Position: Beyond Prediction: Toward Verifiable Physiological Waveform Reasoning with Foundation Models and Agentic LLMs
UCLA; Emory · National Yang Ming Chiao Tung University · USC · UCLA Computer Science Department, University of California, Los Angeles · University of Notre Dame · Emory University · Microsoft Research Asia · University of Wisconsin - Madison · University of Southern California · UCLA
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摘要
Physiological waveforms (e.g., ECG, PPG, EEG) encode clinically meaningful information in fine-grained morphology, precise timing, and cross-channel dynamics, yet most machine learning systems still treat them as generic time series and optimize end-to-end prediction. In this position paper, **we argue for verifiable physiological waveform reasoning: extracting localized, measurable signal evidence from raw signals, interpreting that evidence into physiological semantics, and supporting clinically grounded decisions.** Waveform reasoning is challenging due to acquisition heterogeneity, signal fidelity, complex semantics and cross-channel coupled dynamics. We analyze why existing model families remain insufficient: physiological foundation models learn strong perceptual representations but remain weak at verifiable reasoning, while LLM-based adaptations have limited waveform understanding. To bridge this gap, **we advocate verifiable, closed-loop systems that unify waveform semantics with language intelligence.** Concretely, we propose a dual-process architecture that System 1 aligns physiological waveforms with language, and System 2 provides agentic reasoning via a Plan--Act--Verify loop, together enabling verifiable physiological waveform reasoning. We further propose evaluations beyond accuracy, emphasizing traceability, replayability, counterfactual robustness, and calibrated abstention.