Towards a HIPAA Compliant Agentic AI System in Healthcare

Agentic AI systems powered by Large Language Models (LLMs) as their foundational reasoning engine, are transforming clinical workflows such as medical report generation and clinical summarization by autonomously analyzing sensitive healthcare data and executing decisions with minimal human oversight. However, their adoption demands strict compliance with regulatory frameworks such as Health Insurance Portability and Accountability Act (HIPAA), particularly when handling Protected Health Information (PHI). This work-in-progress paper introduces a HIPAA-compliant Agentic AI framework that enforces regulatory compliance through dynamic, context-aware policy enforcement. Our framework integrates three core mechanisms: (1) Attribute-Based Access Control (ABAC) for granular PHI governance, (2) a hybrid PHI sanitization pipeline combining regex patterns and BERT-based model to minimize leakage, and (3) immutable audit trails for compliance verification.

Causal Disentanglement for Robust Long-tail Medical Image Generation

Counterfactual medical image generation effectively addresses data scarcity and enhances the interpretability of medical images. However, due to the complex and diverse pathological features of medical images and the imbalanced class distribution in medical data, generating high-quality and diverse medical images from limited data is significantly challenging. Additionally, to fully leverage the information in limited data, such as anatomical structure information and generate more structurally stable medical images while avoiding distortion or inconsistency. In this paper, in order to enhance the clinical relevance of generated data and improve the interpretability of the model, we propose a novel medical image generation framework, which generates independent pathological and structural features based on causal disentanglement and utilizes text-guided modeling of pathological features to regulate the generation of counterfactual images. First, we achieve feature separation through causal disentanglement and analyze the interactions between features. Here, we introduce group supervision to ensure the independence of pathological and identity features. Second, we leverage a diffusion model guided by pathological findings to model pathological features, enabling the generation of diverse counterfactual images. Meanwhile, we enhance accuracy by leveraging a large language model to extract lesion severity and location from medical reports. Additionally, we improve the performance of the latent diffusion model on long-tailed categories through initial noise optimization.

ChatEXAONEPath: An Expert-level Multimodal Large Language Model for Histopathology Using Whole Slide Images

Recent studies have made significant progress in developing large language models (LLMs) in the medical domain, which can answer expert-level questions and demonstrate the potential to assist clinicians in real-world clinical scenarios. Studies have also witnessed the importance of integrating various modalities with the existing LLMs for a better understanding of complex clinical contexts, which are innately multi-faceted by nature. Although studies have demonstrated the ability of multimodal LLMs in histopathology to answer questions from given images, they lack in understanding of thorough clinical context due to the patch-level data with limited information from public datasets. Thus, developing WSI-level MLLMs is significant in terms of the scalability and applicability of MLLMs in histopathology. In this study, we introduce an expert-level MLLM for histopathology using WSIs, dubbed as ChatEXAONEPath. We present a retrieval-based data generation pipeline using 10,094 pairs of WSIs and histopathology reports from The Cancer Genome Atlas (TCGA). We also showcase an AI-based evaluation protocol for a comprehensive understanding of the medical context from given multimodal information and evaluate generated answers compared to the original histopathology reports. We demonstrate the ability of diagnosing the given histopathology images using ChatEXAONEPath with the acceptance rate of 62.9% from 1,134 pairs of WSIs and reports. Our proposed model can understand pan-cancer WSIs and clinical context from various cancer types. We argue that our proposed model has the potential to assist clinicians by comprehensively understanding complex morphology of WSIs for cancer diagnosis through the integration of multiple modalities.

DualPrompt-MedCap: A Dual-Prompt Enhanced Approach for Medical Image Captioning

Medical image captioning via vision-language models has shown promising potential for clinical diagnosis assistance. However, generating contextually relevant descriptions with accurate modality recognition remains challenging. We present DualPrompt-MedCap, a novel dual-prompt enhancement framework that augments Large Vision-Language Models (LVLMs) through two specialized components: (1) a modality-aware prompt derived from a semi-supervised classification model pretrained on medical question-answer pairs, and (2) a question-guided prompt leveraging biomedical language model embeddings. To address the lack of captioning ground truth, we also propose an evaluation framework that jointly considers spatial-semantic relevance and medical narrative quality. Experiments on multiple medical datasets demonstrate that DualPrompt-MedCap outperforms the baseline BLIP-3 by achieving a 22% improvement in modality recognition accuracy while generating more comprehensive and question-aligned descriptions. Our method enables the generation of clinically accurate reports that can serve as medical experts' prior knowledge and automatic annotations for downstream vision-language tasks.

