Structured Clinical Memory as Context for Probabilistic Decision Models: A Synthetic Evaluation with Jev

Abstract

Longitudinal clinical context is often distributed across noisy, repetitive forms and narrative records. We study whether a compact structured memory can improve a probabilistic decision model's answers when the underlying patient vignette is already available. We created 30 fully synthetic cases spanning twelve clinical domains, paired each with synthetically generated structured memory, and evaluated 120 typed questions with Jev. The raw-vignette arm achieved 90.0% accuracy (95% normal-approximation confidence interval: 84.6%-95.4%); adding memory achieved 93.3% (88.9%-97.8%). Five questions changed from incorrect to correct and one changed in the opposite direction (exact McNemar $p=0.219$). Choice log loss decreased from 0.258 to 0.175 and binary Brier score from 0.054 to 0.022. Memory added 310 input tokens per call on average, while observed mean latency was unchanged at approximately 0.5 seconds. These results are directionally positive rather than clinically validating: the cases are synthetic, the labels are single-author judgments, and the memory is an oracle upper bound rather than extracted production output. The pilot supports evaluating structured clinical memory as a reusable state interface for decision models.