Automated Clinical Coding: What, Why, and Where We Are?
Authors: Hang Dong, Matúš Falis, William Whiteley, Beatrice Alex, Joshua Matterson, Shaoxiong Ji, Jiaoyan Chen, Honghan Wu
AI-generated Key Points
- Automated clinical coding is a promising task for AI and NLP to improve the efficiency and accuracy of transforming medical information into structured codes.
- Challenges need to be addressed to develop an AI-based automated system that is human-centered, explainable, intelligent, and robust to complex real-world scenarios.
- One of the main challenges is handling long documents with over 10 thousand tokens.
- Text redundancy or "Note Bloat" problem may impede the performance of deep learning models for code prediction.
- Achieving better performance than traditional methods such as CNN-based approaches for multi-label classification applied to clinical coding is another challenge due to inefficiency in modelling concept-level information and long documents.
- Future deep learning-based systems need to integrate knowledge reasoning with rules and ontologies for improved and more explainable results.
- Organizational challenges also need addressing before deploying an AI-based coding tool into the clinical coding environment.
- Coders need to be involved in model development and deployment stages despite being occupied with their coding work.
- Data availability should also be made available within papers related to this topic.
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.
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