Automated Clinical Coding: What, Why, and Where We Are?

TL;DR

This paper reviews the potential and challenges of automating clinical coding using AI and NLP, emphasizing the need for explainability, consistency, and integration of knowledge-based methods for practical deployment.

Contribution

It provides a comprehensive overview of the current state, challenges, and future directions for AI-driven automated clinical coding based on literature, project experience, and expert discussions.

Findings

Deep learning approaches lack explainability and consistency.

Knowledge-based methods could enhance AI clinical coding.

Significant technical and organizational challenges remain.

Abstract

Clinical coding is the task of transforming medical information in a patient's health records into structured codes so that they can be used for statistical analysis. This is a cognitive and time-consuming task that follows a standard process in order to achieve a high level of consistency. Clinical coding could potentially be supported by an automated system to improve the efficiency and accuracy of the process. We introduce the idea of automated clinical coding and summarise its challenges from the perspective of Artificial Intelligence (AI) and Natural Language Processing (NLP), based on the literature, our project experience over the past two and half years (late 2019 - early 2022), and discussions with clinical coding experts in Scotland and the UK. Our research reveals the gaps between the current deep learning-based approach applied to clinical coding and the need for explainability and consistency in real-world practice. Knowledge-based methods that represent and reason the standard, explainable process of a task may need to be incorporated into deep learning-based methods for clinical coding. Automated clinical coding is a promising task for AI, despite the technical and organisational challenges. Coders are needed to be involved in the development process. There is much to achieve to develop and deploy an AI-based automated system to support coding in the next five years and beyond.