A Multi-Agent Pipeline for Source-Grounded Synthetic Note Generation from Longitudinal Structured EHR

Synthetic data is increasingly used to enable the development and evaluation of AI systems in domains where access to real-world data is restricted. In healthcare, clinical documentation presents particular challenges due to its sensitivity. This work introduces a synthetic clinical notes pipeline and dataset designed to support the development of clinical AI tools while avoiding the privacy risks associated with real patient data. The dataset is generated using a modular pipeline that combines structured patient generation, semi-structured patient journey simulation, and unstructured clinical note generation using large language models. The pipeline is designed to prioritise internal consistency across longitudinal patient records, while also capturing variation in writing style, note structure, and clinical detail. Additional mechanisms, including LLM-based validation and augmentation steps, are used to improve faithfulness, realism, and diversity of the generated notes. We release a dataset of 70 synthetic patients, each associated with 20-50 clinical notes spanning a full hospital journey. The dataset is provided at multiple levels of validation, enabling users to balance realism and scalability depending on their use case. This dataset supports the development, testing, and evaluation of clinical AI systems, including summarisation tools, coding models, and decision support systems, without reliance on real patient data.

Large language models (LLMs) can generate or synthesize clinical text for a wide range of applications, from improving clinical documentation to augmenting clinical text analytics. Yet evaluations typically focus on a narrow aspect -- such as similarity or utility comparisons -- even though these aspects are complementary and best viewed in parallel. In this study, we aim to conduct a systematic evaluation of LLM-generated clinical text, which includes intrinsic, extrinsic, and factuality evaluations of synthetic clinical notes rephrased from MIMIC databases at million-note scale. Our analysis demonstrates that synthetic notes preserve core clinical information and predictive utility for coarse-grained tasks despite substantial linguistic changes, but lose fine-grained details for task like ICD coding. We show this loss of detail can be substantially mitigated by rephrasing notes by chunks rather than by the whole note, but at the cost of reduced factual precision under incomplete context. Through fact-checking and error analysis, we further find that synthesis errors are dominated by misinterpretation of clinical context, alongside temporal confusion, measurement errors, and fabricated claims. Finally, we show that the synthetic notes -- despite their task-agnostic nature -- can effectively augment task-specific training for rare ICD codes.

Longitudinal electronic health records (EHRs) document patients' sequences of clinical visits over time, preserving the temporal evolution of disease progression and care delivery. However, real longitudinal EHRs are difficult to access because they contain large amounts of fine-grained, patient-specific information. Synthetic EHR generation therefore provides a valuable approach for preserving the statistical patterns and clinical structure of patient visit trajectories, enabling broader modeling and analysis when real records are limited. Although recent generative models have made progress in producing future visit sequences, they remain limited in explicitly integrating inter-visit irregular temporal evolution and intra-visit clinical event structures in EHRs, leading to clinically inconsistent and temporally unrealistic visit sequences. In this work, we propose SynEHR, a lightweight adaptive LLM-based framework for longitudinal EHR synthesis. There are two novel designs in SynEHR, i.e., a Temporal State Conditioning Module captures irregular temporal states across visits and a Temporal-Relational Adaptation Module combines these states with patient history to dynamically construct patient-specific relational representations. SynEHR then builds on a parameter-efficient LoRA-adapted language-model generator with next-visit generation capability to train the two modules for temporally and clinically informed generation. Extensive experiments on real-world EHR datasets across fidelity, privacy, and downstream utility evaluations demonstrate that SynEHR outperforms state-of-the-art models by generating more clinically coherent and temporally faithful longitudinal EHR data.