TCDiff: Triplex Cascaded Diffusion for High-fidelity Multimodal EHRs Generation with Incomplete Clinical Data

Abstract

The scarcity of large-scale and high-quality electronic health records (EHRs) remains a major bottleneck in biomedical research, especially as large foundation models become increasingly data-hungry. Synthesizing substantial volumes of de-identified and high-fidelity data from existing datasets has emerged as a promising solution. However, existing methods suffer from a series of limitations: they struggle to model the intrinsic properties of heterogeneous multimodal EHR data (e.g., continuous, discrete, and textual modalities), capture the complex dependencies among them, and robustly handle pervasive data incompleteness. These challenges are particularly acute in Traditional Chinese Medicine (TCM). To this end, we propose TCDiff (Triplex Cascaded Diffusion Network), a novel EHR generation framework that cascades three diffusion networks to learn the features of real-world EHR data, formatting a multi-stage generative process: Reference Modalities Diffusion, Cross-Modal Bridging, and Target Modality Diffusion. Furthermore, to validate our proposed framework, besides two public datasets, we also construct and introduce TCM-SZ1, a novel multimodal EHR dataset for benchmarking. Experimental results show that TCDiff consistently outperforms state-of-the-art baselines by an average of 10% in data fidelity under various missing rate, while maintaining competitive privacy guarantees. This highlights the effectiveness, robustness, and generalizability of our approach in real-world healthcare scenarios.