Zeus: Zero-shot LLM Instruction for Union Segmentation in Multimodal Medical Imaging

Medical image segmentation has achieved remarkable success through the continuous advancement of UNet-based and Transformer-based foundation backbones. However, clinical diagnosis in the real world often requires integrating domain knowledge, especially textual information. Conducting multimodal learning involves visual and text modalities shown as a solution, but collecting paired vision-language datasets is expensive and time-consuming, posing significant challenges. Inspired by the superior ability in numerous cross-modal tasks for Large Language Models (LLMs), we proposed a novel Vision-LLM union framework to address the issues. Specifically, we introduce frozen LLMs for zero-shot instruction generation based on corresponding medical images, imitating the radiology scanning and report generation process. {To better approximate real-world diagnostic processes}, we generate more precise text instruction from multimodal radiology images (e.g., T1-w or T2-w MRI and CT). Based on the impressive ability of semantic understanding and rich knowledge of LLMs. This process emphasizes extracting special features from different modalities and reunion the information for the ultimate clinical diagnostic. With generated text instruction, our proposed union segmentation framework can handle multimodal segmentation without prior collected vision-language datasets. To evaluate our proposed method, we conduct comprehensive experiments with influential baselines, the statistical results and the visualized case study demonstrate the superiority of our novel method.}

Multi-modal and Multi-view Fundus Image Fusion for Retinopathy Diagnosis via Multi-scale Cross-attention and Shifted Window Self-attention

The joint interpretation of multi-modal and multi-view fundus images is critical for retinopathy prevention, as different views can show the complete 3D eyeball field and different modalities can provide complementary lesion areas. Compared with single images, the sequence relationships in multi-modal and multi-view fundus images contain long-range dependencies in lesion features. By modeling the long-range dependencies in these sequences, lesion areas can be more comprehensively mined, and modality-specific lesions can be detected. To learn the long-range dependency relationship and fuse complementary multi-scale lesion features between different fundus modalities, we design a multi-modal fundus image fusion method based on multi-scale cross-attention, which solves the static receptive field problem in previous multi-modal medical fusion methods based on attention. To capture multi-view relative positional relationships between different views and fuse comprehensive lesion features between different views, we design a multi-view fundus image fusion method based on shifted window self-attention, which also solves the computational complexity of the multi-view fundus fusion method based on self-attention is quadratic to the size and number of multi-view fundus images. Finally, we design a multi-task retinopathy diagnosis framework to help ophthalmologists reduce workload and improve diagnostic accuracy by combining the proposed two fusion methods. The experimental results of retinopathy classification and report generation tasks indicate our method's potential to improve the efficiency and reliability of retinopathy diagnosis in clinical practice, achieving a classification accuracy of 82.53\% and a report generation BlEU-1 of 0.543.

MedM-VL: What Makes a Good Medical LVLM?

Medical image analysis is a fundamental component. As deep learning progresses, the focus has shifted from single-task applications, such as classification and segmentation, to more complex multimodal tasks, including medical visual question answering and report generation. Traditional shallow and task-specific models are increasingly limited in addressing the complexity and scalability required in clinical practice. The emergence of large language models (LLMs) has driven the development of medical Large Vision-Language Models (LVLMs), offering a unified solution for diverse vision-language tasks. In this study, we investigate various architectural designs for medical LVLMs based on the widely adopted LLaVA framework, which follows an encoder-connector-LLM paradigm. We construct two distinct models targeting 2D and 3D modalities, respectively. These models are designed to support both general-purpose medical tasks and domain-specific fine-tuning, thereby serving as effective foundation models. To facilitate reproducibility and further research, we develop a modular and extensible codebase, MedM-VL, and release two LVLM variants: MedM-VL-2D for 2D medical image analysis and MedM-VL-CT-Chest for 3D CT-based applications. The code and models are available at: https://github.com/MSIIP/MedM-VL

