Longitudinal T cell receptor repertoires contain signals of clonal expansion, contraction, disappearance, and reappearance after immune perturbation. Static repertoire language models usually summarize a sample as a bag of sequences, so the sampling interval, sequencing depth, and clone presence pattern are only weakly represented. This paper presents DynImmune-BERT, a continuous time repertoire model for patient level immune status prediction. The method combines depth adaptive centered log ratio initialization, clone presence gated Neural ordinary differential equation dynamics, bounded neighborhood self attention, event based state restart, and a hybrid transport objective that supervises dominant and rare clone mass. A low rank meta adapter initializes reappearing clonotypes while keeping the parameter count independent of the number of observed clones. The evaluation separates literature reported baselines from internally controlled temporal comparisons, reports uncertainty for small external cohorts, adds calibration and threshold diagnostics, and visualizes latent clone trajectories and attention neighborhoods. The results indicate that event aware temporal modeling can complement strong static encoders when longitudinal repertoire structure is available, while small external cohorts and protocol differences require cautious interpretation.
Large language models (LLMs) exhibit strong natural-language reasoning abilities for clinical decision support, but struggle to effectively model structured longitudinal electronic health records (EHRs). In contrast, EHR foundation models can learn predictive patient representations, yet lack interpretable language-based reasoning. To bridge this gap, we propose ChatHealthAI, a multimodal reasoning framework that aligns structured EHR representations from a pretrained EHR foundation model with the semantic space of a frozen LLM through a task-aware resampler. By integrating longitudinal patient representations with refined clinical event descriptions, ChatHealthAI enables clinically grounded natural-language reasoning while maintaining accurate patient prediction. We evaluated ChatHealthAI on three clinical predictive tasks from the EHRSHOT benchmark. Results show that ChatHealthAI improves reasoning quality and interpretability while preserving competitive predictive performance. These findings highlight the potential of integrating EHR foundation models with pretrained LLMs for interpretable clinical prediction.