CliniCARE-Bench: Clinical Calibrated Audit of Medical Reasoning in EHR

• URL: http://arxiv.org/abs/2608.07796v1
• Date: Fri, 07 Aug 2026 22:39:13 GMT
• Title: CliniCARE-Bench: Clinical Calibrated Audit of Medical Reasoning in EHR
• Abstract summary: CliniCARE-Bench is a benchmark for retrospective clinical audit.<n>25 clinician-validated scenarios instantiated as 750 patient-specific cases over real-patient-derived MIMIC-IV data.<n>System returns one of four verdicts: Yes, No, Indeterminate: Lack of Data, or Indeterminate: Medically Ambiguous.
• Score: 15.66578453195388
• License: http://creativecommons.org/licenses/by/4.0/
• Abstract: Large language models perform strongly on medical knowledge benchmarks, but reliable clinical deployment requires agents to conduct defensible investigations over heterogeneous, longitudinal records: determining what evidence is needed, retrieving and reconciling structured and free-text data, grounding conclusions in verifiable evidence, and deferring cases that cannot be resolved reliably. We introduce CliniCARE-Bench (Clinical Calibrated Audit of Medical Reasoning in EHR), a benchmark for retrospective clinical audit: 25 clinician-validated scenarios instantiated as 750 patient-specific cases over real-patient-derived MIMIC-IV data. Systems investigate each case through a governed, logged tool environment for record retrieval, computation, and policy access, and return one of four verdicts---Yes, No, Indeterminate: Lack of Data, or Indeterminate: Medically Ambiguous---the last two separating missing evidence from residual medical ambiguity. Beyond verdict accuracy, we score patient-evidence and policy grounding, process adherence, calibrated abstention, reliability, and efficiency against case-level reference verdicts produced by independent multi-model adjudication and calibrated against Clinical Board review. Every retrieval, computation, and report is replayable, so the investigation trace is inspectable and scorable. To our knowledge, CliniCARE-Bench is the first deployment-oriented clinical-agent benchmark to jointly evaluate real longitudinal EHR investigation, claim-level evidence grounding, governing-policy use, process adherence, and calibrated abstention within a common patient-level adjudication framework. Across 16 agentic systems, four-way accuracy spans 65.3-76.1%, but raw accuracy overstates investigation quality. Defect-free accuracy, which credits a verdict only when correct and free of prohibited shortcuts, is 4.8-14.8 points lower and reorders the leaderboard.

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