Paper Detail

MedCase-Structured: A Text-to-FHIR Dataset for Benchmarking Diagnostic Reasoning in Clinically Realistic EHR Settings

Valentina Bui Muti, Eugénie Dulout, Ziquan Fu

arxiv Score 14.8

Published 2026-05-28 · First seen 2026-05-31

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Abstract

Large language models (LLMs) show promise for clinical reasoning and decision support, but evaluation in realistic, electronic health record-congruent settings remains limited. Existing benchmarks often rely on static datasets or unstructured inputs that do not reflect the structured, interoperable data formats used in clinical systems. We introduce a pipeline for generating clinically realistic HL7 FHIR R4 bundles from unstructured text, enabling controllable evaluation of clinical decision support systems. The pipeline combines staged LLM generation with terminology-grounded validation and repair to reduce hallucinated codes and enforce structural and semantic consistency. Applying this approach to MedCaseReasoning, we construct MedCase-Structured, a synthetic dataset aligned with clinician-authored diagnostic cases, achieving valid FHIR generation for 82.5% of cases. Evaluation on MedCase-Structured reveals consistently lower diagnostic accuracy for LLMs on structured FHIR inputs than with plain text, highlighting the importance of deployment-aligned benchmarking.

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BibTeX

@article{muti2026medcase,
  title = {MedCase-Structured: A Text-to-FHIR Dataset for Benchmarking Diagnostic Reasoning in Clinically Realistic EHR Settings},
  author = {Valentina Bui Muti and Eugénie Dulout and Ziquan Fu},
  year = {2026},
  abstract = {Large language models (LLMs) show promise for clinical reasoning and decision support, but evaluation in realistic, electronic health record-congruent settings remains limited. Existing benchmarks often rely on static datasets or unstructured inputs that do not reflect the structured, interoperable data formats used in clinical systems. We introduce a pipeline for generating clinically realistic HL7 FHIR R4 bundles from unstructured text, enabling controllable evaluation of clinical decision sup},
  url = {https://arxiv.org/abs/2605.30295},
  keywords = {cs.CL, cs.AI},
  eprint = {2605.30295},
  archiveprefix = {arXiv},
}

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