Research on Collaborative Reasoning Framework and Algorithms of Cloud-Edge Large Models for Intelligent Auxiliary Diagnosis Systems

ObjectiveThe deployment of Large Language Models (LLMs) in intelligent auxiliary diagnosis is constrained by limited computing resources for local hospital deployment and by privacy risks related to the transmission and storage of medical data in cloud environments. Low-parameter local LLMs show 20%～30% lower accuracy in medical knowledge question answering and 15%～25% reduced medical knowledge coverage compared with full-parameter cloud LLMs, whereas cloud-based systems face inherent data security concerns. To address these issues, a cloud-edge LLM collaborative reasoning framework and related algorithms are proposed for intelligent auxiliary diagnosis systems. The objective is to design a cloud-edge collaborative reasoning agent equipped with intelligent routing and dynamic semantic desensitization to enable adaptive task allocation between the edge (hospital side) and cloud (regional cloud). The framework is intended to achieve a balanced result across diagnostic accuracy, data privacy protection, and resource use efficiency, providing a practical technical path for the development of medical artificial intelligence systems.MethodsThe proposed framework adopts a layered architectural design composed of a four-tier progressive architecture on the edge side and a four-tier service-oriented architecture on the cloud side (Fig. 1). The edge side consists of resource, data, model, and application layers, with the model layer hosting lightweight medical LLMs and the cloud-edge collaborative agent. The cloud side comprises AI IaaS, AI PaaS, AI MaaS, and AI SaaS layers, functioning as a center for computing power and advanced models. The collaborative reasoning process follows a structured workflow (Fig. 2), beginning with user input parsed by the agent to extract key clinical features, followed by reasoning node decision-making. Two core technologies support the agent: (1) Intelligent routing: This mechanism defaults to edge-side processing and dynamically selects the reasoning path (edge or cloud) through a dual-driven weight update strategy. It integrates semantic feature similarity computed through Chinese word segmentation and pre-trained medical language models and incorporates historical decision data, with an exponential moving average used to update feature libraries for adaptive optimization. (2) Dynamic semantic desensitization: Employing a three-stage architecture (sensitive entity recognition, semantic correlation analysis, and hierarchical desensitization decision-making), this technology identifies sensitive entities through a domain-enhanced Named Entity Recognition (NER) model, calculates entity sensitivity and desensitization priority, and applies a semantic similarity constraint to prevent excessive desensitization. Three desensitization strategies (complete deletion, general replacement, partial masking) are used based on entity sensitivity. Experimental validation is conducted with two open-source Chinese medical knowledge graphs (CMeKG and CPubMedKG) containing more than 2.7 million medical entities. The experimental environment (Fig. 3) deploys a qwen3:1.7b model on the edge and the Jiutian LLM on the cloud, with a 5 000-sample evaluation dataset divided into entity-level, relation-level, and subgraph-level questions. Performance is assessed with three metrics: answer accuracy, average token consumption, and average response time.Results and DiscussionsExperimental results show that the proposed framework achieves strong performance across the main evaluation dimensions. For answer accuracy, the intelligent routing mechanism attains 72.44% on CMeKG (Fig. 4) and 66.20% on CPubMedKG (Fig. 5), which are higher than the edge-side LLM alone (60.73% and 54.18%) and close to the cloud LLM (72.68% and 66.49%). These results indicate that the framework maintains diagnostic consistency with cloud-based systems while taking advantage of edge-side capabilities. For resource use, the intelligent routing model reduces average token consumption to 61.27, representing 45.63% of the cloud LLM’s token usage (131.68) (Fig. 6), which supports substantial cost reduction. For response time, the edge-side LLM shows latency greater than 6 s because of limited computing power, whereas the cloud LLM reaches 0.44 s latency through dedicated line access (8% of the 5.46 s latency under internet access). The intelligent routing model produces average latency values between those of the edge and cloud LLMs under both access modes (Fig. 7), consistent with expected trade-offs. The framework also shows applicability across common medical scenarios (Table 1), including outpatient triage, chronic disease management, medical image analysis, intensive care, and health consultation, by combining local real-time processing with cloud-based deep reasoning. Limitations appear in emergency rescue settings with weak network conditions because of latency constraints and in rare disease diagnosis because of limited edge-side training samples and potential loss of specific features during desensitization. Overall, the results verify that the cloud-edge collaborative reasoning mechanism reduces computing resource overhead while preserving consistency in diagnostic results.ConclusionsThis study constructs a cloud-edge LLM collaborative reasoning framework for intelligent auxiliary diagnosis systems, addressing the challenges of limited local computing power and cloud data privacy risks. Through the integration of intelligent routing, prompt engineering adaptation, and dynamic semantic desensitization, the framework achieves balanced optimization of diagnostic accuracy, data security, and resource economy. Experimental validation shows that its accuracy is comparable to cloud-only LLMs while resource consumption is substantially reduced, providing a feasible technical path for medical intelligence development. Future work focuses on three directions: intelligent on-demand scheduling of computing and network resources to mitigate latency caused by edge-side computing constraints; collaborative deployment of localized LLMs with Retrieval-Augmented Generation (RAG) to raise edge-side standalone accuracy above 90%; and expansion of diagnostic evaluation indicators to form a three-dimensional scenario-node-indicator system incorporating sensitivity, specificity, and AUC for clinical-oriented assessment.