Trustworthy Agents for Electronic Health Records through Confidence Estimation

Large language models (LLMs) show promise for extracting information from Electronic Health Records (EHR) and supporting clinical decisions. However, deployment in clinical settings faces challenges due to hallucination risks. We propose Hallucination Controlled Accuracy at k% (HCAcc@k%), a novel metric quantifying the accuracy-reliability trade-off at varying confidence thresholds. We introduce TrustEHRAgent, a confidence-aware agent incorporating stepwise confidence estimation for clinical question answering. Experiments on MIMIC-III and eICU datasets show TrustEHRAgent outperforms baselines under strict reliability constraints, achieving improvements of 44.23%p and 25.34%p at HCAcc@70% while baseline methods fail at these thresholds. These results highlight limitations of traditional accuracy metrics in evaluating healthcare AI agents. Our work contributes to developing trustworthy clinical agents that deliver accurate information or transparently express uncertainty when confidence is low.

What Really Matters in Many-Shot Attacks? An Empirical Study of Long-Context Vulnerabilities in LLMs

We investigate long-context vulnerabilities in Large Language Models (LLMs) through Many-Shot Jailbreaking (MSJ). Our experiments utilize context length of up to 128K tokens. Through comprehensive analysis with various many-shot attack settings with different instruction styles, shot density, topic, and format, we reveal that context length is the primary factor determining attack effectiveness. Critically, we find that successful attacks do not require carefully crafted harmful content. Even repetitive shots or random dummy text can circumvent model safety measures, suggesting fundamental limitations in long-context processing capabilities of LLMs. The safety behavior of well-aligned models becomes increasingly inconsistent with longer contexts. These findings highlight significant safety gaps in context expansion capabilities of LLMs, emphasizing the need for new safety mechanisms.