research paper accounting standards

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• 23 Jun 2023

This Company Lets Employees Take Charge—Even with Life and Death Decisions

Dutch home health care organization Buurtzorg avoids middle management positions and instead empowers its nurses to care for patients as they see fit. Tatiana Sandino and Ethan Bernstein explore how removing organizational layers and allowing employees to make decisions can boost performance.

• 07 Feb 2023
• Research & Ideas

Supervisor of Sandwiches? More Companies Inflate Titles to Avoid Extra Pay

What does an assistant manager of bingo actually manage? Increasingly, companies are falsely classifying hourly workers as managers to avoid paying an estimated $4 billion a year in overtime, says research by Lauren Cohen.

• 13 Jan 2023

Are Companies Actually Greener—or Are They All Talk?

More companies than ever use ESG reports to showcase their social consciousness. But are these disclosures meaningful or just marketing? Research by Ethan Rouen delves into the murky world of voluntary reporting and offers advice for investors.

• 24 Feb 2022

Want to Prevent the Next Hospital Bed Crisis? Enlist the SEC

After two years of COVID-19, many hospitals still haven't figured out how to manage the overwhelming wave of patients that flood ICUs during each surge. Regina Herzlinger and Richard Boxer offer a novel solution. Open for comment; 0 Comments.

• 28 Feb 2021
• Working Paper Summaries

Connecting Expected Stock Returns to Accounting Valuation Multiples: A Primer

This paper introduces a framework to investors and researchers interested in accounting-based valuation. The framework connects expected stock returns to accounting valuation anchors. It can be generalized to evaluate an enterprise's expected returns, and can be adapted to correct for the use of stale accounting data.

Measuring Employment Impact: Applications and Cases

Employment impact-weighted accounting statements quantify the positive and negative effects of firm practices for employees and the broader labor community. This analysis of companies in different sectors shows how these statements are beneficial both at an aggregate and more specific level.

• 02 Nov 2020

Accounting for Organizational Employment Impact

Impact-weighted accounting methodology standardizes previously disparate measures of impact, in this case the impact of employment. This paper’s methodology and analysis of Intel, Apple, Costco, and Merck shows the feasibility of measuring firm employment impact for insight into firm practices and performance. Closed for comment; 0 Comments.

• 20 Sep 2020

Updating the Balanced Scorecard for Triple Bottom Line Strategies

Society increasingly expects businesses to help solve problems of environmental degradation, inequality, and poverty. This paper explains how the Balanced Scorecard and Strategy Map should be modified to reflect businesses’ expanded role for society.

• 24 Aug 2020

Performance Hacking: The Contagious Business Practice that Corrodes Corporate Culture, Undermines Core Values, and Damages Great Companies

Performance hacking (or p-hacking for short) means overzealous advocacy of positive interpretations to the point of detachment from actuals. In business as in research there are strong incentives to p-hack. If p-hacking behaviours are not checked, a crash becomes inevitable.

• 27 Feb 2020
• Sharpening Your Skills

How Following Best Business Practices Can Improve Health Care

Why do Harvard Business School scholars spend so much time and money analyzing health care delivery? Open for comment; 0 Comments.

• 18 Feb 2020

A Preliminary Framework for Product Impact-Weighted Accounts

Although there is growing interest in environmental, social, and governance measurement, the impact of company operations is emphasized over product use. A framework like this one that captures a product’s reach, accessibility, quality, optionality, environmental use emissions, and end of life recyclability allows for a systematic methodology that can be applied to companies across many industries.

• 16 Oct 2019

Core Earnings? New Data and Evidence

Using a novel dataset of earnings-related disclosures embedded in the 10-Ks, this paper shows how detailed financial statement analysis can produce a measure of core earnings that is more persistent than traditional earnings measures and forecasts future performance. Analysts and market participants are slow to appreciate the importance of transitory earnings.

• 28 May 2019

Investor Lawsuits Against Auditors Are Falling, and That's Bad News for Capital Markets

It's becoming more difficult for investors to sue corporate auditors. The result? A weakening of trust in US capital markets, says Suraj Srinivasan. Open for comment; 0 Comments.

• 22 Jan 2019

Corporate Sustainability: A Strategy?

Between 2012 and 2017, companies within most industries adopted an increasingly similar set of sustainability practices. This study examines the interplay between common and strategic practices. This dynamic distinction helps for understanding whether and how sustainability practices can help companies establish a competitive advantage over time.

• 03 Jan 2019

Financing the Response to Climate Change: The Pricing and Ownership of US Green Bonds

Green bonds are used for environmentally friendly purposes like renewable energy. Complementing previous research, this paper explores the US corporate and municipal green bond and shows that a subset of investors is willing to give up some return to hold green bonds.

• 03 Dec 2018

How Companies Can Increase Market Rewards for Sustainability Efforts

There is a connection between public sentiment about a company and how the market rewards its corporate social performance, according to George Serafeim. Is your company undervalued? Open for comment; 0 Comments.

• 19 Nov 2018

Lazy Prices

The most comprehensive information windows that firms provide to the markets—in the form of their mandated annual and quarterly filings—have changed dramatically over time, becoming significantly longer and more complex. When firms break from their routine phrasing and content, this action contains rich information for future firm stock returns and outcomes.

• 24 Sep 2018

How Cost Accounting is Improving Healthcare in Rural Haiti

The cost of healthcare in rural Haiti was found to vary widely, even inside the same health organization. A pioneering cost accounting system co-developed by Robert Kaplan was called in to determine the cause. Open for comment; 0 Comments.

• 14 Dec 2017

The Real Exchange Rate, Innovation and Productivity

Addressing debates on the effects of real exchange rate (RER) movements on the economy, this study examines manufacturing firm-level effects of medium-term fluctuations, in particular firm-level productivity across a wide range of countries. RER changes have different impacts depending on the export and import orientation of regions and the prevalence of credit constraints. Effects are non-linear and asymmetric, suggesting that the link between RER changes and macroeconomic performance might be much more nuanced than usually thought.

• 31 May 2017

Stock Price Synchronicity and Material Sustainability Information

This paper seeks to understand and provide evidence on the characteristics of emerging accounting standards for sustainability information. Given that a large number of institutional investors seek sustainability data and have committed to using it, it is increasingly important to develop a robust accounting infrastructure for the reporting of such information.

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The Politics of Accounting Standard Setting: A Review of Empirical Research

We provide an overview of the empirical literature on the politics of accounting standard setting, focusing on the U.S. Financial Accounting Standards Board (FASB). Although it is clear from casual observation that politics sometimes plays a first-order role in the determination of accounting standards, we argue that more can be done to improve our understanding of this important topic. Based on our review, we outline what we see to be a number of potentially fruitful directions for future research.

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Handbook | November 2023

Handbook: ifrs® compared to us gaap, latest edition: side-by-side comparison of ifrs accounting standards and us gaap..

Michael Kraehnke

Partner, Dept. of Professional Practice, KPMG US

+1 303-382-7172

This publication highlights the key differences between IFRS Accounting Standards and US GAAP, based on 2023 calendar year-ends. This edition of IFRS compared to US GAAP includes the new requirements for insurance contracts, which are now effective in 2023. It also addresses the accounting for income taxes, including new guidance on the global minimum top-up tax, and credits under the US’s Inflation Reduction Act and CHIPS and Science Act.

Applicability

• Public companies
• Private companies that do not adopt the private company accounting alternatives

Relevant dates

• Annual reporting periods beginning January 2023, including forthcoming requirements for subsequent periods.

Embracing rapid change

In the 21st century a successful company is one that adapts rapidly to innovation and change. Technological advances have had an enormous impact on businesses and their customers in recent years, with the shift to cloud computing and the growing capabilities of artificial intelligence opening vast new opportunities for commerce.

At the same time, companies are coming to terms with increased global uncertainty – for example, from geopolitical events, natural disasters, climate effects and inflationary pressures.

And as they assess the impacts of these issues on their business, companies continue to face the challenge of providing meaningful and relevant information on these risks and opportunities in their financial reporting, under both IFRS Accounting Standards and US GAAP.

Standard-setters are also responding. The International Accounting Standards Board (IASB) has added intangible assets to its agenda, along with climate-related and other uncertainties. The US Financial Accounting Standards Board (FASB) is developing new requirements for digital assets, software costs and environmental credit programmes. Both the IASB and FASB are also developing new requirements to improve transparency and comparability in the income statement.

Understanding the differences

This publication helps you understand the significant differences between IFRS Accounting Standards and US GAAP. Although it does not discuss every possible difference, this publication provides a summary of those differences that we have encountered most frequently, resulting from either a difference in emphasis, specific application guidance or practice. The focus of this publication is primarily on recognition, measurement and presentation. However, it also covers areas that are disclosure-based, such as segment reporting and the assessment of going concern.

Report contents

• General Issues
• Statement of financial position
• Specific items of profit or loss and OCI
• Special topics
• Financial instruments
• Insurance contracts

Related content

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Accounting Research Online

Access our accounting research website for additional resources for your financial reporting needs.

ACADEMICS IN STANDARD SETTING

Academics: help us improve financial reporting.

• Pre-agenda research
• Comment letters
• Stakeholder outreach activities
• Post-implementation review

IN FOCUS: Governmental and Not-for-Profit Accounting Webcast for Academics

In focus: fasb update for accounting educators and researchers.

EMERGING FINANCIAL REPORTING ISSUES RESEARCH SYMPOSIUM—APRIL 2024

Emerging financial reporting issues research symposium—april 2024.

• The costs and benefits of balance sheet recognition and measurement of intangible items.
• The relevant measurement basis (or bases) and measurement challenges.
• The costs and benefits of disaggregation of expenditures for intangible items.
• The costs and benefits of enhanced disclosures about intangible items.
• The consequences of the differential financial reporting treatment afforded to certain acquired versus internally generated intangible items.
• The potential unintended consequences of the financial reporting for intangible items.
• EVEN Hotel Norwalk (Address: 426 Main Ave #7, Norwalk, CT 06851) – approx. 2 minute drive
• Hotel Zero Degrees Norwalk (Address: 353 Main Ave, Norwalk, CT 06851) – approx. 4 minute drive
• Courtyard by Marriott Norwalk (Address: 474 Main Ave, Norwalk, CT 0685) – approx. 4 minute drive

ARCHIVE: “ACCOUNTING FOR AN EVER-CHANGING WORLD” CONFERENCE 2022

Archive: “accounting for an ever-changing world” conference 2022, keynote sessions.

CONFERENCE PROGRAM

EMERGING SCHOLAR AWARD

• Nominees must have been admitted to candidacy for a PhD degree in accounting
• Nominees may not be on the job market before July of the year the award is granted
• Candidates must be nominated by the Chair of their dissertation committee (multiple nominations from a chair will be accepted)
• Nominator Instructions
• Nominee Instructions

RESOURCES FOR RESEARCH AND TEACHING

• Organizing a student visit to the FASB offices in Norwalk, CT. If you would like more information about a student visit, please contact us at  [email protected] .
• Requesting a FASB speaker through a  FASB Speaker Request Portal  that guides you, step by step, through the process of requesting FASB speakers—including criteria for the acceptance of FASB speaking invitations.
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Post-Implementation Review

Adoption of the International Public Sector Accounting Standards in emerging economies and low-income countries: a structured literature review

Journal of Public Budgeting, Accounting & Financial Management

ISSN : 1096-3367

Article publication date: 6 September 2021

Issue publication date: 10 October 2023

The aim of the study is to review the extant literature on International Public Sector Accounting Standards (IPSAS) adoption in emerging economies (EEs) and low-income countries (LICs) (“what do we know?”), and to propose an agenda for future research (“what do we need to know?”).

Design/methodology/approach

An analytical framework that builds on diffusion theory is developed. The authors follow the “PRISMA Flow Diagram” to reduce a total of 427 articles from four databases to a final sample of 41 articles. These studies are examined, aided by the analytical framework.

The authors find that IPSASs are a relevant issue for EEs/LICs. Overall, existing research is often explorative. The authors discover that the majority of articles rely on secondary data collection. While two-thirds of the studies perform a content analysis of pre-existing material, about one-fifth of the articles each collect primary data through means of interviews and questionnaires. The findings offer a holistic understanding of where and at what stages IPSAS reforms stand in EEs/LICs, and what factors influence the progression of reforms to the next stage of diffusion.

Originality/value

The authors outline a number of avenues for further research after discussing the dominating trends and structuring the literature based on our analytical framework. These stem from looking at the blank spots and an identified need to contextualise IPSASs adoption in EEs/LICs.

• Public sector accounting
• International Public Sector Accounting Standards (IPSAS)
• Emerging economies
• Low-income countries
• Structured literature review

Polzer, T. , Adhikari, P. , Nguyen, C.P. and Gårseth-Nesbakk, L. (2023), "Adoption of the International Public Sector Accounting Standards in emerging economies and low-income countries: a structured literature review", Journal of Public Budgeting, Accounting & Financial Management , Vol. 35 No. 3, pp. 309-332. https://doi.org/10.1108/JPBAFM-01-2021-0016

Emerald Publishing Limited

Copyright © 2021, Tobias Polzer, Pawan Adhikari, Cong Phuong Nguyen and Levi Gårseth-Nesbakk

Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode

1. Introduction

This research stems from our interest in understanding “what is known about the adoption of International Public Sector Accounting Standards (IPSAS) in emerging economies (EEs) and low-income countries (LICs)” [1] and “what needs to be known”, and is based on a systematic review of the literature. The harmonisation of financial reporting in the public sector has been one of the major components of recent public sector accounting (PSA) reform initiatives ( Manes Rossi et al. , 2016 ). In this context, the IPSASs have become an international benchmark for evaluating PSA reforms ( Ben Amor and Damak Ayadi, 2019 ; Polzer et al. , 2021a ).

While a number of literature reviews have been conducted on IPSASs adoption ( Polzer et al. , 2020 ; Schmidthuber et al. , 2020 ), the focus has been on western countries, which represent not more than 10% of the global population. A recent systematic review of IPSASs ( Schmidthuber et al. , 2020 ) refers to the context of EEs and LICs only sporadically. However, a more dedicated focus on the adoption contexts is regarded as highly relevant when analysing IPSASs in EEs/LICs. This is because although some scholars hold the view that EEs and LICs could potentially “benefit more from accounting reforms [such as the adoption of IPSASs] than developed countries” ( Schmidthuber et al. , 2020 , p. 13; Chan, 2006 ), such voices are, however, in the minority. The dominant view asserts the fact that accounting solutions that have been developed in western countries do not always suit the context of EEs and LICs ( Hopper et al. , 2017 ; Soobaroyen et al. , 2017 ).

What dominating trends can be identified in the literature on IPSASs adoption in EEs and LICs over time?

What are the potential avenues for further research on IPSASs in EEs and LICs?

The remainder of the paper is structured as follows. In the next section ( Section 2 ), we present a conceptual orientation, where our research phenomenon is briefly outlined, and an analytical model based on diffusion theory is developed. We then provide an overview of the research methodology ( Section 3 ), followed by a categorisation of reviewed publications ( Section 4 ). Finally, we discuss findings and outline avenues for further research ( Section 5 ).

2. Conceptual orientation

2.1 research phenomenon – ipsass and their adoption in ees and lics.

IPSASs have emerged standard by standard since the establishment of the Public Sector Committee of the International Federation of Accountants (IFAC) in 1986, which was later transformed into the IPSAS Board (IPSASB) ( Christiaens et al. , 2015 ; Polzer et al. , 2021d ). The IPSASs follow the (accrual-based) International Accounting Standards/International Financial Reporting Standards (IASs/IFRSs) as much as appropriate, with some differences (additional commentaries, different terminologies and definitions). In addition, IPSASs have attempted to cater to the particularities of the public sector, such as the disclosure of information about the general government sector or revenues from non-exchange transactions (taxes and transfers). The outreach of the IPSASB to practitioners and academics has increased over the past years ( Jensen, 2020 ).

Although the priority of the IPSASB has been to promote the accrual-based IPSASs, EEs and LICs are encouraged, particularly by international organisations, to adopt the Cash Basis IPSAS as a necessary first step for a longer-term transition towards accrual-based IPSASs ( Adhikari et al. , 2015 ). In a comparative study of IPSASs adoption in South Asia, Adhikari and Mellemvik (2010) illustrate how the World Bank, in collaboration with professional accounting institutions, was involved in creating a myth in the region; an underlying assertion was that a transition towards accrual accounting would not yield any results without first complying with the Cash Basis IPSAS.

