arXiv AI By Daniel Palacios, Matthew Brady Neeley, Angel Adetomike Otto, Shalini Dhamodharan, John P. Woodhouse, Chi-fan Lin, Mark Zobeck, Zhandong Liu, Hyun-Hwan Jeong

Institution-Specific LLM Prompting Recovers PHI That De-identification Systems and Their Gold Standards Both Miss

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The study evaluates whether large language models (LLMs) with in‑context learning can better identify institution‑specific protected health information (PHI) in electronic health records than existing de‑identification systems. Using 100 pediatric oncology notes from Texas Children’s Hospital, eight LLMs were compared to two purpose‑built systems and pattern‑based baselines under three progressively specific prompts. The best LLM achieved an F1 score of 0.918, recovering 79% of previously missed PHI categories and reaching a recall of 0.981 after iterative prompt refinement, demonstrating that calibrated single‑pass prompting can close the institutional PHI gap while balancing precision and recall.

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