# Structured Evidence Routing for Incident Risk Prediction from Multimodal Longitudinal EHRs

arXiv: https://arxiv.org/abs/2608.26191 · HTML: https://mlsanity.com/paper/2608.26191/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 14 of its 19 references that are in the map.
- First posted on arXiv 24 Aug 2026.

## Builds on (most cited first, 14 of 14)

- [XGBoost: A Scalable Tree Boosting System](https://mlsanity.com/paper/1603.02754/) (2016)
- [Med-BERT: pre-trained contextualized embeddings on large-scale structured electronic health records for disease prediction](https://mlsanity.com/paper/2005.12833/) (2020)
- [RETAIN: An Interpretable Predictive Model for Healthcare using Reverse Time Attention Mechanism](https://mlsanity.com/paper/1608.05745/) (2016)
- [BEHRT: Transformer for Electronic Health Records](https://mlsanity.com/paper/1907.09538/) (2019)
- [Doctor AI: Predicting Clinical Events via Recurrent Neural Networks](https://mlsanity.com/paper/1511.05942/) (2015)
- [Dipole: Diagnosis Prediction in Healthcare via Attention-based Bidirectional Recurrent Neural Networks](https://mlsanity.com/paper/1706.05764/) (2017)
- [EHRSHOT: An EHR Benchmark for Few-Shot Evaluation of Foundation Models](https://mlsanity.com/paper/2307.02028/) (2023)
- [MOTOR: A Time-To-Event Foundation Model For Structured Medical Records](https://mlsanity.com/paper/2301.03150/) (2023)
- [Zero Shot Health Trajectory Prediction Using Transformer](https://mlsanity.com/paper/2407.21124/) (2024)
- [Sequential Diagnosis with Language Models](https://mlsanity.com/paper/2506.22405/) (2025)
- [Hi-BEHRT: Hierarchical Transformer-based model for accurate prediction of clinical events using multimodal longitudinal electronic health records](https://mlsanity.com/paper/2106.11360/) (2021)
- [CPLLM: Clinical Prediction with Large Language Models](https://mlsanity.com/paper/2309.11295/) (2023)
- [RAM-EHR: Retrieval Augmentation Meets Clinical Predictions on Electronic Health Records](https://mlsanity.com/paper/2403.00815/) (2024)
- [Count-Based Approaches Remain Strong: A Benchmark Against Transformer and LLM Pipelines on Structured EHR](https://mlsanity.com/paper/2511.00782/) (2025)

## Abstract (arXiv)

Incident risk prediction from longitudinal electronic health records (EHRs) is challenging because relevant signals are multimodal, weak in isolation, and distributed across irregular patient histories. We propose structured evidence routing, a router-predictor-reviewer workflow that separates full-record access from disease-specific assessment. The router organizes the complete pre-index EHR into a compact summary and targeted evidence slices; the predictor uses this evidence to form an evidence-linked risk assessment, which the reviewer critiques. For comparison with supervised EHRSHOT baselines, we pair the routed evidence summaries with a supervised classifier readout. Across five 1-year incident diagnosis tasks, our method reaches the AUROC range of established supervised EHRSHOT baselines and remains competitive on AUPRC, while exposing a patient-specific evidence trail. Internal pre-readout ablations further suggest that routing, laboratory evidence, task guidance, and review each contribute to performance.