ClinEnv: An Interactive Multi-Stage Long Horizon EHR Environment for Agents

Clinical practice is not the selection of an answer from enumerated options: a physician gathers heterogeneous information incrementally and commits to sequential, irreversible decisions under uncertainty. Static benchmarks cannot probe and existing interactive medical benchmarks each compromise on at least one of them. We present ClinEnv, an interactive benchmark that evaluates LLMs as attending physicians over real inpatient admissions under a paradigm we term Longitudinal Inpatient Simulation. Each case is automatically constructed into an ordered sequence of decision stages; at every stage the model must actively query four specialized agents before committing to medications, procedures, and diagnoses. ClinEnv scores both what the model decides, through deterministic ontology-grounded matching, and how it gathers information. Across seven models, the strongest reaches only 0.31 decision F1, and outcome quality is sharply decoupled from process quality. Difficulty concentrates in management decisions and later stages, where models recover discharge diagnoses far more reliably than management actions (0.51 vs. 0.17 F1) and continue to issue redundant queries as cases progress. ClinEnv makes this information-acquisition gap, invisible to outcome-only evaluation, directly measurable.

MENDR: Manifold Explainable Neural Data Representations

Foundation models for electroencephalography (EEG) signals have recently demonstrated success in learning generalized representations of EEGs, outperforming specialized models in various downstream tasks. However, many of these models lack transparency in their pretraining dynamics and offer limited insight into how well EEG information is preserved within their embeddings. For successful clinical integration, EEG foundation models must ensure transparency in pretraining, downstream fine-tuning, and the interpretability of learned representations. Current approaches primarily operate in the temporal domain, overlooking advancements in digital signal processing that enable the extraction of deterministic and traceable features, such as wavelet-based representations. We propose MENDR (Manifold Explainable Neural Data Representations), a filter bank-based EEG foundation model built on a novel Riemannian Manifold Transformer architecture to resolve these issues. MENDR learns symmetric positive definite matrix embeddings of EEG signals and is pretrained on a large corpus comprising over 4,000 hours of EEG data, decomposed via discrete wavelet packet transforms into multi-resolution coefficients. MENDR significantly enhances interpretability by visualizing symmetric positive definite embeddings as geometric ellipsoids and supports accurate reconstruction of EEG signals from learned embeddings. Evaluations across multiple clinical EEG tasks demonstrate that MENDR achieves near state-of-the-art performance with substantially fewer parameters, underscoring its potential for efficient, interpretable, and clinically applicable EEG analysis.