# GLoC-EHR: Evidence-Cited Clinical Reasoning over Global Context and Local EHR Events

arXiv: https://arxiv.org/abs/2610.01076 · HTML: https://mlsanity.com/paper/2610.01076/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 53 of its 71 references that are in the map.
- First posted on arXiv 1 Oct 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)

## Builds on (most cited first, 30 of 53)

- [BERT: Pre-training of Deep Bidirectional Transformers for Language Understanding](https://mlsanity.com/paper/1810.04805/) (2018)
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- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [DeepSeekMath: Pushing the Limits of Mathematical Reasoning in Open Language Models](https://mlsanity.com/paper/2402.03300/) (2024)
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- [Visual Instruction Tuning](https://mlsanity.com/paper/2304.08485/) (2023)
- [DeepSeek-R1: Incentivizing Reasoning Capability in LLMs via Reinforcement Learning](https://mlsanity.com/paper/2501.12948/) (2025)
- [BLIP-2: Bootstrapping Language-Image Pre-training with Frozen Image Encoders and Large Language Models](https://mlsanity.com/paper/2301.12597/) (2023)
- [XGBoost: A Scalable Tree Boosting System](https://mlsanity.com/paper/1603.02754/) (2016)
- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [Learning Phrase Representations using RNN Encoder-Decoder for Statistical Machine Translation](https://mlsanity.com/paper/1406.1078/) (2014)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [FActScore: Fine-grained Atomic Evaluation of Factual Precision in Long Form Text Generation](https://mlsanity.com/paper/2305.14251/) (2023)
- [Qwen3 Embedding: Advancing Text Embedding and Reranking Through Foundation Models](https://mlsanity.com/paper/2506.05176/) (2025)
- [Language Models Don't Always Say What They Think: Unfaithful Explanations in Chain-of-Thought Prompting](https://mlsanity.com/paper/2305.04388/) (2023)
- [Perceiver: General Perception with Iterative Attention](https://mlsanity.com/paper/2103.03206/) (2021)
- [How Contextual are Contextualized Word Representations? Comparing the Geometry of BERT, ELMo, and GPT-2 Embeddings](https://mlsanity.com/paper/1909.00512/) (2019)
- [Measuring Faithfulness in Chain-of-Thought Reasoning](https://mlsanity.com/paper/2307.13702/) (2023)
- [Time-LLM: Time Series Forecasting by Reprogramming Large Language Models](https://mlsanity.com/paper/2310.01728/) (2023)
- [Towards Faithfully Interpretable NLP Systems: How should we define and evaluate faithfulness?](https://mlsanity.com/paper/2004.03685/) (2020)
- [Enabling Large Language Models to Generate Text with Citations](https://mlsanity.com/paper/2305.14627/) (2023)
- [ERASER: A Benchmark to Evaluate Rationalized NLP Models](https://mlsanity.com/paper/1911.03429/) (2019)
- [A Benchmark for Interpretability Methods in Deep Neural Networks](https://mlsanity.com/paper/1806.10758/) (2018)
- [LLM2Vec: Large Language Models Are Secretly Powerful Text Encoders](https://mlsanity.com/paper/2404.05961/) (2024)
- [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)
- [Rationalizing Neural Predictions](https://mlsanity.com/paper/1606.04155/) (2016)
- [Scalable and accurate deep learning for electronic health records](https://mlsanity.com/paper/1801.07860/) (2018)
- [TabLLM: Few-shot Classification of Tabular Data with Large Language Models](https://mlsanity.com/paper/2210.10723/) (2022)
- [HuatuoGPT-o1, Towards Medical Complex Reasoning with LLMs](https://mlsanity.com/paper/2412.18925/) (2024)

## Abstract (arXiv)

Structured electronic health records (EHRs) contain a patient's clinical trajectory as a sequence of clinical codes. Answering clinical questions from such records requires both the context of the whole trajectory and the specific events that support the answer. We introduce GLoC-EHR, a multimodal language model that reads a contextual encoding of the record through a fixed-size global memory of the trajectory and a local memory of selected events. The model learns to generate hospital-course summaries from the global memory and descriptions of masked concepts from the local memory, aligning both with clinical text. It is then trained to cite evidence before answering, through rationale fine-tuning followed by group relative policy optimization (GRPO) with rewards for correct answers and record-supported evidence. On three MIMIC-IV outcome tasks, GLoC-EHR attains the highest macro AUROC among the compared models when it answers directly, whereas zero-shot LLMs reading the serialized record fall far behind. With evidence-cited reasoning, it stays close to its direct multi-task counterpart in macro AUROC, and the evidence terms of the objective reduce unsupported evidence at a similar macro AUROC. The local memory adds distinct supported findings, particularly under strict matching, without a detectable change in macro AUROC. Without retraining, GLoC-EHR transfers to EHRSHOT on par with EHR-BERT and answers two unseen laboratory questions better than zero-shot prompting of its own backbone.