Nikkie Hooman | Searcharxiv

arXiv2026

VERGE: Verification-Enhanced Refinement for Grounded Extraction of Early-Onset Colorectal Cancer Symptoms in Clinical Notes

Early-onset colorectal cancer is increasing among younger adults, yet red-flag symptoms in this age group have no evidence-based guidelines for follow-up testing, and structured encounter data do not capture the detail needed to support early detection and inform follow-up, including symptom duration, context, and fam- ily history, an established colorectal-cancer risk factor. This study aimed to develop and evaluate an automated method for extracting six red-flag symptoms and family-history risk status from free-text clinical notes. We developed VERGE, an agentic workflow in which an initial label and evidence are proposed using retrieval-augmented generation, then passed through a bounded verification- refinement cycle that checks textual grounding and clinical validity, corrects and rechecks a claim until resolved or a limit is reached, and escalates unresolved claims for human review. VERGE was evaluated on 4,033 clinician-labeled note-finding pairs against a single-agent baseline, a rule-based clinical language-processing baseline, and an alternative underlying language model. Compared with the single-agent baseline, VERGE reduced false positive find- ings, improving precision from 0.764 to 0.849 and MCC from 0.681 to 0.730, a balanced gain across the precision-recall trade-off, and resolved most flagged errors autonomously, with human review required for only 1.5 percent of claims. These results indicate that a bounded, verification-based workflow can reduce unnecessary positive findings without sacrificing the ability to detect true ones. This approach offers a path toward more reliable and trustworthy clinical language-processing tools to support colorectal cancer risk assessment in younger patients.

cs.CL↗

arXiv2026

Multimodal Routing for Interpretable, Robust, and Auditable Clinical Prediction

Electronic health record (EHR) data are inherently multimodal, and leveraging multiple modalities can improve predictive performance. However, most existing approaches rely on deep fusion, which obscures how individual modalities contribute to predictions and limits the interpretability of multimodal reasoning. We propose an explicit multimodal routing framework for clinical prediction that enables interpretable, robust, and auditable reasoning across three EHR modalities: structured longitudinal variables (L), clinical notes (N), and chest X-rays (I). Our model constructs discrete unimodal, directional bimodal, and trimodal routes to capture both individual modality signals and asymmetric cross-modal interactions. To audit multimodal reasoning and assess robustness, we introduce inference-time route masking, which simulates missing modalities and reweights the remaining routes without retraining. We analyze changes in performance and routing weights under these scenarios to understand model decision-making. We evaluate our framework on multi-label phenotype prediction (K = 25) and binary ICU mortality prediction using trimodal patient stays from MIMIC-IV, revealing systematic differences in modality reliance across clinical condition groups. Overall, our framework offers a transparent, auditable, and practical approach to multimodal clinical prediction, providing interpretability, robustness, and insights into how different data sources drive model decisions.

cs.LG↗