Claimed benefits for governments of adopting the IPSASs include, among others, enhanced accountability and transparency, improved decision-making and increased efficiency ( Polzer et al. , 2021d ). Such benefits abound in the reports and documents issued by international standard setters such as the International Federation of Accountants (see e.g. IFAC, 2011 ), international organisations (e.g. World Bank, 2010 ) and professional accounting associations and accounting firms (e.g. ACCA, 2017 ; PwC, 2013 ). For instance, the World Bank (2010 , p. 8) argues that the “[a]pplication of IPSAS will support developments in public sector reporting directed at improved decision making, financial management and accountability and will be an integral element of reforms directed at promoting social and economic development”. Also, more favourable conditions in capital markets are expected for adopters due to a better understandability of financial reports by rating agencies ( IPSASB, 2010 ). Other declared benefits concern governmental professionalisation and an access to younger talent, government stability and international comparability ( ACCA, 2017 ).

However, despite such claims, the literature suggests that convergence and harmonisation of accounting systems (such as through the adoption of IPSASs) may face challenges, with regard, for example, to diverging national traditions, to implementation costs or to preserving sovereignty ( Manes Rossi et al. , 2016 ; Polzer et al. , 2021b ). In some countries, the reluctance towards the implementation of IPSASs is quite intense (e.g. Oulasvirta, 2014 ). EEs and LICs might have less discretion, as the drive “to adopt the IPSASs mainly comes from external groups such as donors, consultants and the accountancy profession. These external groups have their own interest, which is not always the interest of the country concerned” ( Hepworth, 2017 , p. 147). As a result, attempts made by many EEs and LICs to embrace IPSASs have proved to be problematic at the implementation stage ( Adhikari et al. , 2019 ; Polzer et al. , 2020 ). Hepworth (2017 , p. 141) notes “that the implementation of the accrual-based IPSASs in European-influenced developing and transition economy countries is not an appropriate reform unless preceded or accompanied by other, essentially managerial, reforms”.

Other studies have emphasised the particularities of EEs and LICs in the area of PSA and governance, examples, among others, being limited planning; poorly grounded reform recipes, mainly the pursuit of once-size-fits-all approaches; inadequate IT facilities and human resources; and the intervention of consultants and professional accountants (see, e.g. Adhikari and Jayasinghe, 2017 ). For instance, success of IPSASs in the Asia-Pacific region is limited and rarely is any evidence available delineating the planned implementation of the standards ( Harun et al. , 2019 ). Adhikari and Mellemvik (2011) , focusing on Nepal, state that the country declared the adoption of IPSASs at a time when it was struggling even to operate a simple form of cash accounting, let alone accrual accounting. This decision was reversed later by prioritising the adoption of the Cash Basis IPSAS, a decision which took a decade to put into practice due to resource constraints ( Adhikari et al. , 2015 ).

In a similar vein, several scholars have demonstrated the challenges that Latin American countries have faced in complying with IPSASs, and have made a claim that hardly any countries in the continent have fully implemented IPSASs in practice as intended, despite their enduring commitments to IPSASs (e.g. Cavanagh and Fernández Benito, 2016 ). Gómez-Villegas et al. (2020 , p. 495) state that “there is more rhetoric than practice” in Latin America, even though most of the countries had already started to embark on implementation years ago.

In Africa, IPSAS reforms have drawn more critics for further weakening the existing accountability mechanisms, thereby impinging on governance problems, patronage politics and endemic corruption ( Hopper et al. , 2017 ; Lassou, 2017 ). For example, in their study of Nigeria, Bakre et al. (2017) demonstrate how the adoption of IPSAS 17 was manipulated to continue using the historical costs in property valuation, which largely benefitted politicians, public officers and their family members. In their study of Tanzania, Goddard et al. (2016) illustrate how resource constraints and donor pressures have led to the manipulation of the compliance of financial statements prepared by local governments.

More recently, Jayasinghe et al. (2020) point out that there is the danger that positive aspects of local accounting practices in EEs and LICs are deliberately ignored by the epistemic community when disseminating IPSASs. However, in many EEs and LICs, local accounting and reporting practices already far exceed the requirements laid down in that standard. ( Jayasinghe et al. , 2020 ). It is important to note in this context that PSA reforms are not neutral, but always have a political and ideological component ( Bakre et al. , 2021 ; see also Adam, 2018 ; Cenar, 2012 ; Mattei et al. , 2020 ). More specifically, in terms of the IPSASs, a number of critical opinions have been raised – for example, that they are being issued by an authority that is not democratically legitimated (the IPSASB, Brusca et al. , 2013 ). There are also critical remarks that the IPSASs represent the Anglo-Saxon method of PSA ( Oulasvirta, 2014 ). They are claimed to be irrelevant in the contexts where the budget has continued to dominate ( Adhikari and Gårseth-Nesbakk, 2016 ). In the following, we develop an analytical framework in order to trace to what extent the argued benefits and critical issues manifest in EEs and LICs.

2.2 Analytical framework – diffusion theory

Diffusion theory concerns providing an understanding of how innovations in the forms of ideas, practices or standards are disseminated in a specific context ( Jackson and Lapsley, 2003 ; Rogers, 2003 ). The application of the theory has steadily increased in accounting research, not least PSA ( Dissanayake et al. , 2020 ; Ezzamel et al. , 2014 ; Lapsley and Wright, 2004 ; Thoradeniya et al. , 2020 ). In the context of EEs/LICs, researchers have drawn on the theory to examine, for example, the unintended consequences of PSA reforms in countries such as Nepal ( Adhikari et al. , 2015 ), Sri Lanka ( Dissanayake et al. , 2020 ) and Egypt ( Adhikari et al. , 2019 ).

With the help of diffusion theory, researchers have demonstrated the extent to which PSA reforms vary in different contexts due to multiple external and internal factors, and formal and informal channels of communication ( Adhikari et al. , 2015 ; Lapsley and Wright, 2004 ). In this regard, the essence of applying diffusion theory concerns its ability to bring out distinct trajectories in the reform process. Such holistic insights are paramount to shed light on the causes of unintended consequences in PSA in general and IPSASs adoption in particular ( Ezzamel et al. , 2014 ; Polzer et al. , 2020 ).

For the purpose of this study, we developed an analytical framework ( Table 1 ) to assess the literature, focusing on two key elements. First, we categorise the identified articles alongside the five stages involved in the diffusion of innovations , as described by Rogers (2003) – this is the upper half of the table. When we refer to IPSASs adoption , we use this term as an umbrella term for (potentially) all five stages. Second, as the context for IPSASs adoption differs in EEs and LICs ( Hopper et al. , 2017 ; Soobaroyen et al. , 2017 ), our framework allows us to take the contextual conditions for each stage explicitly into consideration – this is the lower half of the framework.

The first stage of Rogers' (2003) model (seeking knowledge about reform innovations) highlights information-seeking processes. This stage is strongly guided and influenced by already available knowledge. In the context of the public sectors in EEs and LICs, pre-existing knowledge about accrual accounting might be limited ( Adhikari et al. , 2015 ) or accounting systems might be generally less developed ( Chan, 2006 ).

Persuasion is the second stage in Rogers' (2003) model. Establishing consensus about the need and rationale of IPSASs adoption is a complex social process where multiple actors are involved (on the administrative and political side, professional accounting bodies and international (donor) and non-profit organisations). During this stage, the innovation is often contested. A range of factors increase the likelihood of an innovation becoming accepted: its complexity; piloting of the innovation; the fit with the adopter's existing values; the expected benefits from the innovation; and the possibility of actually observing the results of the innovation. In the EE/LIC context, donor pressures might be the dominant driver of persuasion ( Hopper et al. , 2017 ), limiting the influence of actors within a country. Indeed, PSA reforms introduced in EEs/LICs have been mostly a supplier-led initiative resulting from the loan conditionality and development discourses of international organisations such as the World Bank and the IMF, which is evident in extant work ( Adhikari et al. , 2019 ). International organisations have demonstrated pro-innovation biases in EEs/LICs, designating IPSASs as the best accounting practices which could lead to improved governance and accountability ( Adhikari and Mellemvik, 2010 ; Jayasinghe et al. , 2020 ).

The decision (stage 3) involves the formal approval or rejection of a law or framework document to implement IPSASs. In practice, a decision can come in different forms – for example, a decision for sequencing ( Bietenhader and Bergmann, 2010 ), or a partial approval. The decision has to be made by a legitimate actor, which could be, for example, Parliament, the cabinet, a responsible minister or the accounting standards board. In the context of EEs and LICs, reform decisions are often taken in a top-down manner, i.e. without consulting local implementing organisations or those who are actually involved in implementing reforms ( Zaman Mir and Shiraz Rahaman, 2005 ).

Once the decision to adopt IPSASs has been made, the implementing organisations (in particular, government ministries and agencies) move to stage 4 – implementation ( Rogers, 2003 ). However, implementation is not a simple application of the legal or guidance material resulting from the decision, but also involves its active interpretation in the specific policy context. The implementation requires knowledge transfer and boundary-spanning activities ( Jackson and Lapsley, 2003 ) to ensure a meaningful application. However, at the same time, some actors may seek to modify or reinvent the innovation, partly driven by the need to cater for the specific local and organisational circumstances ( Baskerville and Grossi, 2019 ; Mouritsen, 2005 ). From the extant literature on implementing reforms in EEs and LICs, it is known that power struggles over resources by different individuals and societal groups ( North et al. , 2013 ), a lack of resources ( Gómez-Villegas et al. , 2020 ) and extended training needs of civil servants ( Rajib et al. , 2019 ) are the factors that might pose challenges to the implementation of reforms. Adhikari et al. (2019) state that implementation has been reckoned to be the most complex and problematic stage within the diffusion trajectory, as well as the stage in which the factors and causes of unintended consequences become much clearer.

The final stage 5 – confirmation – is reached when the IPSASs have become an institutionalised and legitimate practice beyond the formal implementation and gain legitimacy ( Rogers, 2003 ). Stakeholders start to recognise the benefits and the innovation spreads throughout the PSA system. The question of how enduring change can be achieved has also been intensely discussed in the PSA literature (e.g. Liguori and Steccolini, 2012 ). For EEs and LICs, changing traditional and precolonial values ( Hopper et al. , 2017 ) might be an additional challenge. Also, very often the adoption of an innovation seldom happens in isolation, but is connected to wider reforms ( Hepworth, 2017 ). With this, judging the outcomes of IPSASs adoption in solitude is challenging.

While the significance of the five stages of the diffusion model and their analytical value were confirmed in prior work, also in the area of PSA ( Ezzamel et al. , 2014 ), we assume that the stages are not clear-cut in practice, but rather serve to structure and rationalise developments ex post. Furthermore, in the context of EEs/LICs, studies discussing (1) the stages of diffusion that PSA reforms pass through and (2) the contextual conditions in each stage (which might result in unintended consequences) are scarce, with a few exceptions (see, e.g. Adhikari et al. , 2015 ). We intend to address this theoretical gap in this study.

3. Research approach

Systematic literature reviews have become increasingly popular in PSA ( De Waele et al. , 2021 ; Schmidthuber et al. , 2020 ) and also in the EE/LIC context (e.g. Nolte et al. , 2021 ; Van Helden et al ., 2021 ; van Helden and Uddin, 2016 ). The purposes of such reviews are to identify the areas of a research field where substantial progress was made and to outline future directions of research ( Bracci et al. , 2019 ; Massaro et al. , 2016 ). In our study, we follow the “PRISMA Flow Diagram” ( Moher et al. , 2009 ) to ensure reproducibility ( Figure 1 ). This flow chart has gained recent popularity for review studies in public sector research (e.g. de Vries et al. , 2016 ).

3.1 Identification of studies

The searches were carried out in autumn 2020. As shown in Table 2 , 16 queries in four literature databases that are commonly used in the social sciences yielded 427 results for a full-text search (the table reports databases and search terms). We did not limit our search to any particular years, so we cover articles from 2003 (being the year when the first relevant article on IPSASs appeared) to 2020. We also did not exclude any subject categories, as we wanted to obtain results from potentially the accounting, development and public administration research areas. However, we limited the results to peer-reviewed journal articles (i.e. excluding book chapters and conference papers) in English, where this was allowed by a database. Such an exclusion strategy is recommended in order to obtain validated knowledge on an issue ( Podsakoff et al. , 2005 ; Polzer et al. , 2021c ). After we removed duplicates in the next step, the number of records decreased to 225.

3.2 Screening

Next, the relevance of search hits was assessed ( Manes Rossi et al. , 2020 ). We performed an initial screening of title, abstract and keywords of each article in order to establish if each one actually focused on IPSASs as a (potential) main topic ( Moher et al. , 2009 ). This further reduced the sample to 69. Following such an approach, articles that were not focusing on IPSASs at all (but instead on, for example, street trading in South Africa; Bénit-Gbaffou, 2018 ) or mentioned IPSASs only in a footnote (e.g. Tooley et al. , 2010 ) were excluded.

3.3 Eligibility and included studies

During the following step – the eligibility check – we reduced our data set to 41 articles after analysing if the IPSASs were actually a central topic of the article. This led, for example, to the exclusion of an initially promising paper on the quality of public sector financial statements ( Ratmono and Sutrisno, 2019 ), which was later not deemed eligible because it covered IPSASs only very marginally. After the eligibility check, 41 papers were included in our analysis.

3.4 Analysis

We structure our findings alongside the following dimensions, as suggested by Massaro et al. (2016) : (a) year of publication, (b) journal ranking, (c) number of citations per year, (d) country and tier of governments, (e) research strategies and methods, (f) conceptual orientation of the studies, (g) keywords and thematic embedding and (h) categorisation of the main findings with respect to the elements of the established analytical framework ( Table 1 ).

In terms of (b) journal ranking, we draw on a measure developed by Scimago Lab. “SCImago JCR” is a form of impact factor and shows the journal citation ranking of 2019 as per the definition developed by Scimago Lab ( Scimago Research Group, 2007 ). In addition to traditional impact factors, this ranking takes into account the prestige of the citing journal. With respect to (g) thematic embedding, extant research found that governments seldom introduce new reform tools (such as the IPSASs) on their own, but often on top of, or interwoven with, existing ones ( Hepworth, 2015 ). We therefore expect that pieces covering IPSASs adoption are frequently related to studies focusing on prevalent, more general PSA topics. To make the interlinkages visible, we draw a network of co-occurrences of author keywords from the articles ( Kumar et al. , 2020 ) in an additional analysis (34 of the 41 identified articles contained keywords).

Turning to (h) categorisation of the main findings, we assigned for each of the articles five values between 0 (minimum) and 3 (maximum) with respect to its focus on knowledge , persuasion , decision , implementation and confirmation as per our analytical framework ( Table 1 ) based on the model by Rogers (2003) . For example, the article by Timoshenko and Adhikari (2010) that compared IPSASs implementation in Nepal and Russia focused on the decision (coded as 2) and implementation (also coded as 2) stages. Coding reliability was ensured by team coding: all preliminarily coded values were double-checked by two members of the research team and discussed, until consensus in the interpretation was reached among the team.

4. Findings

4.1 descriptive analysis, 4.1.1 year of publication and outlet.

An analysis of the number of articles published per year shows that research on IPSASs in EEs and LICs has gained momentum over the years (see Figure 2 ). With the first eight IPSASs published in 1999, IPSASs become an important PSA reform issue in EEs and LICs relatively quickly and the first paper with an IPSASs focus was published four years later ( Chan, 2003 ). We can observe an increasing trend in publications on IPSASs over the years (see the dotted trend line – nine papers in 2020), which is also due to a Special Issue in the International Journal of Public Sector Management ( Nurunnabi, 2020 ).

