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A general-purpose System One decision model for clinical records
摘要
arXiv:2610.27099v1 Announce Type: new Abstract: Clinical care, health-system operations and biomedical discovery depend on extracting reliable answers from patient records, yet applying diverse clinical questions across entire populations remains computationally expensive. Here we present Clinical System One (CS1), a 4-billion-parameter decision model for fast, typed judgments from clinical records, along with two agentic harnesses in which CS1 works together with a generalist language model. CS1-4B is trained on 12.4 million questions and answers from 3.6 million patients across a multi-hospital health system, combining structured-data keys, observed outcomes and language-model supervision across clinical notes, diagnostic reports and patient timelines. It answers multiple typed questions in a single forward pass without task-specific retraining, and each answer carries a probability that can route uncertain cases to human review. On 963,408 held-out patients, CS1-4B outperformed open decision models up to 27 billion parameters on 13 of 14 tasks scored independently of its training teacher. Across 21 external data sets, its aggregate performance approached that of the strongest tested 27-billion-parameter model, with 6.4-fold faster inference in a matched workload. Integrating CS1-4B with a language model agent produced cited answers over complete multi-year patient histories and screened a patient population against the eligibility criteria of 17 registered clinical trials