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No Black Boxes: Interpretable and Interactable Predictive Healthcare with Knowledge-Enhanced Agentic Causal Discovery
Open accessAbstract
Deep learning models trained on extensive Electronic Health Records (EHR) data have achieved high accuracy in diagnosis prediction, offering the potential to assist clinicians in decision-making and treatment planning.However, these models lack two crucial features that clinicians highly value: interpretability and interactivity.The "blackbox" nature of these models makes it difficult for clinicians to understand the reasoning behind predictions, limiting their ability to make informed decisions.Additionally, the absence of interactive mechanisms prevents clinicians from incorporating their own knowledge and experience into the decisionmaking process.To address these limitations, we propose II-KEA, a knowledge-enhanced agent-driven causal discovery framework that integrates personalized knowledge databases and agentic LLMs.II-KEA enhances interpretability through explicit reasoning and causal analysis, while also improving interactivity by allowing clinicians to inject their knowledge and experience through customized knowledge bases and prompts.II-KEA is evaluated on both MIMIC-III and MIMIC-IV, demonstrating superior performance along with enhanced interpretability and interactivity, as evidenced by its strong results from extensive case studies.Our code is available at https://github.com/hanxiaoxue114/II- KEA_HealthcareAgent.
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“These multi-agent systems [66,77,88,102,118] distribute clinical reasoning across specialized agents such as history-takers, evidence retrievers, diagnosticians, and decision-makers, with inter-agent communication channels serving as inherently traceable explanation mechanisms.”
From Explainability of decoder-only clinical large language models: A scoping review (2026) · cites this paper as [118]
In the citing paper
“In our review, twenty studies relied exclusively on closed-source models [62,63,79,89,105,118]”
From Explainability of decoder-only clinical large language models: A scoping review (2026) · cites this paper as [118]
In the citing paper
“Others expose intermediate reasoning steps such as agentic traces, structured decoding chains etc that allow clinicians to audit the logic , as in agentic systems [66,77,88,102,118] and structureddecoding approaches [65,101].”
From Explainability of decoder-only clinical large language models: A scoping review (2026) · cites this paper as [118]
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Ou, Y., Zhang, Q., Meng, C. K., Zhou, X., Na, M., Yu, Z., Ma, W., & Huang, C. (2026) · Therapeutics and Clinical Risk Management · doi:10.2147/tcrm.s596651 · Cited by 4
Liu, J., Wang, T., Liu, S., Hu, X., Tong, R., Wang, L., & Xu, J. (2025) · International Conference on Machine Learning and Natural Language Processing (MLNLP) · doi:10.1109/mlnlp66797.2025.11388207 · Cited by 1
Explainability of decoder-only clinical large language models: A scoping review
Mishra, N., Abu-Hanna, A., & Calixto, I. (2026) · Artificial Intelligence in Medicine · doi:10.1016/j.artmed.2026.103501
Metadata
- Authors
- Han, X., Hu, P., Lu, C., Ding, J.-E., Liu, F., & Ning, Y.
- Affiliations
- Stevens Institute of Technology (US)
- Venue
- Findings of the Association for Computational Linguistics: EMNLP 2025
- Published
- 2025
- Pages
- 23415-23427
- OpenAlex
- W4416034025
- Cited by
- 2
- References
- 0
- Citations by year
- 2026: 1 · 2025: 1
- FWCI
- 1.91
- Type
- conference paper
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Findings of the Association for Computational Linguistics: EMNLP (Findings of EMNLP) (publishedVersion, cc-by)
- arXiv (Cornell University) (submittedVersion)
- arXiv (Cornell University)
- Funders
- National Science Foundation (2047843, 2437621)
- Topics
- Physical Sciences › Computer Science › Artificial Intelligence › Machine Learning in Healthcare
- Physical Sciences › Computer Science › Artificial Intelligence › Explainable Artificial Intelligence (XAI)
- Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
- Keywords
- explainable AI, interactive AI, agentic LLMs, causal discovery, electronic health records, diagnostic prediction, clinical decision support, MIMIC-III, MIMIC-IV, interpretable prediction
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