Looking at the outlets of the identified research papers and using the SCImago JCR 2019 ranking as a benchmark, we find that the article by Bakre et al. (2017) is the one that has been published in the journal with the highest JCR score ( Accounting, Auditing and Accountability Journal : 1.459 – comparators: Accounting, Organizations and Society : 1.924; Critical Perspectives on Accounting : 1.823). The majority of the articles are published in low to medium-ranked journals (JCR values under 1). Just 7.3% of studies are from outlets with a higher score. When looking at the averages of JCR values per year (solid line in Figure 2 ), no clear trend emerges; for example, we cannot observe that the discourse is moving towards outlets with higher impact factors.

4.1.2 Citations per year

The papers that have the highest citations per year (a top ten ranking as per counts on the Google Scholar website divided by years) are listed in Table 3 . The papers by Chan (2003) and Torres (2004) include evidence from both western countries and EEs/LICs. This means that the issue has gained some scholarly attention over the last years. Other frequently cited papers (in absolute terms) include Saleh and Pendlebury (2006) , with 59 citations, Grubišić et al. (2009) , with 42 citations and Deaconu et al. (2011) , with 41 citations.

4.1.3 Locus of studies

Our country analysis ( Table 4 ) shows that the majority of studies (39.0%) are cross-country analyses (e.g. two-country case study comparisons – Ghana and Benin: Lassou, 2017 ; Nepal and Russia: Timoshenko and Adhikari, 2010 ; Arab region: Abushamsieh et al. , 2013 ; Central America: Araya-Leandro et al. , 2016 ; quantitative comparisons of 87 countries: Amiri and Hamza, 2020 ). There are three studies (7.3%) each from Indonesia (e.g. Fahmid et al. , 2020 ) and Romania (e.g. Tiron Tudor, 2010 ), as well as two (4.9%) each from Russia (e.g. Legenkova, 2016 ), Nepal (e.g. Adhikari and Jayasinghe, 2017 ) and Nigeria (e.g. Mustapha et al. , 2019 ). The remaining articles (31.7%) represent a further 13 countries. With this, there is a degree of empirical breadth of research in our sample, with accounts from all continents.

Table 4 also shows which tier of government is being analysed. The majority of studies (56.1%) focus on central government. While the state/regional level is targeted in only one single study (2.4%: Sour, 2020 ), there are just two (4.9%, e.g. Mir and Sutiyono, 2013 ) on the local government level. The study by Deaconu et al. (2011) focuses on the level of single public sector organisations. Finally, 9.8% of studies research IPSASs adoption in multiple levels of government.

4.1.4 Research design

For analysing the research design, we draw on van Thiel's (2014) distinction between research strategies and methods ( Figure 3 ). Regarding the former, we differentiate between experiment, survey, case study, desk research and other. Regarding the latter, we categorise the sampled papers alongside the categories of observation, questionnaire, interview, content analysis, secondary analysis, meta-analysis, mixed methods (only if explicitly mentioned) or other. As a study can make use of more than one strategy and method, we code the two main methods applied.

Our analysis reveals that primary data are collected in about 40% of the studies, and that about two-thirds of the articles follow the qualitative paradigm. In terms of research strategy, about half of the publications are based on desk research (e.g. Carolini, 2010 ; Hepworth, 2015 ). About a quarter follow a case study approach to explore IPSASs adoption. Moving on to the research methods, in over 50% of the studies a form of content analysis is carried out, often without collecting primary data (e.g. Amiri and Hamza, 2020 ; Deaconu et al. , 2011 ). About 20% of the papers analyse primary data collected through means of questionnaires (e.g. a survey among 223 accountants in local governments – Antipova and Bourmistrov, 2013 ) and interviews (e.g. 80 semi-structured conversations in Jordan: Alsharari, 2020 ). Very few studies reanalyse existing data or use other techniques (e.g. Ben Amor and Damak Ayadi, 2019 ; Kartiko et al. , 2018 ). We find no studies that use advanced methods such as experiments. This demonstrates that existing research is often explorative.

4.1.5 Conceptual background

Next, we are interested in how the studies are anchored in the literature, i.e. which theory/-ies were mobilised as an analytical framework. To shed light on this question, we coded up to three conceptual lenses per article (as more than one lens could be mobilised). The results ( Figure 4 ) show that about one-third of the articles are not explicitly conceptually anchored. For example, the recent overview by Fahmid et al. (2020) , which looks at recent developments in the adoption of IPSASs worldwide and in particular at the different governmental ties in Indonesia, draws on no particular conceptual orientation.

Another quarter draw on new institutional theory ( Greenwood et al. , 2017 ). Also, the overview by Van Helden et al . (2021) finds that this theory has dominated PSA research in EEs and LICs in the last decade. Here, a number of studies delve into the different aspects of isomorphism , for example how international donors and organisations exert pressures to implement IPSASs. A study by Hassan (2015) is one of them, looking at the coercive pressures by international lenders on the transformation to more accrual-based accounting practices (including towards IPSASs adoption) in the Indonesian government. An empirical account from Turkey ( Ada and Christiaens, 2018 , p. 8) holds the view that “[t]he influence of IFAC and IPSASB are examples of normative forces being exerted for the adoption of IPSAS”. Traces of mimetic isomorphism are identified in the work by Timoshenko and Adhikari (2010 , p. 474) for Russia, where “mimetic isomorphic pressures may have acted along with normative and coercive ones [… stemming] from a plethora of international agencies and departments worldwide […], which all have been somehow embedded in the transformation process”. Other studies embody the concept of decoupling and connected concepts in new institutional theory. For instance, drawing on the concept of organisational façades, Lassou's study on Ghana and Benin finds that (2017, p. 502) “[w]hile decoupling occurred in the study contexts in different ways, adopted reforms and their subsequent implementation appeared to represent façades”. Yet other papers refer to institutional logics and institutional entrepreneurship (e.g. Rajib et al. , 2019 ).

Thirteen percent of the studies focus on IPSASs adoption mobilising the lens of contingency theory , which was made available to PSA research by Lüder (1992) . For example, scrutinising the case of IPSASs adoption in Nigeria, Mustapha et al. (2019) find that the quality of reporting according to the Cash Basis IPSAS is contingent on a number of organisational factors, with accounting staff competency significantly and positively influencing the perceived reporting quality. Looking at the adoption process of IPSASs in Sri Lanka through the lens of contingency theory, De Silva Lokuwaduge and De Silva (2020 , p. 191) conclude that “prevailing political uncertainty in Sri Lanka has negatively impacted the implementation process”.

Papers that fall under the category of other (17%) use yet another conceptual background. We subsume all approaches under this category that appear only once in the sample. Here, studies such as the one by Adhikari and Jayasinghe (2017) , which mobilises strong structuration theory , are noteworthy. Another example is the paper by Torres (2004) that looks at Mercosur countries (among others). Using Cooke's Index as a starting point, this research takes IPSAS 1 as a benchmark and evaluates the information content of financial statements. The study also describes “to what extent the IPSASs are able to fit into diverse public administration styles in order to improve the transparency, accountability and reliability of the financial information disclosed” ( Torres, 2004 , p. 447).

Finally, it needs to be noted that several articles combine some of the described theories. The paper by Polzer et al. (2020) that develops a framework that combines institutional and diffusion theory is an example. The research evaluates if the IPSAS reform walk (actual implementation) matches the reform talk (announcement). Some authors complete their analytical frameworks with yet other theories, such as contingency theory combined with institutional and economic network theories ( Amiri and Hamza, 2020 ).

4.1.6 Thematic embedding of IPSASs

The network in Figure 5 shows how the keywords from the abstracts of the reviewed studies are linked to each other (co-occurrences; Kumar et al. , 2020 ). Each keyword represents a node, and a link between keywords is established if they are mentioned in the same article or if the same keyword is mentioned in two different articles. The more links nodes are sharing, the closer they are positioned to one another. This approach helps to show the links between IPSASs and further instruments, ideas, actors, discourse communities and geographic areas. In order to focus on the most prominent links, we defined a threshold of two co-occurrences for ties to be included in the network.

Figure 5 shows that the IPSASs are linked to multiple nodes. The most frequent co-occurrences are, somewhat unsurprisingly, with accrual accounting and public sector (both 29.0%), followed by EEs (22.9%). Grouping the links, we first identify a thematic embedding of IPSASs with the targets pursued with their implementation ( accountability , transparency , harmonisation and, maybe of particular relevance to EEs and LICs, corruption ). Second, we find references to general accounting issues and accounting standards (such as accounting reform , accounting standards and accrual accounting ), PSA ( public sector accounting and government accounting ) and wider public sector reforms ( public sector reform and NPM (New Public Management)). Third, country clusters appear in the network ( Indonesia and Nepal ). Looking closer at these clusters, the papers on Indonesia are related to ideas of NPM (e.g. Fahmid et al. , 2020 ) and the studies on Nepal to the EEs context (e.g. Adhikari and Mellemvik, 2011 ). Fourth, three conceptual lenses that are mobilised in the studies come to the fore ( institutional theory , diffusion and contingency factors ). Finally, the keywords refer to two government tiers where the adoption of IPSASs takes place – central government and local government .

4.2 Content analysis

In this section we revisit the individual elements of our analytical framework, as illustrated in Table 1 . We have developed Figure 6 , to show the focus of studies, i.e. if a particular study addresses one of the five stages (an article could focus on more than one stage) of Rogers' (2003) diffusion model (0 being the minimum and 3 being the maximum with respect to its focus on knowledge , persuasion , decision , implementation and confirmation ). The figure indicates that the implementation stage is the most researched one (1.63 of 3), while research addressing the persuasion stage is scarce (0.07). A score of around 0.5 is reached for the other three stages.

4.2.1 Knowledge

About one-fifth of papers (i.e. nine out of 41) address the first stage, knowledge. For example, the normative study by Hughes (2007) illustrates four steps for the adoption of IPSASs and suggests an implementation plan. There is also evidence from Bahrain (a survey among 80 civil servants; Elmezughi and Wakil, 2018 ) that knowledge about the innovation might be an issue. While 59% of respondents feel a lack of knowledge accrual accounting in general, 68% feel uneasy with IPSASs. Regarding valuation according to IPSASs, 63% of respondents expect difficulties in the valuation of inventory and 69% in the valuation of fixed assets such as infrastructure and heritage assets. Applying a diffusion theory lens ( Rogers, 2003 ) and looking at various factors that influence the readiness of the public sector to adopt IPSASs in Qatar, Abdulkarim et al. (2020 , p. 490) conclude that “despite the availability of highly skilled professionals among public sector staff in Qatar, it is still recommended that training programmes be developed to equip employees with up-to-date knowledge about IPSAS, because of the complex nature of the standards”.

4.2.2 Persuasion

Second, persuasion is an issue for under 10% of studies (these are Adhikari et al. , 2019 ; Adhikari and Mellemvik, 2011 ; Polzer et al. , 2020 ). This low value might indicate that – in contrast to western countries – EEs and LICs have a limited say about the general decision to adopt IPSASs, as this reform often appears as a supplier-led reform encouraged by international organisations. This directs attention to the bottom part of our analytical framework (i.e. the contextual factors of adoption).

4.2.3 Decision

About 30% of pieces address the decision stage. Here, studies bring issues of non-participation of stakeholders in EEs and LICs to the forefront. For example, Rajib et al. (2019) find that the Cash Basis IPSAS in Bangladesh was adopted in a rather top-down manner without consulting professional accounting bodies (see Zaman Mir and Shiraz Rahaman (2005) for a similar account on the adoption of international accounting standards in the private sector). Drawing on the experiences from other Arab countries, Abushamsieh et al. (2013) develop a framework facilitating the adoption decision in Palestine based on contingency theory ( Lüder, 1992 ). The study by Boolaky et al. (2018) is a chronology of decisions in Indonesia (PSA regulatory changes including IPSASs).

4.2.4 Implementation

The majority of papers (about three-quarters) focus on the implementation stage of IPSASs adoption. Here, studies often analyse the factors that facilitate or impede implementation (often in research that deploys a contingency theory framework). Hindering factors include political uncertainty ( De Silva Lokuwaduge and De Silva, 2020 ), insufficient training of public sector accountants ( Polzer et al. , 2020 ; Rajib et al. , 2019 ), further institutional incapability ( Hassan, 2015 ) or patronage ( Lassou, 2017 ). In their comparative study of Egypt, Nepal and Sri Lanka, Adhikari et al. (2019) state that delay and resistance have often become the key characteristics of PSA reforms, including IPSAS reforms at the implementation stage.

4.2.5 Confirmation

Another 30% of the studies describe the final stage in Rogers' (2003) model, which looks at reform outcomes ( Figure 6 ). Research often discusses decoupling (e.g. Ada and Christiaens, 2018 ; Antipova and Bourmistrov, 2013 ; Hassan, 2015 ; Lassou, 2017 ). Also, Goddard et al. (2016 , p. 19) find that “despite the inherent weaknesses facing the implementation of IPSAS, all financial statements of the Tanzanian Councils were stamped as “fully IPSAS compliant”. The research by Adhikari and Jayasinghe (2017) provides evidence that the reform in Nepal has not been materialised, which is mainly due to the inability of reform propagators to make a considerable impact on the internal structures of government accountants. On a more positive note, the paper by Korutaro Nkundabanyanga et al. (2013 , p. 65) on Uganda finds “that accounting standards and legal frameworks are all positively and significantly associated with the quality of financial reporting”. This suggests that enforcing compliance with standards can ultimately result in a successful adoption.

4.2.6 Contextual factors present in EEs and LICs

First, it is interesting to note that the majority of studies are silent on whether the IPSASs are regarded suitable to be adopted in EEs/LICs. While 78% of studies take a neutral stance, about 17% take a positive one and the rest are openly critical towards IPSASs adoption by EEs and LICs. For example, Legenkova's article (2016) concludes that the adoption of IPSASs could contribute to the Russian Federal Government's goal to deliver services more effectively and efficiently. In contrast, the research by Carolini (2010 , p. 469) argues that IPSASs currently “fail to adequately encompass and address the voices and concerns of governments in the global South”. Bakre et al. (2017) illustrate that IPSASs can even foster corruption in a patronage-based culture, and Jayasinghe et al. (2020) question the significance of IPSASs for EEs/LICs, which tend to de-emphasise the elements of existing good accounting practices.

In order to overcome decoupling, a number of papers point towards the necessity to respect national peculiarities in EEs and LICs when implementing the IPSASs (e.g. Adhikari et al. , 2013 ). This is in line with what studies have found on the adoption of private sector IFRSs (e.g. Nguyen and Dinh Khoi Nguyen, 2012 ). Having this in mind, in order to accommodate the idiosyncrasies of EEs and LICs, a sequencing or prioritisation reform approach is suggested, i.e. carrying out basic reforms first before more advanced PSA reforms are undertaken ( Bietenhader and Bergmann, 2010 ) – for example, introducing consolidated financial statements ( Santis et al. , 2018 ). Such an approach is also emphasised by the World Bank (2010) that recommends that EEs and LICs implement the Cash Basis IPSAS first before rolling out the full set of IPSASs ( Adhikari and Mellemvik, 2010 ). More recently, Jayasinghe et al. (2020) argue that in many EEs/LICs some elements of good government accounting practices already exist, and reforms should build on these rather than initiating new large-scale reform projects.

5. Discussion and avenues for further research

When applying our analytical framework to assess the literature ( Figure 6 ), our findings demonstrated that much of the empirical research centred on the implementation stage of the IPSASs. For each of the stages, the studies provided accounts on the idiosyncrasies of EEs and LICs ( Hopper et al. , 2017 ; Soobaroyen et al. , 2017 ). An explanation for the low number of studies that focused on the persuasion stage could be that the adoption is externally driven or supply-led innovation. In terms of outcomes or success of IPSASs adoption initiatives, the (limited) evidence was mixed. While some studies present positive accounts (at least regarding some aspects), issues of decoupling between adopted standards and their actual use are frequently reported, indicating a lack of confirmation of the diffusion.

5.1 Research agenda

We propose the following areas for further research (“what do we need to know?”). First, research to fill the identified blank spots in the analytical framework ( Figure 6 ) is proposed. Here, we call in particular for more analytical works assessing the outcomes (confirmation stage) of IPSASs in different contexts. The study by Bakre et al. (2017) on the adoption of IPSAS 17 in Nigeria is a good example. Given a weak regulatory framework and ineffective governmental institutions, “the promise of using alien accounting standards such as IPSAS 17 to purportedly improve transparency and accountability in property sales and the monetisation of fringe benefits to public officials was ultimately unfulfilled” (ibid., p. 1303). Indeed, formally introducing IPSASs might end up as an exercise that adds little to improving PSA and development without corresponding monitoring of progress ( Bakre et al. , 2021 ; Soobaroyen et al. , 2017 ).

