Clinical Intent Extraction: A FHIR-Aligned Representation and the CIRCA Benchmark

In mental health care, reasoning over patient journeys is a key task for clinicians. Yet these journeys, encompassing a longitudinal progression of biological, psychological, and social events, are often spread across disparate unstructured text narratives, making temporal recovery challenging. We present CliniCIRCA, a multi-stage LLM framework for Calendar-anchored, Imprecision-aware Reconstruction of Clinical Annals. To our knowledge, CliniCIRCA is the first to temporally classify clinical events across unstructured discharge summaries without event-level timestamps. From 14,882 MIMIC-III mental health admissions, we first construct a benchmark of 52 discharge summaries on which CliniCIRCA produces 15,891 temporally tagged events. After correcting 629 errors based on a clinician-in-the-loop evaluation, we produce verified gold-standard labels. Finally, the corrected timelines drive a temporally grounded summarization stage that compresses each source 1.52 times into a date-grouped chronological record. We then scale the framework to generate 1,000 silver-standard timelines and evaluate them as training data. Compared with zero- and few-shot prompting, instruction tuning generally improves five open-weight models on event extraction, temporal tagging, and summarization across silver and clinician-verified evaluations.

Patient contexts span hundreds of heterogeneous documents and thousands of structured data points, yet the document-level metadata that AI systems need for retrieval and triage is absent or incomplete. Standard retrieval-augmented generation fails on this data, mishandling temporal reasoning, cross-document dependencies, and missing metadata. We deploy ACIE (Agentic Clinical Information Extraction) at University Medicine Essen: an on-premise agentic RAG pipeline that reasons over complete patient contexts and grounds every answer in source passages for clinician verification. We quantify the metadata gap, trace the architectural decisions it shaped, and evaluate extraction alongside an independent retrospective lymphoma registry study, in which nuclear-medicine physicians verify every extracted value against its cited sources. Across 7,326 judgments, clinicians accepted 96.5% of extractions, with per-type acceptance ranging from 80% to 99%.

Clinical check-up reports are multimodal documents that combine page layouts, tables, numerical biomarkers, abnormality flags, imaging findings, and domain-specific terminology. Such heterogeneous evidence is difficult for laypersons to interpret and translate into concrete follow-up actions. Although large language models show promise in medical summarisation and triage support, their ability to generate safe, prioritised, and patient-oriented actions from multimodal check-up reports remains under-benchmarked. We present Checkup2Action, a multimodal clinical check-up report dataset and benchmark for structured Action Card generation. Each card describes one clinically relevant issue and specifies its priority, recommended department, follow-up time window, patient-facing explanation, and questions for clinicians, while avoiding diagnostic or treatment-prescriptive claims. The dataset contains 2,000 de-identified real-world check-up reports covering demographic information, physical examinations, laboratory tests, cardiovascular assessments, and imaging-related evidence. We formulate checkup-to-action generation as a constrained structured generation task and introduce an evaluation protocol covering issue coverage and precision, priority consistency, department and time recommendation accuracy, action complexity, usefulness, readability, and safety compliance. Experiments with general-purpose and medical large language models reveal clear trade-offs between issue coverage, action correctness, conciseness, and safety alignment. Checkup2Action provides a new multimodal benchmark for evaluating patient-oriented reasoning over clinical check-up reports.