# Deep reflective reasoning in interdependence constrained structured data extraction from clinical notes for digital health

arXiv: https://arxiv.org/abs/2603.20435 · HTML: https://mlsanity.com/paper/2603.20435/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 14 of its 29 references that are in the map.
- First posted on arXiv 20 Mar 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)

## Builds on (most cited first, 14 of 14)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Language Models are Few-Shot Learners](https://mlsanity.com/paper/2005.14165/) (2020)
- [LLaMA: Open and Efficient Foundation Language Models](https://mlsanity.com/paper/2302.13971/) (2023)
- [Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks](https://mlsanity.com/paper/2005.11401/) (2020)
- [Scaling Laws for Neural Language Models](https://mlsanity.com/paper/2001.08361/) (2020)
- [DeepSeek-R1: Incentivizing Reasoning Capability in LLMs via Reinforcement Learning](https://mlsanity.com/paper/2501.12948/) (2025)
- [Reflexion: Language Agents with Verbal Reinforcement Learning](https://mlsanity.com/paper/2303.11366/) (2023)
- [Self-Refine: Iterative Refinement with Self-Feedback](https://mlsanity.com/paper/2303.17651/) (2023)
- [The AI Scientist: Towards Fully Automated Open-Ended Scientific Discovery](https://mlsanity.com/paper/2408.06292/) (2024)
- [CRITIC: Large Language Models Can Self-Correct with Tool-Interactive Critiquing](https://mlsanity.com/paper/2305.11738/) (2023)
- [Towards Accurate Differential Diagnosis with Large Language Models](https://mlsanity.com/paper/2312.00164/) (2023)
- [A Survey of Graph Retrieval-Augmented Generation for Customized Large Language Models](https://mlsanity.com/paper/2501.13958/) (2025)
- [A Survey on Retrieval-Augmented Text Generation for Large Language Models](https://mlsanity.com/paper/2404.10981/) (2024)
- [Auto-RAG: Autonomous Retrieval-Augmented Generation for Large Language Models](https://mlsanity.com/paper/2411.19443/) (2024)

## Abstract (arXiv)

Extracting structured information from clinical notes requires navigating a dense web of interdependent variables where the value of one attribute logically constrains others. Existing Large Language Model (LLM)-based extraction pipelines often struggle to capture these dependencies, leading to clinically inconsistent outputs. We propose deep reflective reasoning, a large language model agent framework that iteratively self-critiques and revises structured outputs by checking consistency among variables, the input text, and retrieved domain knowledge, stopping when outputs converge. We extensively evaluate the proposed method in three diverse oncology applications: (1) On colorectal cancer synoptic reporting from gross descriptions (n=217), reflective reasoning improved average F1 across eight categorical synoptic variables from 0.828 to 0.911 and increased mean correct rate across four numeric variables from 0.806 to 0.895; (2) On Ewing sarcoma CD99 immunostaining pattern identification (n=200), the accuracy improved from 0.870 to 0.927; (3) On lung cancer tumor staging (n=100), tumor stage accuracy improved from 0.680 to 0.833 (pT: 0.842 -> 0.884; pN: 0.885 -> 0.948). The results demonstrate that deep reflective reasoning can systematically improve the reliability of LLM-based structured data extraction under interdependence constraints, enabling more consistent machine-operable clinical datasets and facilitating knowledge discovery with machine learning and data science towards digital health.