Second, the results revealed that the persuasion and decision stages are under-researched, and in particular the role of local stakeholders such as professional accounting bodies and professional associations of public sector accountants who will work with the new standards on a day-to-day basis. The research by Rajib et al. (2019) contrasts the involvement of stakeholders in decision-making in Sri Lanka and Nepal with their non-involvement in Bangladesh during this stage. The paper by Antipova and Bourmistrov (2013) on Russia suggests that the followed top-down approach did not involve what they refer to as “context ambassadors” very much – but the buy-in of these is needed for the reforms to succeed. With this, we require more in-depth insights as to how to secure the commitment of accountants and users of financial reporting in the course of deciding on the adoption.

Third, developing strong PSA systems in EEs and LICs has been argued to be important for a number of reasons. According to a study by ACCA (2010 , p. 2), PSA systems impact “on a broad range of areas including: aggregate financial management – fiscal sustainability; resource mobilisation and allocation; operational management – performance, value-for-money and budget management; governance – transparency and accountability; fiduciary risk management – controls, compliance and oversight. In addition, effective public financial management is important for decision making”. Looking at the co-occurrence network of keywords from the papers ( Figure 5 ), we see that IPSASs adoption is linked to PSA and wider administrative reform issues such as transparency , accountability and regulation , but not overly to topics such as decision-making , budgeting , fiscal sustainability and fiduciary management . Exploring the relationship of IPSASs with these issues (and potentially also risk management ), i.e. their “interlinking theorisation” ( Höllerer et al. , 2020 , p. 1284), could be an area for further studies.

Related to this, the voiced downsides of IPSASs of (1) initially offering limited public sector-specific provisions in recognising, for example, transactions relating to social benefits and tax revenues and (2) not covering budgeting issues, which is central for countries where public finance is centred around the annual budget, have made the usefulness of IPSASs largely redundant in contexts also beyond EEs and LICs ( Adhikari and Gårseth-Nesbakk, 2016 ; European Commission, 2012 ). This has triggered, for example, a momentum towards developing a separate set of European Public Sector Accounting Standards (EPSASs), especially focusing on the European context, as part of harmonising PSA ( Manes Rossi et al. , 2016 ).

Fourth, we call for more research on the regional and local level and the level of individual organisations. This is, for example, done in Chow and Aggestam Pontoppidan's (2019) study, which focuses on IPSAS adoption in the United Nations System of Organizations. It is on this level where the majority of public services are delivered to citizens and where IPSASs can potentially contribute instantaneously to increasing transparency and discharging accountability. Here, IPSASs adoption could be linked to the debate of the publicness of PSA, and the localisation of reforms in particular ( Steccolini, 2019 ).

Fifth, through the application of diffusion theory, we have delineated a clear trajectory of ongoing PSA reforms in EEs/LICs. IPSAS reforms are at different stages in different EE/LIC contexts and these reforms are encountering varied challenges and obstacles as they traverse each successive stage. Prior work discusses that the diffusion of public sector innovation is not automatic ( Adhikari et al ., 2015 , 2019 ; Dissanayake et al. , 2020 ; Ezzamel et al. , 2014 ). However, rarely has prior work delineated a holistic understanding of where and at what stages IPSAS reforms stand in EEs/LICs, and which factors influence the progression of reforms at the next stage. For instance, our findings show that almost 70% of IPSAS reforms have been unable to reach the confirmation stage and that confirmation has been manipulated in many cases ( Bakre et al. , 2017 ; Goddard et al. , 2016 ). Given that many EEs/LICs are in the process of converging with IPSASs ( Gómez-Villegas et al. , 2020 ), further research is warranted focusing on issues relating to the confirmation stage of the diffusion of PSA reforms.

Finally, we reiterate a number of calls from the papers regarding studying the particular challenges that EEs and LICs are facing, such as the consequences of the global financial crisis about a decade ago ( Amiri and Hamza, 2020 ; Ben Amor and Damak Ayadi, 2019 ; Timoshenko and Adhikari, 2010 ) and recently the COVID-19 pandemic. In the advent of the pandemic, reporting of balance sheet risks and guarantees and contingent liabilities have been key issues in PSA ( Anderson and Burke, 2021 ). While the first empirical research has been published in the area of budgeting (see the Special Issue edited by Grossi et al. (2020) in this journal), we call for an extension of the scope to financial accounting and reporting. Further studies along the suggested lines may help to clear some of the “blank spots” (or reduce them) and eventually foster an understanding of IPSAS diffusion in EEs and LICs.

5.2 Practical implications and conclusion

In addition to the outlined research avenues, we derive a number of practical implications from this research.

First, this research echoes observations made by previous authors ( Bakre et al. , 2021 ; Hopper et al. , 2017 ; Jayasinghe et al. , 2020 ), who make a call to take the characteristics of EEs and LICs into account when adopting (public sector) accounting reforms. The main point here is not to “wash away” the structures already in place, but to make “an ‘intelligent’ application of existing regulations and accounting systems” ( Jayasinghe et al. , 2020 , p. 1) when adopting a “development accounting” instrument ( Jayasinghe and Wickramasinghe, 2011 , p. 410) such as IPSASs.

Second, IPSAS reforms are interconnected to a wider range of (PSA and public sector) reform activities, for example enhancing systems of accountability ( Figure 5 ) or internal auditing capacities ( Nerantzidis et al. , 2020 ). After an assessment of institutional capability ( Hassan, 2015 ), a sequencing/prioritisation approach ( Bietenhader and Bergmann, 2010 ) might be suggested, i.e. starting reforms with more basic issues or reform packages before implementing more advanced instruments. Also, IPSASs could be first introduced in pilot entities ( Jorge et al. , 2020 ).

Finally, in line with Chan (2006) and Rajib et al. (2019) , we argue that the implementation of IPSASs in EEs and LICs often requires a large investment in educating and training public sector employees to develop a new range of accounting skills.

To conclude, this is the first review of IPSASs in EEs and LICs to structure the extant literature and point to under-researched areas. However, as with all empirical research, there are a number of limitations to this study. First, our methodological setup did not enable us to include materials such as books, edited volumes, journals that are not peer-reviewed and material in languages other than English in our review. Further research could address this shortcoming ( Massaro et al. , 2016 ). Also, IPSASs need to be contextualised in the broader “ecosystem” of administrative reforms in the public sectors of EEs and LICs. Further research could, for example, explore how IPSASs relate to broader managerial reforms in these countries ( Hepworth, 2015 ) and how they relate to “good governance” principles, such as transparency and accountability (e.g. Bakre et al. , 2021 ).

Flow diagram for systematic literature review

Articles per year, 2003–2020

Research design of papers

Conceptual background of studies

Author keywords co-occurrence network

Revisited analytical framework

Analytical framework to assess the literature on IPSASs

Search query results

Citations per year (as of December 2020)

Locus of studies

In this review, we follow the criteria of the Journal of Accounting in Emerging Economies to determine which countries are considered as EEs ( Tsamenyi and Uddin, 2011 ). EEs are countries within lower- to upper-middle-income bands according to the World Bank, as well as ex-communist countries in Europe, upper-income countries from the Middle East and ASEAN countries (as these countries bear socio-economic similarities to the countries as per the World Bank list). LICs are low-income countries as per the World Bank classification: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups – retrieved: 01/12/2020.

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Abushamsieh , K. , López Hernández , A.M. and Ortiz Rodríguez , D. ( 2013 ), “ The transparency of government financial information systems in Arab countries: evidence from Palestine ”, Journal of Accounting – Business and Management , Vol. 20 No. 2 , pp. 99 - 112 .

ACCA ( 2010 ), Improving Public Sector Financial Management in Developing Countries and Emerging Economies , Association of Chartered Certified Accountants , London .

ACCA ( 2017 ), IPSAS Implementation: Current Status and Challenges , Association of Chartered Certified Accountants , London .

Ada , S.S. and Christiaens , J. ( 2018 ), “ The magic shoes of IPSAS: will they fit Turkey? ”, Transylvanian Review of Administrative Sciences , Vol. 54 No. 1 , pp. 5 - 21 .

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Goddard , A. , Assad , M. , Issa , S. , Malagila , J. and Mkasiwa , T.A. ( 2016 ), “ The two publics and institutional theory – a study of public sector accounting in Tanzania ”, Critical Perspectives on Accounting , Vol. 40 No. 1 , pp. 8 - 25 .

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Acknowledgements

The authors thank the two anonymous reviewers for their thoughtful comments on the manuscript. The authors are indebted to the participants of the AAEE 2018 and EGPA 2019 conferences for the valuable feedback received. The authors would like to thank Editor-in-Chief Giuseppe Grossi for his guidance through the review process. This work was supported by the British Academy/Newton Mobility Grant (Grant Number NG160355). The usual disclaimer applies.

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A Study on Financial Reporting Standards and Accounting Quality- Evidence from China

Cheng-Hwai Liou 1

Published under licence by IOP Publishing Ltd Journal of Physics: Conference Series , Volume 410 , IC-MSQUARE 2012: International Conference on Mathematical Modelling in Physical Sciences 3–7 September 2012, Budapest, Hungary Citation Cheng-Hwai Liou 2013 J. Phys.: Conf. Ser. 410 012107 DOI 10.1088/1742-6596/410/1/012107

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1 National Taichung University of Science and Technology, Department of Accounting Information, Taichung, Taiwan

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According to institutional theorists, the forms and business models of corporation are mainly shaped by factors such as politics, regulations, social norms and cultures. This paper examines how the International Financial Reporting Standards (IFRS) and institutional environment influence the accounting quality, in response to the threat of political extraction in China. We took mainland China as an example instead in our study, following the accounting quality definition of Barth et al. [2], we found that the developments of Chinese government performance audit are conspicuously different by region; to reflect such differences, we elaborated our research by dividing mainland China into 31 categories (provinces or cities). We set 2003-2010 as the time horizon for this study. After testing the Regression model, our empirical research achieved two conclusions: 1) IFRS adoption in China should significantly improve the accounting quality, and 2) IFRS and institutional environment should synthetically influence the quality of accounting as well.

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This IASB  Update  highlights preliminary decisions of the International Accounting Standards Board (IASB). Projects affected by these decisions can be found on the  work plan . The IASB's final decisions on IFRS ®  Accounting Standards, Amendments and IFRIC ® Interpretations are formally balloted as set out in the IFRS Foundation's  Due Process Handbook .

The IASB met on 13–15 November 2023 .

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Equity method (agenda paper 13), primary financial statements (agenda paper 21), business combinations under common control (agenda paper 23), post-implementation review of ifrs 9—impairment (agenda paper 27), second comprehensive review of the ifrs for smes accounting standard (agenda paper 30), maintenance and consistent application, amendments to the classification and measurement of financial instruments (agenda paper 16), provisions—targeted improvements (agenda paper 22), updating the subsidiaries without public accountability: disclosures standard (agenda paper 32).

The IASB met on 14 November 2023 to continue its discussions on the Equity Method project and decide:

• whether to propose improvements to disclosure requirements for investments in joint ventures and subsidiaries; and
• the transitional requirements for the proposed amendments to IAS 28 Investments in Associates and Joint Ventures .

Towards an exposure draft—Possible improvements to disclosure requirements for investments in joint ventures and subsidiaries (Agenda Paper 13A)

The IASB tentatively decided to propose:

• the same improvements to the disclosure requirements that it has tentatively decided to propose for investments in associates for investments in joint ventures. All of the 13 IASB members present agreed with this decision. One member was absent.
• that a parent that elects to use the equity method to account for its investments in subsidiaries in separate financial statements would disclose the gains or losses from the parent’s transactions to its subsidiaries. Ten of the 13 IASB members present agreed with this decision. One member was absent.

Towards an exposure draft—Transitional provisions (Agenda Paper 13B)

The IASB tentatively decided to propose that an investor or a joint venturer would:

• retrospectively apply the requirement to recognise the full gain or loss on all transactions with its associates or joint ventures. Twelve of the 13 IASB members present agreed with this decision. One member was absent.
• recognise and measure contingent consideration at fair value at the transition date, and recognise any corresponding adjustment to the carrying amount of its investments in associates or joint ventures. All of the 13 IASB members present agreed with this decision. One member was absent.
• prospectively apply all the other requirements from the transition date. All of the 13 IASB members present agreed with this decision. One member was absent.

The IASB will consider any outstanding matters and whether it has satisfied the required due process steps to publish an exposure draft of amendments to IAS 28.

The IASB met on 15 November 2023 to discuss sweep issues identified in drafting IFRS 18 Presentation and Disclosure in Financial Statements (draft Standard). The issues relate to subtotals and categories, aggregation and disaggregation, and other topics.

Sweep issues related to subtotals and categories (Agenda Paper 21A)

In previous meetings, the IASB specified the assets for which an entity is required to classify income and expenses in the investing category (specified assets). At this meeting, the IASB tentatively decided to clarify that the income and expenses from the specified assets comprise:

• the income generated by the specified assets;
• the income and expenses arising from the initial and subsequent measurement of those assets; and
• the incremental expenses directly attributable to acquiring and disposing of those assets (for example, transaction costs and costs to sell).

Consequently, to maintain consistency between the investing and financing categories, the IASB tentatively decided to clarify that the income and expenses from liabilities arising from transactions involving only the raising of finance comprise:

• the income and expenses arising from the initial and subsequent measurement of those liabilities; and
• the incremental expenses directly attributable to issuing and disposing of those liabilities (for example, transaction costs).

The IASB also tentatively decided to add application guidance with examples of assets that generate returns individually and largely independently of an entity’s other resources, and those that do not. This application guidance replaces the application guidance the IASB, at its July 2022 meeting, tentatively decided to add on income and expenses from financial assets arising from providing financing to customers.

All of the 13 IASB members present agreed with these decisions. One member was absent.

The IASB also discussed and confirmed the drafting approaches for minor sweep issues related to subtotals and categories.

Sweep issues related to aggregation and disaggregation and other topics (Agenda Paper 21B)

The IASB tentatively decided:

• to clarify that an entity need not assess whether the classification requirements determining a primary financial statement’s structure will result in a useful structured summary (because applying those requirements will always result in a useful structured summary). All of the 13 IASB members present agreed with this decision. One member was absent.
• to clarify that an entity need not present separately a specific line item in a primary financial statement if doing so is unnecessary for the statement to provide a useful structured summary—even if other IFRS Accounting Standards contain a list of specific required line items or describe the line items as minimum requirements. Ten of the 13 IASB members present agreed with this decision. One member was absent.
• to remove the proposed application guidance stating that, in general, presenting the list of items set out in the draft Standard in the operating category of the statement of profit or loss would be unlikely to reduce how effective the statement is in providing a useful structured summary. Eleven of the 13 IASB members present agreed with this decision. One member was absent.
• to make consequential revisions to the example in the application guidance in the draft Standard on how to aggregate and disaggregate operating expenses. Twelve of the 13 IASB members present agreed with this decision. One member was absent.

The IASB also discussed and confirmed the drafting approaches for minor sweep issues including management-defined performance measures, aggregation and disaggregation.

The IASB will continue the balloting process for the draft Standard.

The IASB met on 14 November 2023 to discuss the direction of its project on Business Combinations under Common Control.

The IASB discussed whether to continue to explore developing requirements for recognition and measurement or to change the project direction, and decided to change the project direction.

Ten of the 13 IASB members present agreed with this decision. One member was absent.

The IASB discussed whether to explore developing disclosure-only requirements or to discontinue the project, and decided to discontinue the project.

All of the 13 IASB members present agreed with this decision. One member was absent.

The IFRS Foundation staff will prepare a project summary.

The IASB met on 14 November 2023 to discuss:

• a summary of the feedback to the Request for Information Post-Implementation Review of IFRS 9 Financial Instruments —Impairment ; and
• a plan for the next phase of the project.

The IASB was not asked to make any decisions.

The IASB will discuss detailed feedback on the Request for Information. The IASB expects to complete these discussions by the second quarter of 2024. At the end of this post-implementation review, the IASB will publish a project report and a feedback statement.

