline, we construct nearly 1M (960,067) QA items spanning three core inference-required clinical decision tasks: diagnosis, treatment, and prognosis. We benchmark more than 30 representative LLMs on EHRBench and provide detailed analyses of performance and robustness. The results show consistent capability trends across settings, further validating the reliability of EHRBench and highlighting actionable gaps toward clinically reliable LLM systems.