David Rey-Blanco

David Rey-Blanco, Roberto Cruz

Sentence-embedding models for semantic search are overwhelmingly developed and evaluated on English corpora. When applied to clinical retrieval in other languages -- particularly retrieval of ICD-10-CM / CIE-10 codes -- recall degrades in ways often masked by aggregate benchmarks. We study whether large generative language models can serve as data factories to close this gap. We build a two-stage retriever (bi-encoder followed by cross-encoder reranker), fine-tuned from a Spanish biomedical encoder (PlanTL-GOB-ES/bsc-bio-ehr-es) on Gemini-generated synthetic data covering English, Spanish, Catalan, Italian, Portuguese and French, and evaluate against BioBERT-ST and the un-tuned Spanish encoder. The bi-encoder alone matches BioBERT-ST on MRR (0.876 vs. 0.866) and overtakes it on R@3 (0.650 vs. 0.626) and R@5 (0.804 vs. 0.790) without English biomedical pretraining. Adding a cross-encoder reranker lifts aggregate R@5 to 0.822 and dominates on four of five languages (+0.017 Spanish, +0.033 Catalan, +0.018 French, +0.037 Portuguese) at the cost of a small English regression. The trade-off is clinically acceptable: Portuguese reaches R@5 = 0.829 vs. BioBERT-ST's 0.714. Contributions: an open recipe for building domain-specific medical retrievers from LLM-generated data; quantification of the learning gain (MRR 0.755 to 0.876, +15.9% with ~19,500 synthetic pairs); and a characterisation of where gains concentrate by language and rank.

Roberto Cruz, David Rey-Blanco

Most reported gains on agentic-LLM clinical benchmarks are often attributed to prompt engineering, yet our results suggest that larger improvements can come from architectural and engine-level design. We present MDIA, a Multi-agent Diagnostic Intelligence Agent implemented as a 7-node specialty-routed clinical reasoning graph, on the full HealthBench Professional benchmark (n = 525), on a non-fine-tuned LLM. MDIA achieves 0.6272 under OpenAI's GPT-5.4-2026-03-05, which is +3.72 pp above the performance of OpenAI's ChatGPT for Clinicians. The experimental work shows that performance lift is attributable to system architecture: specialty routing, multi-turn context preservation, drug-state safety gating, site-filtered search, length-aware synthesis, and engine-level reliability. These findings support the view that agentic clinical benchmark performance is shaped both by the underlying foundation model and the orchestration architecture. Nevertheless, we also noticed notable differences when using other models as a grader; in particular, when using Gemini 2.5 Pro, MDIA scored 0.6585, which suggests that the choice of grader is a source of variability. Robust evaluation of LLMs would therefore require assessment across several independent grader models.