Decode Like a Clinician: Enhancing LLM Fine-Tuning with Temporal Structured Data Representation

AbstractPredictive modeling of hospital patient data is challenging due to its structured format, irregular timing of measurements, and variation in data representation across institutions. While traditional models often struggle with such inconsistencies, Large Language Models (LLMs) offer a flexible alternative. In this work, we propose a method for verbalizing structured Electronic Health Records (EHRs) into a format suitable for LLMs and systematically examine how to include time-stamped clinical observations—such as lab tests and vital signs—from previous time points in the prompt. We study how different ways of structuring this temporal information affect predictive performance, and whether fine-tuning alone enables LLMs to effectively reason over such data. Evaluated on two real-world hospital datasets and MIMIC-IV, our approach achieves strong in-hospital and cross-hospital performance, laying the groundwork for more generalizable clinical modeling.