# A Multi-Agent Pipeline for Source-Grounded Synthetic Note Generation from Longitudinal Structured EHR

arXiv: https://arxiv.org/abs/2609.22164 · HTML: https://mlsanity.com/paper/2609.22164/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 11 of its 15 references that are in the map.
- First posted on arXiv 26 Aug 2026.

## Builds on (most cited first, 11 of 11)

- [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)
- [TabPFN: A Transformer That Solves Small Tabular Classification Problems in a Second](https://mlsanity.com/paper/2207.01848/) (2022)
- [Automatic Prompt Optimization with "Gradient Descent" and Beam Search](https://mlsanity.com/paper/2305.03495/) (2023)
- [Language Models are Realistic Tabular Data Generators](https://mlsanity.com/paper/2210.06280/) (2022)
- [ACI-BENCH: a Novel Ambient Clinical Intelligence Dataset for Benchmarking Automatic Visit Note Generation](https://mlsanity.com/paper/2306.02022/) (2023)
- [EHRSHOT: An EHR Benchmark for Few-Shot Evaluation of Foundation Models](https://mlsanity.com/paper/2307.02028/) (2023)
- [REaLTabFormer: Generating Realistic Relational and Tabular Data using Transformers](https://mlsanity.com/paper/2302.02041/) (2023)
- [Synthetic Data Generation Using Large Language Models: Advances in Text and Code](https://mlsanity.com/paper/2503.14023/) (2025)
- [Source2Synth: Synthetic Data Generation and Curation Grounded in Real Data Sources](https://mlsanity.com/paper/2409.08239/) (2024)
- [Improving the Generation and Evaluation of Synthetic Data for Downstream Medical Causal Inference](https://mlsanity.com/paper/2510.18768/) (2025)

## Abstract (arXiv)

Structured EHR is abundant but sparse, coded, and difficult to use directly for note-centric clinical modeling. We present MedNotes, a multi-agent synthetic data generation pipeline that converts longitudinal structured EHR into source-grounded clinical note representations under explicit quality control. MedNotes treats structured-data-to-text synthesis as a closed-loop agentic process: a generator proposes a note, evaluator agents diagnose factual, coverage, structural, and hallucination-related failures, and a router accepts, revises, or rejects the draft. On 1,485 EHRSHOT encounters, MedNotes achieves a 91.4% pass rate, with mean factual accuracy of 0.980, completeness of 99.1%, structural fidelity of 0.761, and 0.028 critical hallucinations per encounter. Iterative refinement improves acceptance from 69.4% to 91.4%. The resulting synthetic corpus improves downstream CPT prediction and paragraph-level section prediction when combined with limited real data.