Towards autonomous medical artificial intelligence agents
Nature, vol. 655, pp. 1282–1291
Abstract
. However, building physician copilots will require models that operate within the electronic health record (EHR), with governed access to patient data and the ability to initiate permitted EHR actions within defined safety constraints. Yet it remains unproven whether such a system can manage patient cases with physician-level performance. Here we show that MIRA (Medical Intelligence for Reasoning and Action), an autonomous artificial intelligence agent operating in a sandboxed EHR environment, can navigate a large clinical action space to obtain patient histories; order and interpret laboratory, imaging and microbiology tests; generate differential diagnoses; and formulate treatment plans such as prescribing medications, scheduling surgical procedures and planning admissions. In simulations on real patient cases spanning multiple diagnoses, MIRA outperformed physicians in diagnostic accuracy and made guideline-concordant, medication-safe and appropriate admission decisions. Compared with previous LLM applications that addressed isolated subtasks or provided free-text advice, these results suggest that an EHR-integrated artificial intelligence agent can turn clinical intent into structured, actionable EHR operations, possibly making it a more effective decision-support partner for physicians. Further work is needed to establish generalization, safety and governance through prospective, real-world studies.
Authors 20
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Heidelberg University · University Hospital Heidelberg · National Center for Tumor Diseases · Else Kröner Fresenius Center for Digital Health
Affiliation as printed
Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany
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University Hospital Carl Gustav Carus · Else Kröner Fresenius Center for Digital Health · Technische Universität Dresden
Affiliation as printed
Department of Medicine I, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany
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Else Kröner Fresenius Center for Digital Health
Affiliation as printed
Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany
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Heidelberg University · University Hospital Heidelberg · NYU Langone Health · New York University
Affiliation as printed
Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
Department of Surgery, New York University Langone Health, New York, NY, USA
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University Hospital Carl Gustav Carus · Else Kröner Fresenius Center for Digital Health · Technische Universität Dresden
Affiliation as printed
Department of Medicine I, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany
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University Hospital Carl Gustav Carus · Technische Universität Dresden
Affiliation as printed
Department of Medicine I, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
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University Hospital Carl Gustav Carus · Technische Universität Dresden
Affiliation as printed
Department of Medicine I, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
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University Hospital Carl Gustav Carus · Technische Universität Dresden
Affiliation as printed
Department of Medicine I, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
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German Cancer Research Center · Universitätsklinikum Aachen · University Hospital Carl Gustav Carus · German Cancer Research Center (DKFZ) Dresden · Else Kröner Fresenius Center for Digital Health · German Cancer Consortium (DKTK) Dresden · Technische Universität Dresden · RWTH Aachen University
Affiliation as printed
Department of Medicine I, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany
German Cancer Consortium (DKTK) partner site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
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Heidelberg University · University Hospital Heidelberg
Affiliation as printed
Department of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
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Heidelberg University · University Hospital Heidelberg
Affiliation as printed
Department of Oral and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
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Heidelberg University · Unfallkrankenhaus Berlin · Charité - Universitätsmedizin Berlin
Affiliation as printed
Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany
Department of Hand-, Replantation-, and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin and Chair of Hand-, Replantation-, and Microsurgery at the Charité Universitätsmedizin Berlin, Berlin, Germany
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Affiliation as printed
Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany
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Else Kröner Fresenius Center for Digital Health
Affiliation as printed
Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany
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German Cancer Research Center · German Cancer Research Center (DKFZ) Dresden · Else Kröner Fresenius Center for Digital Health · German Cancer Consortium (DKTK) Dresden
Affiliation as printed
Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany
German Cancer Consortium (DKTK) partner site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
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University Hospital Carl Gustav Carus · Else Kröner Fresenius Center for Digital Health · Technische Universität Dresden
Affiliation as printed
Department of Medicine I, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany
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Harvard University · Massachusetts General Hospital
Affiliation as printed
Department of Pathology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
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Affiliation as printed
Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany
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Heidelberg University · University Hospital Heidelberg · National Center for Tumor Diseases
Affiliation as printed
Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
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Jakob Nikolas Kather corresponding
Heidelberg University · University Hospital Heidelberg · National Center for Tumor Diseases · University Hospital Carl Gustav Carus · Else Kröner Fresenius Center for Digital Health · Technische Universität Dresden
Affiliation as printed
Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany. jakob.kather@med.uni-heidelberg.de
Department of Medicine I, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany. jakob.kather@med.uni-heidelberg.de
Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany. jakob.kather@med.uni-heidelberg.de
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