Prasanna Desikan

Harshit Rajgarhia, Shuubham Ojha, Asif Shaik et al.

We present MedMosaic, a medical audio question-answering dataset designed to benchmark language and audio reasoning models under realistic clinical constraints. Medical audio data is difficult to collect due to privacy regulations and high annotation costs arising from domain expertise. Thus, existing benchmarks tend to underrepresent complex medical audio scenarios. To address these challenges, MedMosaic features a diverse range of medical audio types, including condition-related physiological sounds, carefully constructed synthetic voices to mimic speech with artifacts as well as real short and long length clinical conversations to model varying context lengths. The dataset also features a total of 46,701 question-answer pairs, spanning categories such as multiple-choice, sequential multi-turn, and open-ended question-answers, enabling systematic evaluation of multi-hop reasoning and answer generation capabilities. Benchmarking 13 audio and multimodal reasoning models reveals that reasoning remains challenging for all evaluated systems, with substantial performance variation across question types. In particular, even state-of-the-art model like Gemini-2.5-pro can only achieve 68.1% accuracy approximately. These findings underscore persistent limitations in medical reasoning and highlight the need for more robust, domain-specific multimodal reasoning models.

Akshat Dasula, Prasanna Desikan, Jaideep Srivastava

Incomplete or inconsistent discharge documentation is a primary driver of care fragmentation and avoidable readmissions. Despite its critical role in patient safety, auditing discharge summaries relies heavily on manual review and is difficult to scale. We propose an automated framework for large-scale auditing of discharge summaries using locally deployed Large Language Models (LLMs). Our approach operationalizes core transition-of-care requirements such as follow-up instructions, medication history and changes, patient information and clinical course, etc. into a structured validation checklist of questions based on DISCHARGED framework. Using adult inpatient summaries from the MIMIC-IV database, we utilize a privacy-preserving LLM to identify the presence, absence, or ambiguity of key documentation elements. This work demonstrates the feasibility of scalable, automated clinical auditing and provides a foundation for systematic quality improvement in electronic health record documentation.

Prasanna Desikan, Harshit Rajgarhia, Shivali Dalmia et al.

AI models are increasingly deployed in live clinical environments where they must perform reliably across complex, high-stakes workflows that standard training and validation datasets were never designed to capture. Evaluating these systems requires benchmarks: structured combinations of tasks, datasets, and metrics that enable reproducible, comparable measurement of what a model can do. The central challenge in healthcare AI is not performance alone, but the absence of systematic methods to measure reliability, safety, and clinical relevance under real-world conditions. Most existing benchmarks test what a model knows; too few test whether it can perform reliably and without failing across the full complexity of real clinical tasks. Current benchmarks have accumulated through ad hoc dataset construction optimized for narrow task performance: frontier models achieve near-perfect scores on medical licensing examinations, but when evaluated across real clinical tasks, performance degrades sharply, scoring 0.74--0.85 on documentation, 0.61--0.76 on clinical decision support, and only 0.53--0.63 on administrative and workflow tasks \cite{medhelm}. High benchmark scores give a false sense of deployment readiness, and the gap between performance and utility widens precisely as AI systems take on more consequential clinical roles. Without a principled framework for benchmark design, the field cannot determine whether poor clinical performance reflects model limitations or failures in how performance is being measured.

Shivali Dalmia, Ananya Mantravadi, Prasanna Desikan

The work in this paper evaluates zero-shot and few-shot large language models (LLMs) for safety-critical clinical action extraction using the CLIP discharge-note dataset, with particular emphasis on transitions of care and post-discharge patient safety. To manage the complexity of clinical documentation, we introduce a two-stage extraction framework that decomposes discharge notes, that are written in narrative form, into fine-grained, explicitly actionable clinical tasks through a staged prompting strategy. Our contributions include a systematic assessment of generative LLMs for clinical action extraction, a detailed comparison between general-purpose LLMs and task-specific supervised BERT-based models, and an analysis of annotation inconsistencies across different action categories. We show that contemporary LLMs achieve performance comparable to or exceeding supervised models on binary actionability detection, while supervised baselines retain a meaningful advantage on fine-grained multi-label category classification, despite the absence of task-specific fine-tuning and under strict data-privacy constraints. Qualitative error analysis reveals that many failures stem from misalignment between model reasoning and dataset annotation conventions, particularly in cases involving implicit clinical actions and rigid structural labeling rules. These results indicate that reported performance reflects model limitations due to lack of clinical reasoning, that is not captured by plain annotations. Labels without rationales make it impossible to distinguish clinical reasoning failures from annotation convention mismatches. Advancing clinical NLP requires reasoning-annotated datasets that document why specific spans are actionable, not merely which spans were labeled, enabling proper evaluation of model clinical understanding.