New guidelines have been released to support the responsible integration of artificial intelligence (AI) into clinical coding practices in Australia. The guidelines outline key considerations that are essential for the responsible, ethical, and effective application of AI in producing clinical coded data.

They have been developed by the Health Information Management Association of Australia and are aimed at healthcare organisations as well as coding and software companies. The guidelines said AI technologies offer “significant potential to enhance clinical documentation integrity, enable autonomous coding, support clinical coding audits, and improve health information management”.

“Healthcare is dependent on accurate clinical coding for safety and quality monitoring; continuous improvement; funding models such as activity-based funding; health research; epidemiology; health care planning; health service evaluation; national statistics and population health reporting.

“Without guardrails in place to inform the safe and ethical application of these elements in AI coding solutions, there is a high risk of inaccurate and incomplete clinical coding outcomes…”

The guidelines said that to successfully embed AI in the clinical coding function, organisations must “go beyond technical deployment and consider the broader ecosystem of governance, workforce, and regulatory expectations”.

“The ability to balance automation with human oversight, data quality with system standardisation, and compliance with innovation will be critical to achieving safe, effective, and ethical AI-driven clinical coding,” the guidelines noted.

The guidelines are available at: himaa.org.au/our-work/clinicalcoding-and-ai-industry.