DENSE: Longitudinal Progress Note Generation with Temporal Modeling of Heterogeneous Clinical Notes Across Hospital Visits

TL;DR

DENSE is a system that generates coherent, temporally aligned progress notes from scattered clinical data across multiple hospital visits using a large language model and a novel retrieval mechanism.

Contribution

The paper introduces DENSE, a novel approach that organizes heterogeneous clinical notes temporally and uses retrieval-augmented prompting of LLMs for progress note generation.

Findings

Achieves a temporal alignment ratio of 1.089, indicating improved narrative continuity.

Restores longitudinal coherence in clinical documentation.

Enhances downstream tasks like summarization and decision support.

Abstract

Progress notes are among the most clinically meaningful artifacts in an Electronic Health Record (EHR), offering temporally grounded insights into a patient's evolving condition, treatments, and care decisions. Despite their importance, they are severely underrepresented in large-scale EHR datasets. For instance, in the widely used Medical Information Mart for Intensive Care III (MIMIC-III) dataset, only about $8.56\%$ of hospital visits include progress notes, leaving gaps in longitudinal patient narratives. In contrast, the dataset contains a diverse array of other note types, each capturing different aspects of care. We present DENSE (Documenting Evolving Progress Notes from Scattered Evidence), a system designed to align with clinical documentation workflows by simulating how physicians reference past encounters while drafting progress notes. The system introduces a fine-grained note categorization and a temporal alignment mechanism that organizes heterogeneous notes across visits into structured, chronological inputs. At its core, DENSE leverages a clinically informed retrieval strategy to identify temporally and semantically relevant content from both current and prior visits. This retrieved evidence is used to prompt a large language model (LLM) to generate clinically coherent and temporally aware progress notes. We evaluate DENSE on a curated cohort of patients with multiple visits and complete progress note documentation. The generated notes demonstrate strong longitudinal fidelity, achieving a temporal alignment ratio of $1.089$, surpassing the continuity observed in original notes. By restoring narrative coherence across fragmented documentation, our system supports improved downstream tasks such as summarization, predictive modeling, and clinical decision support, offering a scalable solution for LLM-driven note synthesis in real-world healthcare settings.