Exposure to Content Written by Large Language Models Can Reduce Stigma Around Opioid Use Disorder in Online Communities

Widespread stigma, both in the offline and online spaces, acts as a barrier to harm reduction efforts in the context of opioid use disorder (OUD). This stigma is prominently directed towards clinically approved medications for addiction treatment (MAT), people with the condition, and the condition itself. Given the potential of artificial intelligence based technologies in promoting health equity, and facilitating empathic conversations, this work examines whether large language models (LLMs) can help abate OUD-related stigma in online communities. To answer this, we conducted a series of pre-registered randomized controlled experiments, where participants read LLM-generated, human-written, or no responses to help seeking OUD-related content in online communities. The experiment was conducted under two setups, i.e., participants read the responses either once (N = 2,141), or repeatedly for 14 days (N = 107). We found that participants reported the least stigmatized attitudes toward MAT after consuming LLM-generated responses under both the setups. This study offers insights into strategies that can foster inclusive online discourse on OUD, e.g., based on our findings LLMs can be used as an education-based intervention to promote positive attitudes and increase people's propensity toward MAT.

UMIT: Unifying Medical Imaging Tasks via Vision-Language Models

With the rapid advancement of deep learning, particularly in the field of medical image analysis, an increasing number of Vision-Language Models (VLMs) are being widely applied to solve complex health and biomedical challenges. However, existing research has primarily focused on specific tasks or single modalities, which limits their applicability and generalization across diverse medical scenarios. To address this challenge, we propose UMIT, a unified multi-modal, multi-task VLM designed specifically for medical imaging tasks. UMIT is able to solve various tasks, including visual question answering, disease detection, and medical report generation. In addition, it is applicable to multiple imaging modalities (e.g., X-ray, CT and PET), covering a wide range of applications from basic diagnostics to complex lesion analysis. Moreover, UMIT supports both English and Chinese, expanding its applicability globally and ensuring accessibility to healthcare services in different linguistic contexts. To enhance the model's adaptability and task-handling capability, we design a unique two-stage training strategy and fine-tune UMIT with designed instruction templates. Through extensive empirical evaluation, UMIT outperforms previous methods in five tasks across multiple datasets. The performance of UMIT indicates that it can significantly enhance diagnostic accuracy and workflow efficiency, thus providing effective solutions for medical imaging applications.

PathOrchestra: A Comprehensive Foundation Model for Computational Pathology with Over 100 Diverse Clinical-Grade Tasks

The complexity and variability inherent in high-resolution pathological images present significant challenges in computational pathology. While pathology foundation models leveraging AI have catalyzed transformative advancements, their development demands large-scale datasets, considerable storage capacity, and substantial computational resources. Furthermore, ensuring their clinical applicability and generalizability requires rigorous validation across a broad spectrum of clinical tasks. Here, we present PathOrchestra, a versatile pathology foundation model trained via self-supervised learning on a dataset comprising 300K pathological slides from 20 tissue and organ types across multiple centers. The model was rigorously evaluated on 112 clinical tasks using a combination of 61 private and 51 public datasets. These tasks encompass digital slide preprocessing, pan-cancer classification, lesion identification, multi-cancer subtype classification, biomarker assessment, gene expression prediction, and the generation of structured reports. PathOrchestra demonstrated exceptional performance across 27,755 WSIs and 9,415,729 ROIs, achieving over 0.950 accuracy in 47 tasks, including pan-cancer classification across various organs, lymphoma subtype diagnosis, and bladder cancer screening. Notably, it is the first model to generate structured reports for high-incidence colorectal cancer and diagnostically complex lymphoma-areas that are infrequently addressed by foundational models but hold immense clinical potential. Overall, PathOrchestra exemplifies the feasibility and efficacy of a large-scale, self-supervised pathology foundation model, validated across a broad range of clinical-grade tasks. Its high accuracy and reduced reliance on extensive data annotation underline its potential for clinical integration, offering a pathway toward more efficient and high-quality medical services.