Generating Diverse and Verified Synthetic Clinical Notes with Labels by Construction

De-identification of clinical text is a prerequisite for the secondary use of electronic health records. Existing public benchmarks such as the i2b2 2006 and 2014 corpora are over a decade old and lack the semantic and demographic diversity of modern clinical narratives. Large Language Models (LLMs) reach state-of-the-art zero-shot extraction, but their use at enterprise scale is limited by computational cost and by hospital data governance that restricts sending Protected Health Information (PHI) to cloud APIs. We introduce SHIELD (Synthetic Human-annotated Identifier-replaced Entries for Learning and De-identification), a diverse clinical note dataset of 1,381 notes with 10,229 gold-standard PHI spans across 9 categories, built with set-cover diversity sampling across demographic and document-type strata and human-in-the-loop adjudication. We evaluate four LLMs (two proprietary, two open-weight) to establish a performance ceiling on SHIELD, then show that a teacher-student distillation framework transfers these capabilities into locally deployable Small Language Models. Our best distilled model reaches micro-averaged span-level precision of 0.89 and recall of 0.88 while running on standard workstation hardware. It trails its cloud teacher on per-category recall (0.90 vs. 0.81 macro-averaged) but remains competitive given its lower cost and on-premise deployability. Cross-dataset evaluation shows that diversity-trained models generalize well on universal structured PHI categories, while institution-specific entities remain hard to transfer in both directions, which suggests pairing broad-coverage models with specialized models for high-volume, semi-structured note types. We publicly release the SHIELD dataset and the distilled DeBERTa v3 model to provide an accurate, cost-effective de-identification pipeline deployable entirely behind institutional firewalls.

Clinical notes contain personally identifiable information (PII), restricting reuse for research and medical AI, especially when data cannot leave an institution. We developed MedDeID, an on-premises framework combining in-house annotation and synthetic-note generation with model training, inference, pseudonymisation and evaluation. On an independently annotated, adjudicated 300-note Dutch hospital benchmark, a hospital-trained compact transformer detected 98.9% of identifying text while redacting 0.24% of text outside annotated identifiers; a synthetic-only counterpart detected 96.1%. On 100 primary-care notes, the synthetic-trained model achieved higher recall than the hospital-trained model (90.3% versus 87.0%) and greater robustness to identifier-format perturbations. An English instantiation trained without real text detected 99.7% and 98.9% of annotated identifier characters on two external synthetic benchmarks. These results demonstrate transfer of the workflow to another language, but not clinical English performance. MedDeID provides a route to locally governed de-identification using real or synthetic training data.

De-identifying clinical notes with a hosted language model discloses the information the step is meant to protect. We present EdgeDeID, a 0.6B-parameter decoder-only de-identifier that runs locally and is trained without real patient text: three LLM teachers write synthetic notes, a single labeler re-annotates them into one convention, and the model learns to emit a typed XML schema of the identifiers it finds. On a 100-note synthetic in-domain benchmark with manually verified annotations it reaches 0.994 micro-F1 and leaves no missed identifier in 99% of notes, against 0.857 and 12% for the strongest of eight off-the-shelf systems. Quantized, it runs on CPU in 615 MB. Of three additions to supervised training, only a verifier adapter helps: it separates complete from incomplete outputs of other systems at 0.94 AUROC, whereas reinforcement learning with a recall-weighted reward and a rule-based post-processing layer leave in-domain results unchanged. On MIMIC ICU nursing notes F1 falls to 0.48. The errors follow two properties our synthetic notes lack, telegraphic style and low identifier density, and three hand-written in-context examples recover 0.08 F1 without annotated target data.