The IASB met on 14 November 2023 to redeliberate the proposals in the Exposure Draft Third edition of the IFRS for SMEs Accounting Standard .

Proposed amendments to Section 15 Investments in Joint Ventures ( to be renamed Joint Arrangements ) (Agenda Paper 30A)

• to align the definition of ‘joint control’ in Section 15 of the IFRS for SMEs Accounting Standard (Standard) with the definition in IFRS 11 Joint Arrangements. All of the 13 IASB members present agreed with this decision. One member was absent.
• to retain the classification and measurement requirements for jointly controlled assets, jointly controlled operations and jointly controlled entities in Section 15 of the Standard. Twelve of the 13 IASB members present agreed with this decision. One member was absent.
• to align Section 15 of the Standard with the requirements of paragraph 23 of IFRS 11, so that a party to a jointly controlled operation or a jointly controlled asset that does not have joint control of those arrangements would account for its interest according to the classification of that jointly controlled operation or jointly controlled asset. All of the 13 IASB members present agreed with this decision. One member was absent.

Simplification in paragraph 28.19 (Agenda Paper 30B)

• to retain paragraph 28.19 of the Standard. All of the 13 IASB members present agreed with this decision. One member was absent.
• to clarify that an entity applying paragraph 28.19 measures its obligation from the defined benefit plan at the current termination amount, assuming all the entity’s employees terminate their employment at the reporting date. All of the 13 IASB members present agreed with this decision. One member was absent.
• to specify that an entity applying paragraph 28.19 measures the current termination amount of its obligation from the defined benefit plan on an undiscounted basis. All of the 13 IASB members present agreed with this decision. One member was absent.
• to require that an entity applying paragraph 28.19 discloses its basis for determining the current termination amount of its obligation from the defined benefit plan. Eleven of the 13 IASB members present agreed with this decision. One member was absent.

The IASB will continue to redeliberate the proposals in the Exposure Draft.

The IASB met on 13 November 2023 to discuss feedback on the Exposure Draft Amendments to the Classification and Measurement of Financial Instruments , which proposed amendments to IFRS 9  Financial Instruments and IFRS 7 Financial Instruments: Disclosures .

The IASB discussed its proposals relating to:

• derecognition of financial liabilities through electronic transfer (Agenda Paper 16A); and
• equity instruments and other comprehensive income (Agenda Paper 16B).

Derecognition of financial liabilities through electronic transfer (Agenda Paper 16A)

The IASB tentatively decided to finalise the proposed amendments in the Exposure Draft, subject to:

• deleting the reference to ‘settlement date accounting’ in paragraph B3.1.2A of the Exposure Draft and replacing it with ‘settlement date’ and an explanation that ‘settlement date’ refers to the date on which the right to receive or obligation to pay cash (or another financial asset) is established or extinguished; and
• aligning the requirements in paragraphs B3.3.8(a) and B3.3.8(b) of the Exposure Draft so that both refer to ‘practical ability’.

Equity instruments and other comprehensive income (Agenda Paper 16B)

• amending the introductory sentence in paragraph 11A of IFRS 7 to require an entity to apply the disclosure requirement in that paragraph per class of equity investment; and
• including in paragraph 11B of IFRS 7 a disclosure requirement similar to that in paragraph 11A(e) of IFRS 7.  

The IASB will continue discussing the feedback on the Exposure Draft.

The IASB met on 15 November 2023 to discuss possible amendments to IAS 37 Provisions, Contingent Liabilities and Contingent Assets .

The IASB tentatively decided to propose amendments to IAS 37:

• to specify the basis on which an entity calculates the discount rate it uses when measuring a provision.  All of the 13 IASB members present agreed with this decision. One member was absent.
• to specify that an entity uses a rate that reflects the time value of money—represented by a risk-free rate—with no adjustment for non-performance risk. Twelve of the 13 IASB members present agreed with this decision. One member was absent.

The IASB will continue its discussions on possible amendments to IAS 37 and related guidance.

The IASB met on 15 November 2023 to receive an update on its plan for publishing a ‘catch-up’ exposure draft after it issues the prospective Standard Subsidiaries without Public Accountability: Disclosures . 

With the ‘catch-up’ exposure draft, the IASB will consult stakeholders on requirements arising from IFRS Accounting Standards that have been issued or amended since the IASB published the Exposure Draft Subsidiaries without Public Accountability: Disclosures in July 2021. 

The IASB will discuss the content of the 'catch-up' exposure draft in early 2024. 

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List of 70 Accounting Paper Topics for Your Research

Accounting might not sound like the world’s most exciting job, but you’d be surprised just how important it is. Every company worth its salt will need a top-shelf accountant, and to become one, you have to go through the necessary academic process.

Now, learning to become an accountant is an uphill task, especially when you consider just how many research papers you’ll have to produce throughout your education. Finding the perfect accounting topics for research paper will be quite challenging, even for the most seasoned and well-prepared student.

Theoretically, you can draw inspiration for your accounting research paper topic from anywhere and from anything – but if you’ve ever actually written one, you’ll know that that isn’t the case. Instead, coming up with the topic alone will require extensive research and a lot of time, as a great research paper has to be:

• Well worded
• Properly formatted
• Based on research
• Extensive enough

It’s important to note that the quality of your research partially depends on the topic you choose. That means that by picking a good accounting topic (consider broadening it with our top picks of business research topics ), you can practically build your entire paper from there on forth, making the process far, far easier.

Accounting Research Paper Topics

Now, to make the entire process that much easier, you can always opt for a research paper topic that someone else has thought of. It’s true, finding original topics can be arduous because as time goes by, the number of research papers done on any given subject keeps growing. 

However, human creativity knows no bounds, which is why there will always be plenty of attention-grabbing and original options for you to pick from. To make it that much easier for you, we’ve decided to develop seventy top-tier accounting research paper topic ideas that you can use for your next research paper, which you can find below.

• How Can a Global Economic System Moving Toward Decentralized Currencies Ensure That Tax Revenue Is Protected?
• When Should a Business Consider Getting an Accountant?
• Is It Ethical to Use a Family Member as Your Accountant?
• Should Your Accountant Have Complete Control of the Organization’s Accounts?
• How Can the Accountancy Industry Adapt to the Shift Towards Digital Personal Accountancy Services That Threaten Monopolizing the Entire Industry?
• What Are the Ethical Ramifications of Trying to Secure the Lowest Possible Tax Payment for Large Companies Employing Thousands of People?
• Should Accounting Be Made Easier and More Accessible At a Governmental Level?
• What Are the Responsibilities of an Accountant When a Mistake Is Made?
• What Are the Best Practices for Accountants in Ensuring an Accurate Record of Finances Are Kept?
• Are Electronic Personal Accountancy Services an Excellent Alternative to a Trained Accountant?
• What Are the Most Common Methods Large Companies Employ to Reduce Their Tax Overhead?
• Should Large Companies Be Allowed to Reduce Their Tax Overheads?
• As the World Is Attempting to Move to a Flat Standard Global Tax Rate, How Will This Affect Industries?
• How Should an Accountant Best Manage Volatile Assets?
• Are Standard Yield and Inflation Calculations Still Viable Today?
• Can a Company Outgrow Standard Methods of Accountancy? How Should a Firm Manage This?
• Do Accountants Have the Moral Obligations to Follow All of Their Client’s Instructions, Even if They Ask for Something Improper?
• Should Accountants Consider Bitcoin and Other Cryptocurrencies When Assessing a Client’s Net Worth?
• Is the Academic World of Accounting Keeping up With the Way That the Industry Is Changing?
• What Role Does Live Information Play in the Accounting Process and How Can Live Data Provide More Accurate Results?
• Government Regulations and How They Influence the World of Accounting
• Accounting Software and SAAS Solutions in the Modern Accounting World
• How Much Should Accountants Charge Now That Outsourcing Is Becoming an Increasingly Popular Choice
• Accounting, Gambling, Cryptocurrencies, and Other Forms of Loosely Regulate Income and How Accountants Should Deal With Them
• Why Do the World’s Largest Companies Avoid Paying Taxes, and How New Accounting Regulations Can Put a Stop to That?

Simple Accounting Research Topics

• Are the Current Financial Legislations Up to Date Enough For the Modern Financial World?
• How Companies Use Software to Improve Their Accounting
• Do More Money, Taxes, and Transactions Mean More Trouble for Accountants?
• How Accountants Use Financial Balance Sheets to Streamline Their Operations
• Should the Government Have Insight Into Every Megacorporation Financial and Accounting History
• Lying and Accounting – a Match Made in Heaven or a Match That Leads to a Lengthy Prison Sentence
• the Rapidly Emerging Threat of Decentralization and What It Means for the Modern Financial Framework
• Finances, Accounting, and Fraud – How Accountants Wash Their Hands of White-Collar Crime
• Tax Regulations for Small Businesses Vs. Tax Regulations for Larger Businesses | Why Does the Small Guy Pay More in Taxes?
• The Dangers of Outsourcing Accounting Departments to Loosely Regulated Countries.
• Debts, Leases, and Rent – How Small Businesses Bury Themselves Before They Even Start Working
• What Do 2008, 2012, and 2021 Global Financial Crises Have in Common?
• Stunting Economies and Who Makes the Most Money Out of It
• Accounting Automation and What This Means for Accountants
• How Does Capital Budgeting Work for Businesses With Next to No Start-Out Capital

Forensic Accounting Research Paper Topics

• The Mechanics of Money Laundering and How to Know Your Enemy as an Accountant
• How Corruption Might Blur the Line Between Finances and Fraud
• So You’re Being Investigated. What to Do?
• How to Conduct Yourself When You’re Representing Your Company in Court
• Governments and What They’re Looking for in Bad Books
• The Different Methodologies Behind Exploring and Finding Out Forgeries in Accounting Reports
• Forensic Accounting in Theory vs. Forensic Accounting in Practice, the Fundamental Differences Between the Two
• What Are the Skills Required for Forensic Accounting
• The Dangerous World of Forensic Accounting. What They Don’t Teach You in School
• Unraveling the Mystery Behind the Goldman Sachs Accounting Fraud Accusations
• Mass Processing and How It Might Invalidate Accounting Reports
• Public Accounting and Corporate Accounting. Two Different Beasts With the Same Goals
• Career Options as a Forensic Accountant and How to Find a Job in the Industry
• Criminal Forensics and Accounting Fraud. What Does the Government Really Know About Your Books
• Forged, Fraudulent, or Substandard – How Semantics Can Turn a Court Case Into a Prison Sentence

Managerial Accounting Research Paper Topics

• How Leading an Accounting Department Can Make or Break a Business
• The Software That Accountants Use and Its Implication in Day-to-Day Activities
• How Managing a Companies Finances Opens a Lot of Doors to Less-Than-Legal Activities
• Managing an in-House Team vs. Managing an Outsourced Accounting Them | The Challenges and Benefits of Both
• Why Companies Should Invest More Resources Into Their Accounting Departments
• The Risks That Lead Accountants and Managers Take On When Doing Day-to-Day Accounting
• Getting Accused of Fraud and Who Gets to Flip the Bill
• Avoiding Jail as a Dirty Accountant | The Many Tactics That Allow You to Lie in the Books and Avoid Prison Time at the Same Time
• The Digital World and Whether It’s a Safer Platform for Accounting or an Unnecessary Liability Prone to Cybercrime
• Stolen Accounting Information and What It Means for the Financial Future of Your Company
• Playing the IRS | How Accounting Managers Steer Their Departments to Minimize Taxes
• Long Term Debt vs. Short Term Debt, Which One Works Better for Smbs
• Financial Experts, Investors, and Accountants | Exploring the Relationship Between the Money Flowing in and the Ones Handling It
• The Multiplication of Long-Term Debt and How to Minimize It
• How to Hire the Best Accountants to Be a Part of Your Accounting Department and What to Look Out for

Writing a paper isn’t easy, which is why you might want to consider getting someone else to do it for you. You might be surprised, but most students opt to  pay for college papers rather than write the papers themselves.

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Related Posts

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• 100+ Best Religion Research Paper Topics in 2023
• 110 Unique Tranding Fashion Research Paper Topics and Ideas

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• Business tax
• Autumn Statement 2023: Overview of tax legislation and rates (OOTLAR)
• HM Revenue & Customs

Autumn Statement 2023 — Overview of tax legislation and rates (OOTLAR)

Updated 22 November 2023

© Crown copyright 2023

This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: [email protected] .

Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.

This publication is available at https://www.gov.uk/government/publications/autumn-statement-2023-overview-of-tax-legislation-and-rates-ootlar/autumn-statement-2023-overview-of-tax-legislation-and-rates-ootlar

Introduction

This document sets out the detail of each tax policy measure announced at Autumn Statement 2023 and of previously announced measures that will be included in Autumn Finance Bill 2023. It is intended for tax practitioners and others with an interest in tax policy changes, especially those who will be involved in consultations both on the policy and on draft legislation.

All measures listed below are applicable UK wide unless specified otherwise.

The information in the document is set out as follows:

Chapter 1 contains details of all measures that are included in Autumn Finance Bill 2023.

Chapter 2 contains details of measures which are part of Autumn Statement 2023 but are not in Autumn Finance Bill 2023.

Table 1 lists measures in this document without a corresponding announcement in the Budget report. (TBC)

Annex A provides tables of tax rates and allowances for the tax year 2023 to 2024 and the tax year 2024 to 2025.

Annex B provides a guide to the impact assessments set out in tax information and impact notes.

For an update on previously announced consultations, see the tax policy consultation tracker .

Chapter 1 — Autumn Finance Bill 2023

Personal tax, 1.1 abolition of pensions lifetime allowance.

As announced at Spring Budget 2023, the government will introduce legislation in Autumn Finance Bill 2023 to complete the work to remove the Lifetime Allowance. The measure will clarify the taxation of lump sums and lump sum death benefits, and the application of protections. It will also clarify the tax treatment for overseas pensions, transitional arrangements, and reporting requirements. The measure will take effect from 6 April 2024.

The tax information and impact note for this measure provides more information: Abolition of the Lifetime Allowance from 6 April 2024

1.2 Taxation of the pension remedies for Members of Parliament, Members of Senedd and Members of the Legislative Assembly

As announced at Autumn Statement 2023, the government will introduce legislation in the Autumn Finance Bill 2023 with supporting regulations to ensure the pensions tax framework applies as intended to redress payments from the Parliamentary Contributory Pension Fund, the Senedd Pension Scheme and the Assembly Members’ Pension. The changes will take effect from the date of Royal Assent to the Autumn Finance Bill 2023.

The tax information and impact note for this measure provides more information Taxation of Members of Parliament, Members of the Senedd and Members of the Legislative Assembly of Northern Ireland pension reform remedies

1.3 Off-payroll working (IR35): calculation of Pay As You Earn ( PAYE ) liability in cases of non-compliance

As announced at Autumn Statement 2023, the government will introduce legislation in Autumn Finance Bill 2023 to enable HMRC to reduce the PAYE liability of a deemed employer, where that engagement was incorrectly treated as self-employed for tax purposes. This would account for tax and National Insurance contributions already paid by a worker and their intermediary on payments received from an off-payroll working engagement. Secondary legislation will be laid in due course to set out how it will work. The changes will take effect from 6 April 2024.

A response to the consultation launched in April 2023 has also been published alongside the Statement.

The tax information and impact note for this measure provides more information: Calculation of PAYE liability in cases of non-compliance with off-payroll working

1.4 Enterprise Management Incentives ( EMI ): extending the time limit to submit a notification of a grant of options

As announced at Spring Budget 2023, the government will introduce legislation in Autumn Finance Bill 2023 to extend the time limit to notify HMRC of a grant of EMI options from 92 days following the grant to 6 July following the end of the tax year in which the grant was made. The change will apply to EMI options granted on or after 6 April 2024.

The tax information and impact note for this measure provides more information: Enterprise Management Incentives: Changes to the process to grant options

1.5 Enterprise Investment Scheme ( EIS ) and Venture Capital Trust ( VCT ) extension

As announced at Autumn Statement 2023, the government will introduce legislation in Autumn Finance Bill 2023 to extend the existing sunset clauses for the EIS and VCT scheme from 6 April 2025 to 6 April 2035. This will continue the availability of Income and Capital Gains Tax reliefs for investors in new shares issued before this date by EIS qualifying companies and VCTs . The changes will take effect in accordance with regulations made by HM Treasury.

