Abstract
Patients have distinct information needs about their hospitalization that can be addressed using clinical evidence from electronic health records (EHRs). While artificial intelligence (AI) systems show promise in meeting these needs, robust datasets are needed to evaluate the factual accuracy and relevance of AI-generated responses. To our knowledge, no existing dataset captures patient information needs in the context of their EHRs. We introduce ArchEHR-QA, an expert-annotated dataset based on real-world patient cases from intensive care unit and emergency department settings. The cases comprise questions posed by patients to public health forums, clinician-interpreted counterparts, relevant clinical note excerpts with sentence-level relevance annotations, and clinician-authored answers. To establish benchmarks for grounded EHR question answering (QA), we evaluated three open-weight large language models (LLMs)--Llama 4, Llama 3, and Mixtral--across three prompting strategies: generating (1) answers with citations to clinical note sentences, (2) answers before citations, and (3) answers from filtered citations. We assessed performance on two dimensions: Factuality (overlap between cited note sentences and ground truth) and Relevance (textual and semantic similarity between system and reference answers). The final dataset contains 134 patient cases. The answer-first prompting approach consistently performed best, with Llama 4 achieving the highest scores. Manual error analysis supported these findings and revealed common issues such as omitted key clinical evidence and contradictory or hallucinated content. Overall, ArchEHR-QA provides a strong benchmark for developing and evaluating patient-centered EHR QA systems, underscoring the need for further progress toward generating factual and relevant responses in clinical contexts.
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