MIRA: autonomous AI navigates EHRs to match physician-level care in emergency simulations

A autonomous AI agent named MIRA operates inside a sandboxed electronic health record to autonomously gather history, order and interpret tests, generate differential diagnoses, and formulate treatment and admission plans. In 574 real-case emergency department simulations drawn from MIMIC-IV, MIRA achieved diagnostic accuracy at or above physician performance, produced guideline-concordant and medication-safe orders, and demonstrated strong robustness to adversarial prompts and bias, while maintaining fidelity to the documented history and avoiding premature information disclosure. The study positions MIRA as a potential, governance-aware aid to clinical workflows rather than a replacement for clinicians; however, prospective real-world validation and safety/governance frameworks are still essential before deployment.