Electronic health record (EHR) feature engineering is a major bottleneck in clinical research and AI, accounting for 39-45% of data scientists'workload. This is especially pronounced in heart failure, which affects an estimated 6.7 million U.S. adults and requires integrating fragmented EHR data with disease-specific, guideline-based clinical reasoning. Existing rule-based and large language model (LLM)-based approaches offer only partial automation with limited maintainability and evidence traceability. We developed the Nimblemind Multi-Agent System (nMAS), an evidence-linked, rubric-grounded pipeline for automated heart-failure feature engineering, and evaluated it on 500 dummy patient records from nine EHR source tables. nMAS generated 132 structured and 70 rubric-scored aggregated features, verified for structural integrity, rubric compliance, and provenance, and audited by a restricted LLM. Adding the aggregated features improved held-out AUROC from 0.895 to 0.963 for HFrEF and 0.870 to 0.910 for HFpEF phenotyping, and an independent LLM-based rubric assessment of evidence support and methodological soundness scored the features at 81.5% of maximum points. These results demonstrate the feasibility of automated, auditable feature engineering for complex cardiovascular EHR data, though evaluation was limited to a single-institution cohort and external validation is needed.
Clinical feature extraction from pathology reports is challenging because relevant evidence may be distributed across coded and narrative fields and depend on specimen attribution, negation, ancillary findings, and diagnostic context. We retrospectively evaluated the NimbleMind Multi-Agent System (nMAS), a configurable workflow that separates clinician-defined field specifications from extraction models and returns report-level predictions with source-linked evidence. The study included 54 dummy gastric biopsy pathology reports from Singapore and four binary target fields, yielding 216 feature-case decisions. nMAS correctly classified 213 of 216 decisions (98.61\%), and all evidence spans associated with correct predictions occurred verbatim in the corresponding source reports. All three errors occurred in the two context-dependent \textit{H. pylori}-related fields requiring negation handling or diagnostic attribution. A single-model UMA-style comparator produced the similar label-level performance and error pattern. These findings do not demonstrate predictive superiority for the multi-agent architecture.Rather, the contribution of nMAS lies in workflow integration and traceability through configurable field specifications, complexity-based routing, report-level aggregation, and source-text validation within a clinician-reviewable workflow. Larger multi-institutional studies should assess generalizability, semantic evidence quality, adaptation effort, and clinician verification time.
Yufan Wang, Anit Kumar Sahu, Y. Ng et al.· 1 citation
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