Transfer Learning for FHIR Questionnaire Terminology Binding
Electronic prior authorization workflows require FHIR Questionnaire items to carry LOINC codes, yet most items in the HL7 Da Vinci CDS-Library lack these bindings. We treat this as a retrieval problem: given a Questionnaire item's text, find the correct LOINC code in a pool of 97,314 active codes. We compare six methods (TF-IDF, frozen MiniLM, BioBERT, BioLORD, contrastively fine-tuned MiniLM, and a TF-IDF+GPT reranker) on a 54-item evaluation set spanning three query styles (natural question, medium, and terse). No single method wins on every metric. BioLORD, a frozen encoder pre-trained on biomedical ontology definitions, has the best top-rank accuracy (R@1 = 0.185, MRR = 0.246) despite seeing no task-specific data, while a contrastive fine-tune on raw LHC-Forms pairs takes R@5 (0.389) and R@10 (0.426). A distribution-shift ablation shows why the fine-tune in our main table is not the strongest one: adding GPT-generated paraphrases to the raw pairs drops R@5 from 0.389 to 0.296, so the augmented union underperforms raw-only training on every metric except R@1. Performance peaks at 5k training pairs. Error analysis on BioLORD's R@1 failures shows that wrong-specificity and ambiguous-text cases together account for 59% of errors.