The tax information and impact note for this measure provides more information: Extension of the Enterprise Investment Scheme and Venture Capital Trust Scheme

1.6 Expanding the cash basis

As announced at Autumn Statement 2023, the government will introduce legislation in Autumn Finance Bill 2023 to expand the income tax cash basis for the self-employed and partnerships. The cash basis is a simplified way of calculating taxable profits for income tax purposes. The changes that will be made are to set the cash basis as the default method for small businesses, and remove the turnover, interest, and loss relief restrictions that currently apply to the cash basis. The changes will take effect from 6 April 2024. Read the ‘Expanding the Cash Basis Summary of Responses’ document for more information.

The tax information and impact note for this measure provides more information: Expanding the Income Tax cash basis for self-employed individuals and partnerships

Corporate Tax

1.7 capital allowances: permanent full expensing.

As announced at Autumn Statement 2023, the government will introduce legislation in Autumn Finance Bill 2023 to make temporary full expensing permanent.

Introduced at Spring Budget 2023, temporary full expensing allows companies incurring qualifying expenditure on the provision of new plant and machinery on or after 1 April 2023 but before 1 April 2026 to claim:

• a 100% first-year allowance for main rate expenditure — known as full expensing
• a 50% first-year allowance for special rate expenditure

The expiry date of 1 April 2026 will be removed in Autumn Finance Bill 2023 to give effect to permanent full expensing. The government will also launch a technical consultation on wider changes to further simplify the UK’s capital allowances legislation.

Expenditure on plant and machinery for leasing remains excluded from full expensing. The government will publish a technical consultation on draft legislation in due course to help it consider any potential extension to include plant and machinery for leasing, which is subject to future decision.

The tax information and impact note for this measure provides more information: Capital allowances — permanent full expensing

1.8 Research and Development ( R&D ) tax reliefs: merger of current small or medium enterprise ( SME ) and R&D Expenditure Credit ( RDEC ) scheme

As announced at Autumn Statement 2023,the government will introduce legislation in Autumn Finance Bill 2023 to merge the current RDEC and R&D SME schemes for accounting periods beginning on or after 1 April 2024. This will simplify and improve the system.

The rate offered under the merged scheme will be implemented at the current RDEC rate of 20%.

The notional tax rate applied to loss-makers in the merged scheme will be the small profit rate of 19%, rather than the 25% main rate currently set in the RDEC .

The tax information and impact note for this measure provides more information: Research & Development ( R&D ) tax relief reforms

1.9 Research and Development ( R&D ) tax reliefs: enhanced support for R&D intensive small or medium enterprises ( SMEs )

As announced at Spring Budget 2023, the government will introduce legislation in Autumn Finance Bill 2023 to implement the enhanced support for R&D intensive SMEs , providing a higher rate of payable tax credit for eligible SMEs . Loss-making companies claiming the existing SME tax relief will be eligible for a higher payable credit rate of 14.5% if they meet the definition for R&D intensity.

The intensity threshold required to qualify for this enhanced support will be reduced from 40% to 30% from 1 April 2024. A one-year grace period will also be introduced, enabling a company which has claimed successfully but which fails to meet the intensity threshold, for example due to a one-off shock, to continue to claim for the following period provided it meets the other conditions for the relief.

1.10 Research and Development ( R&D ) tax reliefs: restricting nominations and assignments

As announced at Autumn Statement 2023, the government will introduce legislation in Autumn Finance Bill 2023 to remove the use of nominations for R&D tax credit payments (subject to limited exceptions). This will stop payments being made to third parties, with payments now going directly to claimants. The government will also legislate to prevent any new assignment (whether equitable or statutory) of R&D tax credits. HMRC will withhold payment until it is able to make payment directly to the claimant company. The change on nominations will take effect for all claims to payable R&D tax credits made on or after 1 April 2024. The restriction on new assignments will apply in relation to assignments made on or after 22 November 2023.

1.11 Reform of audio-visual creative tax reliefs

As announced at Spring Budget 2023, the government will introduce legislation in Autumn Finance Bill 2023 to reform the film, TV and video games tax reliefs to refundable expenditure credits — an Audio-Visual Expenditure Credit ( AVEC ) for film and TV programmes, and a Video Games Expenditure Credit ( VGEC ) for video games. Under the Audio-Visual Expenditure Credit, animated film and TV and children’s TV programmes will be eligible or a rate of 39%. The credits will be available from 1 January 2024.

The definition of a ‘documentary’ for the purpose of AVEC will be amended to align with guidance used by the British Film Institute.

The tax information and impact note for this measure provides more information: Reform of film, TV and video games tax reliefs to expenditure credits

1.12 Administrative changes to the creative industry tax reliefs

As announced at Spring Budget 2023, the government will introduce legislation in Autumn Finance Bill 2023 for minor administrative changes to the creative industry tax reliefs. This includes rules for connected party transactions and for additional information to be shared with HMRC by companies when they claim relief. The government will also legislate technical clarifications to the cultural tax reliefs for theatre, orchestras and museums and galleries.

The tax information and impact note for this measure provides more information: Creative industry tax reliefs: administrative changes

1.13 Pillar 2: multinational top-up tax and domestic top-up tax amendments

Further to the publication of draft legislation on 18 July and 27 September 2023, the government will introduce legislation in Autumn Finance Bill 2023 to amend the Multinational Top-up Tax and Domestic Top-up Tax which were introduced in Spring Finance Bill 2023.

These taxes are the UK’s adoption of Pillar 2, an international agreement to help tackle profit shifting and aggressive tax planning by multinationals. The amendments reflect recent internationally agreed guidance and clarify areas identified from stakeholder consultation. They will take effect for accounting periods beginning on or after 31 December 2023.

Draft legislation for some of the amendments was published for consultation on 18 July and 27 September 2023. Minor changes have been made reflecting responses received

The tax information and impact note for this measure provides more information: Multinational top-up tax and domestic top-up tax amendments

1.14 Real Estate Investment Trusts ( REITs )

Further to the publication of draft legislation on 18 July 2023, the government will introduce legislation in Autumn Finance Bill 2023 to make amendments to the rules for Real Estate Investment Trusts ( REITs ) to enhance the competitiveness of the regime. The changes will generally take effect from the date of Royal Assent to Autumn Finance Bill 2023, with the exception of two of the amendments which will be treated as always having had effect and an amendment which will apply for accounting periods ending on or after 1 April 2023.

The tax information and impact note for this measure provides more information: Amendments to the Real Estate Investment Trust regime

1.15 Stamp Duty and Stamp Duty Reserve Tax: widening access to the Growth Market Exemption

As announced at Autumn Statement 2023, the government will introduce legislation in Autumn Finance Bill 2023 to extend the Growth Market Exemption, a relief from Stamp Duty and Stamp Duty Reserve Tax, to include smaller, innovative growth markets. The change will allow Financial Conduct Authority regulated multilateral trading facilities ( MTFs ), that are operated by investment firms, to access the exemption. MTFs will apply through the usual HMRC application and approval process. It will also legislate to increase the company market capitalisation cap condition within the growth market exemption from £170m to £450m.

These changes will take effect from 1 January 2024.

The tax information and impact note for this measure provides more information: Growth Market Exemption for Stamp Duty and Stamp Duty Reserve Tax

1.16 Stamp Duty and Stamp Duty Reserve Tax: removal of the 1.5% charge on issues and certain related transfers

As announced on 14 September 2023, the government will introduce legislation in Autumn Finance Bill 2023 to ensure that the existing 0% charges under Stamp Duty and Stamp Duty Reserve Tax on issues (and certain related transfers) of securities onto foreign markets, will remain in place and be brought permanently into UK law following the changes in the Retained EU Law (Revocation and Reform) Act 2023 taking effect. The legislation will also preserve the 0% charge on issues of bearer instruments. Draft legislation was published for technical consultation on 14 September. The changes will take effect from 1 January 2024.

The tax information and impact note for this measure provides more information: Stamp Taxes on Shares: Removal of 1.5% charge on issues and certain related transfers

1.17 Tonnage Tax: extension to ship management and capital allowance leasing limits

As announced at Spring Budget 2023, the government will introduce legislation in Autumn Finance Bill 2023 to permit third party ship management companies to join the Tonnage Tax regime. At present, only ship operators, defined as vessel owners or charterers, may elect into the regime. The government will also bring forward legislation to raise the limit on capital allowances to £200 million for lessors of ships into the regime in line with inflation and the cost of ships. These measures will take effect from 1 April 2024.

The tax information and impact notes for this measure provides more information: Tonnage tax elections to include third party ship managers and Increasing the capital allowance limits for leasing into tonnage tax

1.18 Post Office compensation schemes, Corporate Entities

The government will introduce legislation in Autumn Finance Bill 2023 to ensure that compensation recipients of the Post Office schemes (Horizon Shortfall Scheme, Group Litigation Order, Suspension Remuneration Review and Post Office Process Review Scheme), who are structured as a corporate entity, will be taxed in a similar way to individual recipients.

Furthermore, any top up payment received to account for a tax liability will not be subject to tax at either the corporate or individual level. The changes will be retrospective to the date at which the compensation payments were received.

The tax information and impact note for this measure provides more information: Tax exemption for corporate recipients of compensation payments made under the Post Office compensation schemes: Group Litigation Order, Horizon Shortfall Scheme, Suspension Remuneration Review or Post Office Process Review Scheme

Indirect Tax

1.19 tobacco duty rates.

As announced at Autumn Statement 2023, the government will introduce legislation in Autumn Finance Bill 2023 to:

• increase the duty rates for all tobacco products by the tobacco duty escalator of 2% above inflation (based on the Retail Price Index ( RPI ))
• increase the rate for hand-rolling tobacco by an additional 10% above the escalator, to 12% above RPI inflation

The changes will take effect from 6pm on 22 November 2023. The rates are set out in Annex A.

The tax information and impact note for this measure provides more information: Changes to tobacco duty rates from 22 November 2023

1.20 Aggregates Levy Rate for 2024 to 2025

As announced at Spring Budget 2023, the government will introduce legislation in Autumn Finance Bill 2023 to increase the rate of Aggregates Levy in line with Retail Price Index ( RPI ).

The change will take effect from 1 April 2024 as set out in Annex A.

The tax information and impact note for this measure provides more information: Changes to the Aggregates Levy rate from 1 April 2024

1.21 Landfill Tax: rates for 2024 to 2025

As announced at Spring Budget 2023, the government will introduce legislation in Autumn Finance Bill 2023 to increase the standard and lower rates of Landfill Tax in line with Retail Price Index ( RPI ), rounded up to the nearest 5 pence. The changes will take effect on and after 1 April 2024, as set out in Annex A.

Landfill Tax was devolved to the Scottish Parliament in April 2015 and to the Welsh Assembly in April 2018.

The tax information and impact note for this measure provides more information: Landfill Tax rates for 2024 to 2025

1.22 Plastic Packaging Tax rate

As announced at Autumn Statement 2023, the government will introduce legislation in the Autumn Finance Bill 2023 to increase the rate of Plastic Packaging Tax in line with the Consumer Price Index ( CPI ). The change will take effect from 1 April 2024. The rate is set out in Annex A.

The tax information and impact note for this measure provides more information: Changes to Plastic Packaging Tax rates from 1 April 2024

1.23 Air Passenger Duty rates for 2024 to 2025

As announced at Spring Budget 2023, the government will introduce legislation in Autumn Finance Bill 2023 to increase Air Passenger Duty ( APD ) rates (rounded to the nearest pound) for 2024 to 2025 in line with the Retail Price Index ( RPI ) as forecast at Spring Budget 2023. These changes will take effect from 1 April 2024. The APD rates are set out in Annex A.

The tax information and impact note for this measure provides more information: Changes to Air Passenger Duty rates from 1 April 2024

1.24 Rebate on heavy oil and certain bioblends used for heating

As announced at Autumn Statement 2023, the government will introduce legislation in Autumn Finance Bill 2023 to make a minor technical amendment to restrictions on the use of certain rebated heavy oils and bioblends. With the exception of those that use kerosene, this measure permits machines and appliances to use rebated heavy oil (other than gas oil) or bioblends that do not contain gas oil, for commercial heating. This measure will take effect from the date of Royal Assent to Autumn Finance Bill 2023.

The tax information and impact note for this measure provides more information: Fuel Duty for heavy oil and bioblends for heating

1.25 Vehicle Excise Duty ( VED ) and Heavy Goods Vehicle ( HGV ) levy uprating

As announced at Autumn Statement 2023, the government will introduce legislation in Autumn Finance Bill 2023 to increase VED rates for cars, vans and motorcycles in line with the Retail Price Index ( RPI ) from 1 April 2024. To continue to support the haulage sector, the rates for VED for Heavy Goods Vehicles (HGVs) will be maintained at 2023 to 2024 levels, with effect from 1 April 2024.

VED rates are set out in Annex A.

The tax information and impact note for this measure provides more information: Vehicle Excise Duty rates for cars, vans and motorcycles from 1 April 2024

1.26 Vehicle Excise Duty exemption for Ukrainian vehicles

As announced on 18 July 2023, the government will introduce legislation in Autumn Finance Bill 2023 to exempt Ukrainian nationals in the UK under the Family, Sponsor and Extension Ukrainian visa schemes from the requirement to register and tax their Ukrainian-plated and registered vehicles in the UK for a period of 36 months.

The tax information and impact note for this measure provides more information: Exemption for Vehicle Excise Duty for Ukrainian vehicles

1.27 Interpretation of VAT and excise law

The government will introduce legislation in Autumn Finance Bill 2023 to clarify how VAT and excise law should be interpreted in the light of changes made by the Retained EU Law (Revocation and Reform) Act 2023 ( REUL Act). This was announced and draft legislation published for technical consultation on 20 October 2023.

The measure confirms that, in relation to VAT and excise law, in line with the REUL Act, it will no longer be possible for any part of any UK Act of Parliament or domestic subordinate legislation to be quashed or disapplied on the basis that it was incompatible with EU law. It also ensures that UK VAT and excise legislation continues to be interpreted as Parliament intended, drawing on rights and principles that currently apply in interpreting UK law.

The tax information and impact note for this measure provides more information: Interpretation of VAT and excise legislation

Tax administration and other measures

1.28 tougher consequences for promoters of tax avoidance.

As announced at Autumn Statement 2023, the government will introduce legislation in the Autumn Finance Bill 2023 to introduce:

• a criminal offence for promoters of tax avoidance who continue to promote avoidance schemes after receiving a Stop Notice requiring them to stop promoting schemes described in that notice
• a new power enabling HMRC to bring disqualification action against directors of companies involved in promoting tax avoidance, including those who control or exercise influence over a company

These changes will take effect from Royal Assent to Autumn Finance Bill 2023.

The tax information and impact note for these measures provides more information: Dealing with promoters of tax avoidance

1.29 Doubling maximum sentences for tax fraud

As announced at Spring Budget 2023, the government will introduce legislation in Autumn Finance Bill 2023 to double the maximum sentences for the most egregious forms of tax fraud from 7 to 14 years. These changes will take effect from the date of Royal Assent to Autumn Finance Bill 2023.

The tax information and impact note for this measure provides more information: Increasing the maximum prison term for tax fraud

1.30 Construction Industry Scheme ( CIS ) reform: reforms to the Gross Payment Status test

As announced at Autumn Statement 2023, the government will introduce legislation in the Autumn Finance Bill 2023 to add compliance with VAT obligations to the Construction Industry Scheme Gross Payment Status compliance test. The changes will also expand HMRC’s powers to remove Gross Payment Status immediately in cases of serious non-compliance involving VAT, Income Tax Self-Assessment, Corporation Tax Self-Assessment and PAYE . Regulations will be laid to set out exceptions to VAT compliance obligations and to remove the majority of payments made by landlords to tenants from the scope of the Scheme. All legislation will come into force from 6 April 2024.

The summary of responses to the consultation was also published at Autumn Statement 2023.

