Building Safe and Deployable Clinical Natural Language Processing under Temporal Leakage Constraints

arXiv:2602.15852v1 Announce Type: new
Abstract: Clinical natural language processing (NLP) models have shown promise for supporting hospital discharge planning by leveraging narrative clinical documentation. However, note-based models are particularly vulnerable to temporal and lexical leakage, where documentation artifacts encode future clinical decisions and inflate apparent predictive performance. Such behavior poses substantial risks for real-world deployment, where overconfident or temporally invalid predictions can disrupt clinical workflows and compromise patient safety. This study focuses on system-level design choices required to build safe and deployable clinical NLP under temporal leakage constraints. We present a lightweight auditing pipeline that integrates interpretability into the model development process to identify and suppress leakage-prone signals prior to final training. Using next-day discharge prediction after elective spine surgery as a case study, we evaluate how auditing affects predictive behavior, calibration, and safety-relevant trade-offs. Results show that audited models exhibit more conservative and better-calibrated probability estimates, with reduced reliance on discharge-related lexical cues. These findings emphasize that deployment-ready clinical NLP systems should prioritize temporal validity, calibration, and behavioral robustness over optimistic performance.