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

Alexander Apartsin; Yehudit Aperstein

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arXiv · 2609.29479

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

Alexander Apartsin·Yehudit Aperstein

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Abstract

Prospective clinical actions, the follow-ups, orders, referrals, and instructions that deter-mine what happens to a patient next, are annotated today in thin fragments across incom-patible corpora: each records a text span and one coarse category. We introduce Clinical Intent Extraction (CIE), the task of recovering these actions as complete structured rec-ords, and the Clinical Intent Representation (CIR), which decomposes each action into its verb, type, coded target, timing, and condition, and adds two axes prior datasets do not jointly represent: request-intent, the authority behind the action (proposal, plan, order, or option, aligned to HL7 FHIR), and modality, a seven-valued scale of clinical strength. Re-expressing five heterogeneous corpora (CLIP, MedDec, ap_parsing, PaniniQA, SIMORD) in the CIR yields CIRCA: 10,011 harmonized intents spanning two note distributions, with a human-validated subset, source-to-CIR crosswalks, and a deterministic FHIR R4 mapper. CIRCA is built by three-model consensus that auto-accepts high-agreement in-tents and routes the rest to human review; the audited agreement stratum matches human decisions 88.4% of the time. Benchmarking five existing models without task-specific training exposes the gap CIRCA targets: given the span, they label type well (85 to 91%) but get all four closed fields right only 18 to 35% of the time. All artifacts are released, with MIMIC-derived layers shared as stand-off annotations under PhysioNet credentialed access.

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Alexander Apartsin, Yehudit Aperstein. 2026-08-24. Clinical Intent Extraction: A FHIR-Aligned Representation and the CIRCA Benchmark. https://arxiv.org/abs/2609.29479

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