# Closed-Loop Validation-Repair for Healthcare Interoperability: A Multi-Model Study of Schema Compliance in Clinical LLMs

arXiv: https://arxiv.org/abs/2607.24371 · HTML: https://mlsanity.com/paper/2607.24371/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 14 of its 28 references that are in the map.
- First posted on arXiv 27 Jul 2026.

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

- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [Qwen2.5 Technical Report](https://mlsanity.com/paper/2412.15115/) (2024)
- [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)
- [Constitutional AI: Harmlessness from AI Feedback](https://mlsanity.com/paper/2212.08073/) (2022)
- [Gemma 2: Improving Open Language Models at a Practical Size](https://mlsanity.com/paper/2408.00118/) (2024)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [Capabilities of GPT-4 on Medical Challenge Problems](https://mlsanity.com/paper/2303.13375/) (2023)
- [ClinicalBERT: Modeling Clinical Notes and Predicting Hospital Readmission](https://mlsanity.com/paper/1904.05342/) (2019)
- [PICARD: Parsing Incrementally for Constrained Auto-Regressive Decoding from Language Models](https://mlsanity.com/paper/2109.05093/) (2021)
- [Towards Expert-Level Medical Question Answering with Large Language Models](https://mlsanity.com/paper/2305.09617/) (2023)
- [Lexically Constrained Decoding for Sequence Generation Using Grid Beam Search](https://mlsanity.com/paper/1704.07138/) (2017)
- [Grammar-Constrained Decoding for Structured NLP Tasks without Finetuning](https://mlsanity.com/paper/2305.13971/) (2023)
- [Evidence Graph Consistency in Retrieval-Augmented Generation: A Model-Dependent Analysis of Hallucination Detection](https://mlsanity.com/paper/2606.06748/) (2026)

## Abstract (arXiv)

Healthcare interoperability requires AI systems to produce structured outputs conforming to standardized schemas including ICD-10 for diagnostic coding, CPT for procedure billing, and HL7 FHIR for data exchange. While large language models demonstrate clinical reasoning capabilities, their integration into electronic health record systems faces a critical barrier: schema noncompliance. We evaluate three open-source models, Qwen2.5 7B, Llama 3.1 8B, and Gemma2 9B, via local deployment across 320 clinical scenarios spanning ten medical specialties, yielding 960 model-scenario pairs assessed under paired baseline and validation-repair conditions. First, schema noncompliance is consistent across the three model families, with baseline compliance rates ranging from 85.9 to 91.6 percent despite varying architectures and training data, suggesting shared gaps in medical training corpora rather than model-specific limitations. Second, 96 percent of validator-detected failures are representation-level format violations such as alternative medical abbreviations and code prefixes, indicating models follow clinical writing conventions but lack awareness of healthcare IT standards. Third, the validation-repair framework achieves 99.0 percent overall compliance, ranging from 98.4 to 99.4 percent across models, with most errors resolving within one or two iterations. Exact McNemar p-values below 0.001 and absolute improvements of 7.8 to 12.5 percentage points across model sizes confirm statistical significance. These results support closed-loop validation-repair as an effective system-level safeguard for healthcare interoperability, improving schema-level readiness for downstream clinical system integration.