Count-Based Approaches Remain Strong: A Benchmark Against Transformer and LLM Pipelines on Structured EHR

Abstract

Structured electronic health records (EHR) are essential for clinical prediction. While count-based learners continue to perform strongly on such data, no benchmarking has directly compared them against more recent mixture-of-agents LLM pipelines, which have been reported to outperform single LLMs in various NLP tasks. In this study, we evaluated three categories of methodologies for EHR prediction using the EHRSHOT dataset: count-based models built from ontology roll-ups with two time bins, based on LightGBM and the tabular foundation model TabPFN; a pretrained sequential transformer (CLMBR); and a mixture-of-agents pipeline that converts tabular histories to natural-language summaries followed by a text classifier. We assessed eight outcomes using the EHRSHOT dataset. Across the eight evaluation tasks, head-to-head wins were largely split between the count-based and the mixture-of-agents methods. Given their simplicity and interpretability, count-based models remain a strong candidate for structured EHR benchmarking. The source code is available at: https://github.com/cristea-lab/Structured_EHR_Benchmark.