Improving the Realism of Synthetic Clinical Benchmarks Under Utility Constraints

Abstract:Synthetic clinical benchmarks for enterprise AI agents can pass existing utility checks and still remain structurally unrealistic, especially in privacy-sensitive healthcare settings where operational data are hard to access. We study how to improve such benchmarks without breaking the downstream utility checks already used in practice. We formulate benchmark revision as utility-constrained realism improvement: dataset changes should increase realism while staying above an operational utility floor. We instantiate this idea on a care-gap benchmark derived from Synthea-generated patients exercised through demonstration electronic health record workflows and then processed by the same downstream pipeline as operational data. Realism is measured through missingness structure, simplicity, structural plausibility, and population alignment. The baseline benchmark is extremely thin: sampled-pair missingness is 79.44%, only 12.75% of rows are actionable, 38.94% of patients have zero actionable measures, and top-three token concentration reaches 100.0%. Two deterministic revisions improve these panels while remaining above the current utility floor, whereas a naive densification control preserves unrealistic templating. We further show that internal benchmark realism and source fidelity to an aggregate operational reference are related but distinct objectives. These results suggest that synthetic benchmark quality should be optimized explicitly, with utility treated as one constraint rather than as sufficient evidence of realism.

Artificial Intelligence (cs.AI); Databases (cs.DB); Machine Learning (cs.LG)

arXiv:2608.06265 [cs.AI]

(or arXiv:2608.06265v1 [cs.AI] for this version)

https://doi.org/10.48550/arXiv.2608.06265 Focus to learn more arXiv-issued DOI via DataCite (pending registration)

arXivLabs is a framework that allows collaborators to develop and share new arXiv features directly on our website.

Both individuals and organizations that work with arXivLabs have embraced and accepted our values of openness, community, excellence, and user data privacy. arXiv is committed to these values and only works with partners that adhere to them.

Have an idea for a project that will add value for arXiv's community? Learn more about arXivLabs.