Clinical Note Bloat Reduction for Efficient LLM Use

TL;DR

This paper presents TRACE, a scalable method to reduce clinical note bloat by leveraging EHR metadata and deduplication, significantly decreasing computational costs while maintaining model performance.

Contribution

The paper introduces TRACE, a novel preprocessing pipeline that effectively reduces note bloat in clinical texts using EHR metadata and deduplication techniques.

Findings

TRACE removed 47.3% of chart text

Preserved performance for information extraction and outcome prediction

Estimated $9.5 million annual cost savings at a medical center

Abstract

Health systems are rapidly deploying large language models (LLMs) that use clinical notes for clinical decision support applications. However, modern documentation practices rely heavily on templates, copy--paste shortcuts, and auto-populated fields, producing extensive duplicated text (``note bloat'') that dilutes clinically meaningful signal and substantially increases the computational cost of LLM use. We introduce TRACE, a scalable preprocessing pipeline that removes note bloat by leveraging EHR attribution metadata to identify templated and copied content and applying frequency-based deduplication when metadata are unavailable. We evaluated TRACE across four real--world clinical cohorts spanning liver transplantation, obstetrics, and inpatient care (5.3 million notes) using blinded physician review and downstream modeling tasks. TRACE removed 47.3% of chart text while preserving performance for information extraction and clinical outcome prediction. At a large academic medical center, this reduction corresponds to an estimated $9.5 million annual decrease in LLM inference costs assuming one query per encounter. These findings show how underutilized EHR metadata can enable more scalable and cost-efficient deployment of LLM-based clinical systems.