{
  "abstract": ". However, building physician copilots will require models that operate within the electronic health record (EHR), with governed access to patient data and the ability to initiate permitted EHR actions within defined safety constraints. Yet it remains unproven whether such a system can manage patient cases with physician-level performance. Here we show that MIRA (Medical Intelligence for Reasoning and Action), an autonomous artificial intelligence agent operating in a sandboxed EHR environment, can navigate a large clinical action space to obtain patient histories; order and interpret laboratory, imaging and microbiology tests; generate differential diagnoses; and formulate treatment plans such as prescribing medications, scheduling surgical procedures and planning admissions. In simulations on real patient cases spanning multiple diagnoses, MIRA outperformed physicians in diagnostic accuracy and made guideline-concordant, medication-safe and appropriate admission decisions. Compared with previous LLM applications that addressed isolated subtasks or provided free-text advice, these results suggest that an EHR-integrated artificial intelligence agent can turn clinical intent into structured, actionable EHR operations, possibly making it a more effective decision-support partner for physicians. Further work is needed to establish generalization, safety and governance through prospective, real-world studies.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany",
    "Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany",
    "Department of Medicine I, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany",
    "Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany",
    "Department of Surgery, New York University Langone Health, New York, NY, USA",
    "Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany",
    "German Cancer Consortium (DKTK) partner site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany",
    "Department of Nephrology, Heidelberg University Hospital, Heidelberg, Germany",
    "Department of Oral and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany",
    "Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany",
    "Department of Hand-, Replantation-, and Microsurgery, BG Klinikum Unfallkrankenhaus Berlin and Chair of Hand-, Replantation-, and Microsurgery at the Charité Universitätsmedizin Berlin, Berlin, Germany",
    "Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany",
    "Department of Pathology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA",
    "Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany",
    "Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany. jakob.kather@med.uni-heidelberg.de",
    "Department of Medicine I, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany. jakob.kather@med.uni-heidelberg.de",
    "Else Kroener Fresenius Center for Digital Health, Technical University Dresden, Dresden, Germany. jakob.kather@med.uni-heidelberg.de"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 20,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Dyke Ferber",
      "orcid": "0009-0006-6195-9276"
    },
    {
      "affs": [
        2,
        1
      ],
      "name": "Lars Hilgers",
      "orcid": "0009-0001-9444-0730"
    },
    {
      "affs": [
        1
      ],
      "name": "Christiane Höper"
    },
    {
      "affs": [
        3,
        4
      ],
      "name": "Benedict Kinny‐Köster",
      "orcid": "0009-0003-7040-9725"
    },
    {
      "affs": [
        2,
        1
      ],
      "name": "Jan‐Niklas Eckardt",
      "orcid": "0000-0002-3649-2823"
    },
    {
      "affs": [
        2
      ],
      "name": "Katharina Egger‐Heidrich",
      "orcid": "0000-0002-0472-4335"
    },
    {
      "affs": [
        2
      ],
      "name": "Marius Bill",
      "orcid": "0000-0002-1175-2406"
    },
    {
      "affs": [
        2
      ],
      "name": "Martin M. K. Schneider",
      "orcid": "0000-0002-5501-4050"
    },
    {
      "affs": [
        2,
        5,
        1,
        6
      ],
      "name": "Jan Clusmann",
      "orcid": "0000-0003-2925-8438"
    },
    {
      "affs": [
        7
      ],
      "name": "Lejla Kadric"
    },
    {
      "affs": [
        8
      ],
      "name": "Marcel Oehme"
    },
    {
      "affs": [
        9,
        10
      ],
      "name": "Maximilian Mayrhofer‐Schmid",
      "orcid": "0000-0003-2184-8337"
    },
    {
      "affs": [
        11
      ],
      "name": "Alexander Oeser",
      "orcid": "0000-0003-3767-6437"
    },
    {
      "affs": [
        1
      ],
      "name": "Georg Wölflein",
      "orcid": "0000-0002-0407-7617"
    },
    {
      "affs": [
        1,
        6
      ],
      "name": "Isabella C. Wiest",
      "orcid": "0009-0004-4848-614X"
    },
    {
      "affs": [
        2,
        1
      ],
      "name": "Jan Moritz Middeke",
      "orcid": "0000-0003-3250-293X"
    },
    {
      "affs": [
        12
      ],
      "name": "A. John Iafrate"
    },
    {
      "affs": [
        13
      ],
      "name": "Daniel Truhn",
      "orcid": "0000-0002-9605-0728"
    },
    {
      "affs": [
        0
      ],
      "name": "Dirk Jaeger",
      "orcid": "0000-0002-1276-7802"
    },
    {
      "affs": [
        14,
        15,
        16
      ],
      "name": "Jakob Nikolas Kather",
      "orcid": "0000-0002-3730-5348"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/2z53vdxye9ev4.bib",
  "cited_by": 57,
  "doi": "10.1038/s41586-026-10675-5",
  "fulltext_url": null,
  "id": "2z53vdxye9ev4",
  "issns": [
    "0028-0836",
    "1476-4687"
  ],
  "landing_url": "https://doi.org/10.1038/s41586-026-10675-5",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2718|Artificial Intelligence in Healthcare and Education"
    ]
  ],
  "openalex": "W7164998152",
  "pdf_url": null,
  "pmcid": "PMC13421332",
  "pmid": "42310457",
  "published": "2026-06-17",
  "publisher": "Nature Portfolio",
  "ris": "https://research.draconitic.com/paper/2z53vdxye9ev4.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T13:26:54Z",
      "native_id": "W7164998152",
      "source": "openalex",
      "url": "https://doi.org/10.1038/s41586-026-10675-5"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2718|Artificial Intelligence in Healthcare and Education",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Towards autonomous medical artificial intelligence agents",
  "title_text": "Towards autonomous medical artificial intelligence agents",
  "type": "peer-reviewed",
  "updated_at": "2026-11-08T13:20:50Z",
  "url": "https://research.draconitic.com/paper/2z53vdxye9ev4",
  "venue": "Nature",
  "versions": []
}