The tax information and impact note for this measure provides more information: Construction Industry Scheme reform from 6 April 2024

1.31 Improving the data HMRC collects from its customers

As announced on 27 April 2023, the government will introduce legislation in Autumn Finance Bill 2023 to require employers, company directors, and the self-employed to provide new or improved data to HMRC to enable better outcomes for citizens and businesses. Through PAYE reporting, employers will be required to provide data on employee hours paid, and through Self Assessment returns taxpayers will be required to provide dividend income and the percentage share from shareholders in owner-managed businesses separately to other dividend income, and, for trading businesses, the start and end dates of self-employment. Following further technical consultation, regulations will be laid spring 2024, with changes taking effect from the tax year 2025 to 2026.

The tax information and impact note for this measure provides more information: Change to data HMRC collects from customers

1.32 Making Tax Digital: volunteers and penalties

As announced at Autumn Statement 23, the government will introduce legislation in Autumn Finance Bill 2023 to ensure that taxpayers who volunteer to join Making Tax Digital ( MTD ) from April 2024 are subject to the government’s new, fairer penalty regime for late filing of tax returns and late payment of tax. These changes, which will apply new penalties to annual obligations only, will take effect from 6 April 2024.

The tax information and impact note for this measure provides more information: Penalty Reform for Making Tax Digital for Income Tax Self Assessment volunteers

Chapter 2 — Measures announced at Autumn Statement 2023 but not in the Autumn Finance Bill 2023

This chapter contains details of other tax measures announced at Autumn Statement 2023 but are not in Autumn Finance Bill 2023. This includes consultations and measures that will be legislated by secondary legislation and future Finance Bills.

2.1 National Insurance contributions ( NICs ) rates

As announced at Autumn Statement 2023, the government will introduce legislation to reduce the main rate of primary Class 1 National Insurance contributions by 2 percentage points from 12% to 10% from 6 January 2024. For the self-employed the main rate of Class 4 National Insurance contributions will be reduced by 1 percentage point from 9% to 8% from 6 April 2024.

From 6 April 2024, self-employed people with profits above £12,570 will no longer be required to pay Class 2, but will continue to receive access to contributory benefits including the state pension. Those with profits between £6,725 and £12,570 will continue to get access to contributory benefits including the state pension through a National Insurance credit without paying National Insurance contributions as they do currently. Those with profits under £6,725 who choose to pay Class 2 voluntarily to get access to contributory benefits including the state pension will continue to be able to do so.

Technical specifications for payroll software companies will be published in due course.

2.2 National Insurance contributions ( NICs ) rates and thresholds

As announced at Autumn Statement 2023, the government will freeze the Lower Earnings Limit ( LEL ) and the Small Profits Threshold ( SPT ) at 2023 to 2024 levels in 2024 to 2025.

For those paying voluntarily, the government will also freeze Class 2 and Class 3 National Insurance contribution rates at their 2023 to 2024 levels in 2024 to 2025. The main Class 2 rate will remain at £3.45 per week, and the Class 3 rate will remain at £17.45 per week. This will not affect existing arrangements for payments of voluntary Class 2 or Class 3 National Insurance contributions connected with previous tax years.

In line with previous announcements at Autumn Statement 2022, most National Insurance limits and thresholds will be maintained at 2023 to 2024 levels, until the 2027 to 2028 tax year. Details can be found within Annex A.

2.3 Extension of National Insurance contributions ( NICs ) relief for hiring veterans

As announced at Autumn Statement 2023, the government is extending the employer National Insurance contributions relief for employers hiring qualifying veterans for a further year from April 2024 until April 2025. This means that businesses will continue to pay no employer National Insurance contributions up to annual earnings of £50,270 for the first year of a qualifying veteran’s employment in a civilian role. The government will extend the relief through secondary affirmative legislation ahead of April 2024.

2.4 Van benefit charge and the car and van fuel benefit charges for 2024 to 2025

As announced at Autumn Statement 2023, the government announced that the van benefit charge and the car and van fuel benefit charges will be maintained at 2023 to 2024 levels for 2024 to 2025.

The flat-rate van benefit charge will remain at £3,960. The multiplier for the car fuel benefit will remain at £27,800. The flat-rate van fuel benefit charge will remain at £757.

2.5 Individual Savings Account ( ISA ) annual subscription limit

As announced at Autumn Statement 2023, the adult ISA annual subscription limit for 2024 to 2025 will remain unchanged at £20,000.

2.6 Child Trust Funds annual subscription limit

As announced at Autumn Statement 2023, the annual subscription limit for Child Trust Funds for 2024 to 2025 will remain unchanged at £9,000.

2.7 Junior ISA annual subscription limit

As announced at Autumn Statement 2023, the annual subscription limit for Junior ISAs for 2024 to 2025 will remain unchanged at £9,000.

2.8 Lifetime ISA annual subscription limit

As announced at Autumn Statement 2023, the annual subscription limit for Lifetime ISAs for 2024 to 2025 will remain unchanged at £4,000.

2.9 Help to Save reform

As announced at Autumn Statement 2023, the government is reforming the Help to Save scheme. The new design will be published in due course, alongside the launch of a consultation on the most effective way to deliver it.

2.10 ISA : digitise the ISA reporting system

As announced at Autumn Statement 2023, the government will make changes to ISAs to simplify the scheme and widen the scope of investments that can be included in ISAs .

To simplify the scheme the government will:

• allow multiple subscriptions in each year to ISAs of the same type, from 6 April 2024
• remove the requirement to make a fresh ISA application where an existing ISA account has received no subscription in the previous tax year, from 6 April 2024
• allow partial transfers of current year ISA subscriptions between providers, from 6 April 2024
• harmonise the account opening age for any adult ISAs to 18, from 6 April 2024
• digitise the ISA reporting system to enable the development of digital tools to support investors

To widen the scope of investments the government will:

• allow Long-Term Asset Funds to be permitted investments in the Innovative Finance ISA , from 6 April 2024
• allow open-ended property funds with extended notice periods to be permitted investments in the Innovative Finance ISA , from 6 April 2024
• engage with the finance industry on allowing certain fractional shares contracts to become permitted ISA investments

For those measures that take effect from 6 April 2024 a statutory instrument will follow early next year.

Over the next few months, HMRC will establish stakeholder forums and communication channels for ISA managers and relevant trade bodies to ensure the pace and sequencing of the move to a digital system reflects the needs of ISA providers and investors, as well as the requirement to upgrade HMRC’s own infrastructure.

2.11 Pension Schemes Relief at Source ( RAS )

A draft enabling clause to support the digitalisation of Relief at Source ( RAS ) pensions tax administration was published in July 2023. Recent discussions with industry have confirmed that a solution for digitising RAS , that could be delivered for April 2025, would not meet the needs of the largest schemes. Furthermore, the deferral of digitisation of RAS will assist industry’s concerns on their capacity to deliver an ambitious programme of government reform. Therefore, the digitisation of RAS will not be operative until April 2027 at the earliest, and there will be no enabling clause in the Autumn Finance Bill 2023.

2.12 Surplus extraction arrangements for defined benefit pension scheme

As announced at Autumn Statement 2023, the government will introduce secondary legislation to reduce the free-standing tax charge which applies to authorised surplus payments to sponsoring employers of a registered pension scheme from 35% to 25%. This measure will take effect from 6 April 2024.

2.13 Announcement of future guidance changes to tax relief for self-employed

As announced at Autumn Statement 2023, HMRC will clarify guidance to businesses on what training costs can be deductible for tax purposes. This will ensure that businesses can be confident that updating existing skills or maintaining pace with technological advances or changes in industry practices, are allowable costs when calculating the taxable profits of a business.

2.14 Compensation Schemes — Post Office Limited

The government will introduce legislation to exempt top-up payments made under the Suspension Remuneration Review ( SRR ) scheme and payments yet to be made under both SRR and the Post Office Process Review Scheme from Income Tax, National Insurance contributions and Capital Gains Tax. The exemptions will be provided through further statutory instruments. Exemptions for corporate recipients are being legislated for separately.

This builds from 6 July 2023, where the government introduced two statutory instruments to exempt top-up payments made under the Horizon Shortfall Scheme, created in response to the Horizon failures, from Income Tax, National Insurance contributions and Capital Gains Tax.

2.15 Pillar 2: Undertaxed Profits Rule ( UTPR )

As announced at Autumn Statement 2023, the government will introduce legislation in a future Finance Bill to amend the multinational top-up tax to introduce the Undertaxed Profits Rule ( UTPR ). This is the backstop rule in Pillar 2, an international agreement to help tackle profit shifting and aggressive tax planning by multinationals.

Draft legislation was published for consultation on 18 July 2023.

The UTPR will take effect for accounting periods beginning on or after 31 December 2024.

2.16 Repeal of Offshore Receipts in respect of Intangible Property ( ORIP )

As announced in Autumn Statement 2023, the government will introduce legislation to repeal the Offshore Receipts in respect of Intangible Property ( ORIP ) rules in 2024.

The repeal will take effect for income arising from 31 December 2024 alongside the introduction of the Pillar 2 Undertaxed Profits Rule, which will more comprehensively discourage the multinational tax-planning arrangements that ORIP sought to counter.

2.17 Electricity Generator Levy: new investment exemption

As announced at Autumn Statement 2023, the government will introduce legislation in an upcoming Finance Bill to provide for an exemption from the Electricity Generator Levy for receipts from new electricity generating stations. New electricity generating stations will include new standalone stations and substantial expansions and repowering of existing stations. This measure will take effect for revenues from new electricity generating stations where the substantive decision to invest is taken on or after 22 November 2023.

2.18 Energy Profits Levy ( EPL ): Energy Security Investment Mechanism ( ESIM )

As announced at Autumn Statement 2023, the government will publish a Summary of Responses and Technical Note on the ESIM following the discussion note published in July 2023. The technical note provides detail on how the ESIM will apply, and how the EPL will cease if triggered by oil and gas prices returning to historically normal levels for a sustained period. The government will introduce legislation to give effect to the ESIM in due course.

2.19 Oil and gas taxation: treatment of payments into decommissioning funds for Carbon Capture Usage and Storage ( CCUS ) purposes

As announced at Autumn Statement 2023, the government will introduce legislation in a future Finance Bill to provide tax relief for payments by oil and gas companies into decommissioning funds where this relates to the repurposing of assets within the oil and gas corporation tax ring fence for use in CCUS activities. Additionally, the government will introduce legislation to remove corresponding asset value payments for those assets from the charge to the Energy Profits Levy.

2.20 Freeport tax reliefs sunset date extension

As announced at Autumn Statement 2023, the government will extend the sunset date for the Freeport tax reliefs to 30 September 2031 for Freeports in England. In each Freeport, the extension will be conditional on agreement of delivery plans and will be legislated once those delivery plans are agreed. For Freeports in Scotland and Wales the reliefs will be extended from five to ten years, subject to agreement with the devolved administrations.

The current sunset date for the Stamp Duty Land Tax ( SDLT ) relief, enhanced structures and buildings allowances and enhanced capital allowances for plant and machinery is 30 September 2026. The secondary Class 1 National Insurance contributions relief is currently available on the earnings of eligible new employees starting by 5 April 2026 only. The National Insurance contributions relief will continue to apply for 36 months per employee within the extended ten-year window.

2.21 Investment Zones tax reliefs sunset date extension

As announced at Autumn Statement 2023, the government will extend the Investment Zones tax reliefs from five to ten years. This extension is subject to the ongoing co-design of proposals and agreement of delivery plans with the Department for Levelling Up, Housing and Communities (DLUHC) and HM Treasury and will be legislated in 2024. The UK government will work in partnership with the Scottish and Welsh governments with the intention of delivering an extension to the Investment Zones programme in Scotland and Wales.

2.22 Call for evidence on further support for visual effects

As announced at Autumn Statement 2023, the government has published a call for evidence on recent trends in the visual effects industry. The call for evidence will run until the 3 January 2024.

The government will follow the call for evidence with a consultation on the design of additional tax relief for visual effects expenditure, which the government intends to implement from April 2025.

2.23 Alcohol duty rates

As announced at Autumn Statement 2023, the government is freezing the rates of alcohol duty until 1 August 2024 and delaying its annual uprating decision announcement on uprating to Spring Budget 2024 to give businesses time to adapt to the duty system introduced on 1 August 2023.

2.24 The tax treatment of remote gambling

As announced at Autumn Statement 2023, the government will shortly publish a consultation on proposals to bring remote gambling (meaning gambling offered over the internet, telephone, TV and radio) into a single tax, rather than taxing it through a three tax structure as at present.

2.25 Gaming duty

As announced at Autumn Statement 2023, the Gross Gaming Yield bandings used to determine the rate of gaming duty will be frozen from 1 April 2024.

2.26 Aggregates Levy rate for 2025 to 2026

As announced at Autumn Statement 2023, the government will introduce legislation in a future Finance Bill to increase the rate of Aggregates Levy in line with the Retail Price Index ( RPI ). The change will take effect from 1 April 2025. The rate is set out in Annex A.

2.27 Carbon Price support rates

As announced at Autumn Statement 2023, the government will continue the freeze of Carbon Price Support ( CPS ) rates of Climate Change Levy ( CCL ) and Fuel Duty to maintain a cost of £18 per tonne of carbon dioxide in Great Britain in 2025 to 2026. No legislation is required to implement the freeze. The CPS rates of CCL and Fuel Duty are set out in Annex A.

2.28 Climate Change Levy rate

As announced at Autumn Statement 2023, the government will freeze the main and reduced rates of Climate Change Levy ( CCL ) from 1 April 2025. No legislation is required to implement the freeze. The main and reduced rates of CCL from 1 April 2025 are set out in Annex A.

2.29 Future of the Climate Change Agreement scheme

As announced at Autumn Statement 2023, a new six-year Climate Change Agreement ( CCA ) scheme will be introduced. The Department for Energy Security and Net Zero (DESNZ) have published a consultation on the detail of the new scheme. Legislation will be prepared during 2024. The new CCA scheme will give access to reduced rates of Climate Change Levy from 1 July 2027 to 31 March 2033 for energy intensive firms that meet energy efficiency or emissions reduction targets agreed with the Environment Agency.

2.30 Emissions Trading Scheme ( ETS ) net zero cap

As set out by the UK ETS Authority in July 2023, will reduce the number of ETS permits available for purchase from government by 45% between 2023 and 2027. It will also extend the scheme to cover emissions from domestic maritime and energy from waste in 2026 and 2028 respectively. This change has been enacted by amending the Greenhouse Gas Emissions Trading Scheme Auctioning Regulations 2021 through an enabling power under the Finance Act 2020.

2.31 Women’s sanitary products

As announced at Autumn Statement 2023, the government will introduce legislation to extend the scope of the current VAT zero rate relief on women’s sanitary products to include reusable period underwear. Currently, reusable period underwear is standard rated for VAT. The changes will take effect from 1 January 2024.

2.32 Reforms to the VAT energy-saving materials relief

As announced at Autumn Statement 2023, the government will introduce legislation to expand the VAT relief available on the installation of energy-saving materials by extending the relief to additional technologies, such as water-source heat pumps, and bringing buildings used solely for a relevant charitable purpose within scope. These reforms will be implemented from February 2024. Full details on these reforms will be published in a summary of responses document shortly.

2.33 VAT Treatment of private hire vehicle operator

As announced at Autumn Statement 2023, the government will consult in early 2024 on the implications of the High Court’s ruling in Uber Britannia Ltd vs Sefton MBC.

2.34 Simplifying Making Tax Digital ( MTD ) for Income Tax Self Assessment

As announced at Autumn Statement 2023, the government will make design changes to Making Tax Digital for Income Tax Self Assessment, simplifying and improving the system for taxpayers and their representatives. The government will:

• simplify the requirements for all taxpayers providing quarterly updates and for taxpayers with more complex affairs, such as landlords with jointly-owned property
• remove the requirement to provide an End of Period Statement
• exempt some taxpayers, including those without a National Insurance number, from MTD
• enable taxpayers using MTD to be represented by more than one tax agent

Draft regulations will be published for technical consultation later in 2023.

2.35 Annual Tax on Enveloped Dwellings ( ATED )

As announced at Autumn Statement 2023, the ATED annual charges will rise by 6.7% from 1 April 2024 in line with the September 2023 Consumer Price Index. The 2024 to 2025 charges are set out in Annex A.

