Auditable Clinical Timeline Reconstruction with Provenance-Aware Evidence Graphs

Judith Jeyafreeda Andrew

A patient-timeline reconstruction system is auditable only if it keeps the mentions behind each answer, records how facts were revised, and declines to answer when the evidence is not in the text. This study tests these three properties on a fully synthetic corpus (1,000 patients, 3,353 notes, 220 revision edges). Two provenance-aware Evidence Graph operators reduced the node-plus-edge count to 67% and 63% (77-78% of serialized size) while preserving every answer and mention link across 6,813 query points answerable by recency; a fixed-window baseline returned no value for 53.4% of points, unflagged. On evidence-unavailable controls that announce the omission, a BioClinicalBERT gate and a zero-shot LLM gate responded mainly to the announcement. On marker-free controls, BERT abstained on 0 of 81 notes while its accuracy fell from 93.8% to 59.3% across all three relation classes; the LLM's coverage fell from 75.6% to 27.7% on notes its own model family judged undeterminable. Against 482 regenerated gold spans, the LLM's cited evidence reached recall 0.850 and precision 0.864; BERT's span head, trained without span labels, did not localize evidence. A temporally versioned provenance…