Advancing Multimodal Fusion on Heterogeneous Medical Data with Hybrid Geometry Attention

Multimodal fusion learning (MFL) has shown great potential in the medical domain, where we are faced with disparate data modalities such as imaging, clinical records, and omics. However, existing MFL strategies face several major challenges. First, they struggle to capture complex cross-modal interactions effectively, which in turn limits performance improvements. Second, they incur high computational costs, restricting their applicability in resource-constrained healthcare AI applications. Finally, they are often designed and evaluated for narrow, fixed modality configurations (e.g., imaging-only, or specific pairs such as image and omics), which limits evidence of their adaptability and generalizability to broader collections of heterogeneous medical modalities. To address these challenges, we propose a novel MFL framework - Cascaded Unified Representation Learning for Efficient Fusion Network (CURE) - a lightweight and scalable framework that progressively integrates various modalities through a novel efficient Hybrid Geometry Aware Fusion layer (HyFuse), where each HyFuse layer is sequentially learned for each modality, making the framework adaptable and generalizable. Within HyFuse, an efficient residual convolution module captures rich multi-scale features to ensure cost-effective learning, while a hybrid-space aware attention mixer learns coarse-to-fine structural cues to better preserve cross-modal relationships. Complementary learnable late-fusion and shared information refinement modules are then employed to learn robust modality-order-invariant shared representations, which in turn yields consistent performance improvements. Extensive evaluations on 16 public datasets show that CURE outperforms leading multimodal fusion methods, boosting performance by up to 3.97% and lowering computational costs by up to 87.8%, ensuring more effective and reliable predictions.

Multi-Large Language Model Orchestrated Severity Assessment of Clinical Records (MOSAIC)

Background: Disease severity is a multidimensional construct difficult to capture with rule-based approaches in Electronic Healthcare Records (EHR). Agentic large language model (LLM) systems could synthesise clinical evidence and reason over EHRs, but remain unevaluated for this task. Methods: MOSAIC is a two-phase agentic LLM framework for severity phenotyping, using type 2 diabetes (T2D) as a proof-of-concept. MOSAIC was evaluated on a synthetic cohort (SyntheticMass; open-weight N = 4,886; closed-weight N = 200) against three algorithmic ground truths (DCSI, DiSSCo, Cooper) and against all-cause mortality and incident complications. Open-weight (locally deployable) and proprietary pipelines were also compared. Results: The generated framework spanned domains absent from the comparators, including biomarker-based glycaemic staging, beta-cell function, and social determinants of health. Open-weight MOSAIC matched the proprietary pipeline (closed- vs open-weight weighted kappa = 0.773) and reached moderate agreement with Cooper (kappa = 0.597) and DCSI (kappa = 0.534) and fair agreement with DiSSCo (kappa = 0.320). Agent-based (Type 1) tiers showed significant separation of all-cause mortality (log-rank p < 0.001; crude hazard ratios 1.6-2.4 for non-Baseline tiers), with non-monotonic separation at the upper tiers, and an inverse gradient for incident complications (log-rank p < 0.001) consistent with depletion of susceptibles. Agentic classification also diverged from deterministic execution of the same rubric (MOSAIC Frozen; kappa = 0.428), indicating reasoning beyond fixed rules. Conclusion: MOSAIC shows agentic LLM systems can generate and apply clinically meaningful severity phenotypes from structured EHR data in T2D. Extending it to other diseases with similarly multidimensional severity warrants further research.