WISTERIA: Learning Clinical Representations from Noisy Supervision via Multi-View Consistency in Electronic Health Records

Representation learning in electronic health records (EHR) has largely followed paradigms inherited from natural language processing, relying on sequence modeling and reconstruction based objectives that treat clinical labels as ground truth. However, real world clinical supervision is inherently weak, arising from heterogeneous, noisy, and institution specific labeling processes such as billing codes, heuristic phenotypes, and incomplete annotations. In this work, we propose WISTERIA, a weakly supervised representation learning framework that models labels as stochastic observations of an underlying latent clinical state. Instead of optimizing against a single supervision signal, WISTERIA constructs multiple weak supervision operators and learns representations by enforcing consistency across their induced label distributions. This multi view formulation induces an implicit denoising mechanism, allowing the model to recover clinically meaningful structure by reconciling disagreement between noisy labelers. We further incorporate ontology aware regularization in the label space to impose semantic structure over supervision signals. Empirically, WISTERIA improves predictive performance across standard EHR benchmarks, demonstrates strong robustness to label noise, and exhibits superior cross institutional generalization compared to sequence based pretraining objectives. These results suggest that explicitly modeling the supervision process rather than treating labels as fixed targets provides a more appropriate inductive bias for learning robust and clinically meaningful representations from EHR data.

Uncertainty-Aware Foundation Models for Clinical Data

Healthcare foundation models have largely followed paradigms from natural language processing and computer vision, emphasizing large scale pretraining and deterministic representations over heterogeneous clinical data. However, clinical observations are inherently incomplete, reflecting sparse, irregular, and modality dependent measurements of an underlying physiologic state. In this work, we propose a framework for uncertainty aware foundation modeling that represents each patient not as a point embedding, but as a distribution over plausible latent states. By learning set valued representations and enforcing consistency across partial views of the same patient, the model captures what is invariantly inferable while explicitly encoding epistemic uncertainty. We integrate this formulation with multimodal encoders and scalable self supervised objectives, combining reconstruction, contrastive alignment, and distributional regularization. Across diverse clinical tasks, our approach improves predictive performance, robustness under missing data, and uncertainty calibration relative to strong baselines. These results suggest that modeling what is not observed rather than only what is constitutes a critical inductive bias for healthcare foundation models.

Dense Feature Learning via Linear Structure Preservation in Medical Data

Deep learning models for medical data are typically trained using task specific objectives that encourage representations to collapse onto a small number of discriminative directions. While effective for individual prediction problems, this paradigm underutilizes the rich structure of clinical data and limits the transferability, stability, and interpretability of learned features. In this work, we propose dense feature learning, a representation centric framework that explicitly shapes the linear structure of medical embeddings. Our approach operates directly on embedding matrices, encouraging spectral balance, subspace consistency, and feature orthogonality through objectives defined entirely in terms of linear algebraic properties. Without relying on labels or generative reconstruction, dense feature learning produces representations with higher effective rank, improved conditioning, and greater stability across time. Empirical evaluations across longitudinal EHR data, clinical text, and multimodal patient representations demonstrate consistent improvements in downstream linear performance, robustness, and subspace alignment compared to supervised and self supervised baselines. These results suggest that learning to span clinical variation may be as important as learning to predict clinical outcomes, and position representation geometry as a first class objective in medical AI.

Learning Longitudinal Health Representations from EHR and Wearable Data

Foundation models trained on electronic health records show strong performance on many clinical prediction tasks but are limited by sparse and irregular documentation. Wearable devices provide dense continuous physiological signals but lack semantic grounding. Existing methods usually model these data sources separately or combine them through late fusion. We propose a multimodal foundation model that jointly represents electronic health records and wearable data as a continuous time latent process. The model uses modality specific encoders and a shared temporal backbone pretrained with self supervised and cross modal objectives. This design produces representations that are temporally coherent and clinically grounded. Across forecasting physiological and risk modeling tasks the model outperforms strong electronic health record only and wearable only baselines especially at long horizons and under missing data. These results show that joint electronic health record and wearable pretraining yields more faithful representations of longitudinal health.

Temporal Entailment Pretraining for Clinical Language Models over EHR Data

Clinical language models have achieved strong performance on downstream tasks by pretraining on domain specific corpora such as discharge summaries and medical notes. However, most approaches treat the electronic health record as a static document, neglecting the temporally-evolving and causally entwined nature of patient trajectories. In this paper, we introduce a novel temporal entailment pretraining objective for language models in the clinical domain. Our method formulates EHR segments as temporally ordered sentence pairs and trains the model to determine whether a later state is entailed by, contradictory to, or neutral with respect to an earlier state. Through this temporally structured pretraining task, models learn to perform latent clinical reasoning over time, improving their ability to generalize across forecasting and diagnosis tasks. We pretrain on a large corpus derived from MIMIC IV and demonstrate state of the art results on temporal clinical QA, early warning prediction, and disease progression modeling.

ChronoFormer: Time-Aware Transformer Architectures for Structured Clinical Event Modeling

The temporal complexity of electronic health record (EHR) data presents significant challenges for predicting clinical outcomes using machine learning. This paper proposes ChronoFormer, an innovative transformer based architecture specifically designed to encode and leverage temporal dependencies in longitudinal patient data. ChronoFormer integrates temporal embeddings, hierarchical attention mechanisms, and domain specific masking techniques. Extensive experiments conducted on three benchmark tasks mortality prediction, readmission prediction, and long term comorbidity onset demonstrate substantial improvements over current state of the art methods. Furthermore, detailed analyses of attention patterns underscore ChronoFormer's capability to capture clinically meaningful long range temporal relationships.