Background: Clinical natural language processing (NLP) refers to the use of computational methods for extracting, processing, and analyzing unstructured clinical text data, and holds a huge potential to transform healthcare in various clinical tasks. Objective: The study aims to perform a systematic review to comprehensively assess and analyze the state-of-the-art NLP methods for the mainland Scandinavian clinical text. Method: A literature search was conducted in various online databases including PubMed, ScienceDirect, Google Scholar, ACM digital library, and IEEE Xplore between December 2022 and February 2024. Further, relevant references to the included articles were also used to solidify our search. The final pool includes articles that conducted clinical NLP in the mainland Scandinavian languages and were published in English between 2010 and 2024. Results: Out of the 113 articles, 18% (n=21) focus on Norwegian clinical text, 64% (n=72) on Swedish, 10% (n=11) on Danish, and 8% (n=9) focus on more than one language. Generally, the review identified positive developments across the region despite some observable gaps and disparities between the languages. There are substantial disparities in the level of adoption of transformer-based models. In essential tasks such as de-identification, there is significantly less research activity focusing on Norwegian and Danish compared to Swedish text. Further, the review identified a low level of sharing resources such as data, experimentation code, pre-trained models, and rate of adaptation and transfer learning in the region. Conclusion: The review presented a comprehensive assessment of the state-of-the-art Clinical NLP for electronic health records (EHR) text in mainland Scandinavian languages and, highlighted the potential barriers and challenges that hinder the rapid advancement of the field in the region.

International Statistical Classification of Diseases and Related Health Problems codes, tenth revision (ICD-10) [1] play an important role in healthcare. All hospitals in Scandinavia record their activity by summarizing patient encounters into ICD-10 codes. Clinical coding directly affects how health institutions function on a daily basis because they are partially reimbursed based on the codes they report. The same codes are used to measure both volume and quality of care, thereby providing an important foundation of knowledge for decision makers at all levels in the healthcare service. Clinical coding is a highly complex and challenging task that requires a deep understanding of both the medical terminology and intricate clinical documentation. Coders must accurately translate detailed patient records into standardized codes, navigating the inherently complex medical language, which make this task prone to errors and inconsistencies.