Table 1: Measures in this document without a corresponding announcement in the Budget report

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This paper is in the following e-collection/theme issue:

Published on 22.11.2023 in Vol 25 (2023)

Guidelines, Consensus Statements, and Standards for the Use of Artificial Intelligence in Medicine: Systematic Review

Authors of this article:

• Ying Wang 1 * , MD   ; 
• Nian Li 1 * , PhD   ; 
• Lingmin Chen 2 , PhD   ; 
• Miaomiao Wu 3 , MD   ; 
• Sha Meng 4 , MD   ; 
• Zelei Dai 5 , MD   ; 
• Yonggang Zhang 6 , PhD   ; 
• Mike Clarke 7 , PhD  

1 Department of Medical Administration, West China Hospital, Sichuan University, Chengdu, China

2 Department of Anesthesiology, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China

3 Department of General Practice, National Clinical Research Center for Geriatrics, International Medical Center, West China Hospital, Sichuan University, Chengdu, China

4 Department of Operation Management, West China Hospital, Sichuan University, Chengdu, China

5 Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China

6 Department of Periodical Press, National Clinical Research Center for Geriatrics, Chinese Evidence-based Medicine Center, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China

7 Northern Ireland Methodology Hub, Queen's University Belfast, Belfast, United Kingdom

*these authors contributed equally

Corresponding Author:

Yonggang Zhang, PhD

Department of Periodical Press, National Clinical Research Center for Geriatrics, Chinese Evidence-based Medicine Center, Nursing Key Laboratory of Sichuan Province

West China Hospital

Sichuan University

No. 37 Guoxue Lane

Chengdu, 610041

Phone: 86 28 85421729

Email: [email protected]

Background: The application of artificial intelligence (AI) in the delivery of health care is a promising area, and guidelines, consensus statements, and standards on AI regarding various topics have been developed.

Objective: We performed this study to assess the quality of guidelines, consensus statements, and standards in the field of AI for medicine and to provide a foundation for recommendations about the future development of AI guidelines.

Methods: We searched 7 electronic databases from database establishment to April 6, 2022, and screened articles involving AI guidelines, consensus statements, and standards for eligibility. The AGREE II (Appraisal of Guidelines for Research & Evaluation II) and RIGHT (Reporting Items for Practice Guidelines in Healthcare) tools were used to assess the methodological and reporting quality of the included articles.

Results: This systematic review included 19 guideline articles, 14 consensus statement articles, and 3 standard articles published between 2019 and 2022. Their content involved disease screening, diagnosis, and treatment; AI intervention trial reporting; AI imaging development and collaboration; AI data application; and AI ethics governance and applications. Our quality assessment revealed that the average overall AGREE II score was 4.0 (range 2.2-5.5; 7-point Likert scale) and the mean overall reporting rate of the RIGHT tool was 49.4% (range 25.7%-77.1%).

Conclusions: The results indicated important differences in the quality of different AI guidelines, consensus statements, and standards. We made recommendations for improving their methodological and reporting quality.

Trial Registration: PROSPERO International Prospective Register of Systematic Reviews (CRD42022321360); https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=321360

Introduction

The application of artificial intelligence (AI) has become increasingly common in the medical field. AI has been widely used in medical imaging [ 1 ], disease screening [ 2 ], the prediction and evaluation of treatments [ 3 ], the development of disease models from patient trajectories [ 4 ], and other areas. AI is expected to make medicine-related practice, research, and applications more accurate [ 5 ]. For example, a systematic review found 78 studies on the use of AI applications for COVID-19 up to September 19, 2020 [ 6 ]. Undoubtedly, this is a promising area, but as an emerging technology with a lot of gaps and grey zones to fill in, AI has prompted concerns about safety, accuracy, and applicability [ 7 - 10 ]. To promote the standardized application of AI in medicine, AI guidelines, consensus statements, and standards on various topics have been developed, and they contain recommendations aimed at improving patient care and use evidence from systematic reviews and assessments of potential benefits and harms [ 11 ]. Guidelines that are clear, precise, and transparent can assist health care practitioners, administrators, program managers, and the general public in understanding and implementing recommendations that will support and improve applications in medicine [ 11 , 12 ]. With the likely further clinical translation of AI systems, it will become increasingly important for AI guidelines to be both followed and regularly updated [ 13 ]. Therefore, high-quality guidelines on AI medicine would help professionals to improve decision-making and incorporate the best evidence into AI systems. Up to now, although many AI guidelines, consensus statements, and standards have been published in the medical field, quality issues resulting from their applications still exist [ 14 , 15 ], and low-quality guidelines might lead to widespread use of poor treatments and wasteful practices, which can ultimately harm patients [ 16 ].

To assess the scale of these issues, the current content and quality of AI guidelines in the medical field need to be evaluated, whether in medical research, medical practice, or other applications. We are not aware of any existing systematic review on this topic. In addition, the AGREE II (Appraisal of Guidelines for Research & Evaluation II) instrument is the most commonly used guideline appraisal tool. According to the latest description on the official website of the RIGHT (Reporting Items for Practice Guidelines in Healthcare) checklist, it can be used to evaluate the reporting quality of guidelines [ 17 ].

Therefore, in this systematic review, we used the RIGHT [ 17 ] and AGREE II [ 18 ] tools to assess the quality of guidelines in the field of AI for medicine and to provide a foundation for recommendations about the future development of AI guidelines.

Search Strategies

The authors agreed on the search strategies that were used to search the following databases from database establishment to April 6, 2022: PubMed, Web of Science, Embase, CNKI (Chinese National Knowledge Infrastructure), VIP, WanFang Data, and Sinomed. A manual search of unpublished literature (including conference proceedings, theses, dissertations, and grey literature) was also conducted. Only Chinese and English articles were included. The search strategies are presented in Multimedia Appendix 1 .

Inclusion and Exclusion Criteria

We included published and grey literature reports of guidelines, consensus statements, and standards according to the following criteria: (1) The purpose of the report should be to provide recommendations or statements on the application of AI in any medical field, with no limitations on the subject; and (2) Considering the title, abstract, and full text, the report should involve guidelines, consensus statements, or standards. We excluded the following types of papers: (1) Duplicate literature (only 1 article of the same report published in a different journal was retained); (2) Systematic reviews, meta-analyses, narrative reviews, literature reviews, and scoping reviews; (3) Reports related to only the guideline development process; (4) Conference abstracts; (5) Letters; and (6) Protocols. If more than one version of the report on guidelines, consensus statements, or standards was identified, we include the most recent version only.

Study Selection

The results of the search were entered into the reference management program NoteExpress 3.4.0.8878 (Beijing Aegean Sea Lezhi Technology Co, Ltd). After removing duplicates, 2 authors examined the titles and abstracts of all included references, and deleted the literature that did not meet the theme. Then, the full text was retrieved for further screening, and a decision was made on eligibility for review. We removed research that lacked implementation suggestions or only included a summary statement or introduction. Disagreements were resolved by discussion or consultation with a third author.

Data Extraction

For each study, the data extraction was conducted by 2 authors and then validated by another author. The extracted information included title, author, publication year, region, country, publishing organization, journal, number of authors, number of pages, number of references, registration or no registration, methods used to form recommendations, research subjects, use of AI, etc. In this study, strict and detailed data collection methods were formulated, and data extraction personnel were trained intensively. Disagreements were resolved by discussion.

Evaluation of Quality

Using the AGREE II tool, 4 authors independently assessed the methodological quality of each included guideline and consensus statement [ 18 ]. The appraisal included an examination of technical and supporting materials, including (1) Scope and purpose; (2) Stakeholder involvement; (3) Rigor of development; (4) Clarity of presentation; (5) Applicability; and (6) Editorial independence, using the 23 components in the 6 domains of the AGREE II tool. Each item was graded on a 7-point scale, with 1 indicating significant disagreement and 7 indicating strong agreement. Each domain score was generated in Excel (Microsoft Corp) from its item scores by the AGREE II tool, with a minimum domain score of 0% and a maximum domain score of 100%. We analyzed the scores of items inside each domain and produced a scaled domain score for each domain for each guideline according to the AGREE II manual as follows: (obtained score – minimum score) / (maximum score – minimum score) × 100%. The overall mean score was derived using the average score of the 6 domains. We used an intraclass correlation coefficient (ICC) consistency analysis to analyze the κ value for the 4 evaluations. A κ value of >0.7 suggested strong consistency, while a value of 0.4 suggested low consistency.

Four researchers also used the RIGHT checklist to assess the quality of reporting. The RIGHT checklist has 7 domains, with 22 items and 35 subitems: basic information (items 1-4), background (items 5-9), evidence (items 10-12), recommendations (items 13-15), review and quality assurance (items 16 and 17), funding and declaration and management of interests (items 18 and 19), and other information (items 20-22). We provided a binary score of “Yes” (compliant) or “No” (not compliant) for each item. We analyzed the reporting rate for the results of the RIGHT assessment as number of compliant subitems/total sub items × 100%. A higher value indicated a higher reporting quality. We reached a single decision through discussion if there were contradictions in the evaluation results of the 4 researchers.

Systematic Review and Statistical Analysis

This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist ( Multimedia Appendix 2 ). The systematic review was performed to analyze the quality of the guidelines, consensus statements, and standards, and tabulate the study intervention characteristics. Moreover, a content analysis was performed to compare and contrast the recommendations. Guidelines, consensus statements, and standards were classified and analyzed, and different applications and development trends were classified and analyzed. SPSS 21.0 software (IBM Corp) was used for data analysis. The ICCs between the 4 reviewers were high (>0.7).

Results of the Literature Search

The searches retrieved 12,874 articles. A total of 2149 articles were excluded owing to duplication and 10,671 were excluded after title or abstract screening, leaving 54 full-text articles for further evaluation. The eligibility of the 54 articles was determined, and 18 were excluded for the following reasons: comment (n=1), original study (n=4), online medical guidelines (n=2), review (n=5), forum collection (n=1), system development (n=1), not in English or Chinese (n=1), additional notes to guidelines (n=1), data set (n=1), and nonmedical correlation (n=1). The remaining 36 articles were included (19 articles involved guidelines, 14 involved consensus statements, and 3 involved standards). The screening process is summarized in the PRISMA flowchart ( Figure 1 ).

Characteristics of the Included Articles Involving Guidelines

Considering the full text, we defined the distinction of guidelines, consensus statements, and standards. The included articles involving guidelines (n=19), consensus statements (n=14), and standards (n=3) were published from 2019 to 2022.

Of the 36 articles, 16 were from European and American countries, and 20 were from China and Australia ( Multimedia Appendix 3 ). Nine articles were related to disease screening, diagnosis, or treatment, including retinal screening (n=2), breast disease screening (n=1), esophageal cancer diagnosis and treatment (n=1), colorectal tumor (n=2), glaucoma auxiliary screening (n=1), and pulmonary nodules (n=2). Three articles involved methodological guidelines for the reporting of AI interventions. Five articles aimed to guide clinical practitioners to apply AI imaging and promote radiology development and cooperation. Fourteen articles involved AI data acquisition, labeling and calculation of digestive endoscopy, central nervous system tumor, local lesion of the liver, colorectal cancer, chest radiography, eye disease imaging, body composition assessment, personalized medicine, biomedical data set construction, population-based health indicators, AI electrocardiography (ECG), pneumoconiosis, and pulmonary nodules on chest computed tomography (CT). Five articles were related to AI ethics and governance.

The included guidelines, consensus statements, and standards were related to general surgery, ophthalmology, radiology, dermatology, oncology, etc, involving diabetic retinopathy, tumors, and other related diseases ( Table 1 ).

a AI: artificial intelligence.

Trend of AI Guideline Application and Development

Classification 1: disease screening, diagnosis, and treatment.

A total of 9 articles on guidelines and consensus statements described the application of AI in disease screening, diagnosis, and treatment. Two guideline articles were about AI screening of retinopathy, with one emphasizing the remote determination of retinopathy severity by AI using optical coherence tomography images [ 19 ] and the other emphasizing the urgent need to establish a unified standard for AI-assisted retinopathy screening and formulate relevant specifications and recommendations for an AI diagnosis platform in terms of hardware parameters, color fundus photography, equipment configuration, data acquisition and standards, database establishment, AI algorithm requirements, AI screening report content format, and clinical AI screening follow-up programs [ 20 ]. One guideline article was about AI screening of breast diseases, and the results indicated that AI CAD programs could be applied to 2D mammography and mastectomy, synthetic mammography, and personalized screening [ 21 ]. One guideline article was about color endoscopy technology for AI detection of colorectal tumor lesion characterization. The results indicated that high-definition endoscopes, color endoscopes or dye-based endoscopes, virtual color endoscopes, and additional devices can be used for the detection of colorectal tumors [ 22 ]. In a guideline article, AI was used for the identification of rectal cancer, the preoperative assessment variables for rectal cancer staging were “T, N, CRM, and extramural vascular invasion (EMVI),” and AI was employed to complete the assessment of tumor staging [ 23 ]. One consensus statement article was about the application of AI in esophageal cancer diagnosis and treatment, which showed the data management, image feature extraction and feature screening requirements, model construction and validation, current status, and clinical application recommendations of AI in esophageal cancer diagnosis and treatment [ 24 ]. One guideline article was about the application of AI in glaucoma auxiliary screening, which formulated unified standards for data acquisition, algorithm model construction, hardware requirements, data set establishment and annotation, and an AI screening scheme for an AI glaucoma auxiliary screening system [ 25 ]. One guideline article was about the diagnosis and treatment of lung nodules. It recommended that 3D visualization of lung nodules by AI could be used for localization and surgical planning, noting that 3D visualization analysis for patients who had been initially diagnosed with lung nodules and required surgery could provide greater support for accurate preoperative diagnosis, precise intraoperative surgery, rapid patient recovery, and maximum benefit [ 26 ]. One consensus statement article looked at the current state and limitations of pulmonary nodule diagnosis, summarized the role of AI in pulmonary nodule identification and the differential diagnosis of benign and malignant pulmonary nodules, and highlighted the role of AI in the pathological classification prediction of pulmonary nodules, which was useful for surgical planning and surgical safety and accuracy [ 27 ].

Classification 2: AI Intervention Trial Reporting Guidelines

Two guideline articles sought to standardize the reporting of clinical trials and protocols that involve AI interventions, such as CONSORT-AI [ 28 ] and the SPIRIT-AI extension [ 29 ]. They standardized the intervention integration environment, data processing considerations, and error case analysis procedure of AI interventions in clinical trials. A standard article set forth the minimum information required for medical AI reports, which can be used to help the design and implementation of medical AI models, promote clinical decision-making, and manage issues related to accuracy and bias [ 30 ].

Classification 3: AI Imaging Development and Collaboration

There were 3 guideline articles [ 31 - 33 ] and 2 consensus statement articles [ 34 , 35 ] for AI development in medical images and collaboration. One guideline article offered up-to-date application suggestions for clinical practitioners, researchers, scholars, and users of clinical imaging and therapeutic radiotherapy services. It illustrated that radiotherapy practice, education, and research must be gradually adapted to AI development to maximize the benefits of AI technology [ 31 ]. A guideline article provided suggestions on model performance evaluation for medical image segmentation and suggestions on the evaluation index and measurement [ 32 ]. Many commercial solutions based on AI technology are on the market, and another guideline article suggested that radiologists should focus on practical problems to be considered when evaluating AI solutions for medical imaging, allowing all stakeholders to discuss with manufacturers and make an informed decision on whether to purchase AI commercial solutions for imaging applications [ 33 ].

One consensus statement article presented the development of AI molecular imaging in China and proposed expert consensus on promoting AI application and organizing implementation [ 35 ]. One consensus statement article was about the practices for AI image development and evaluation in dermatology, and included a project list that had been developed for AI skin image reports, establishing a comprehensive standard for report development and performance evaluation [ 34 ].

Classification 4: AI Data Application

Ten consensus statement articles, 3 guideline articles, and 1 standard article reported on the application rules for AI data acquisition, annotation, calculation, and quality control. One consensus statement article presented usage standards on AI data acquisition, annotation, storage, privacy protection, and data security for gastrointestinal endoscopy [ 36 ]. One consensus statement article presented the unified magnetic resonance imaging (MRI) data acquisition and AI image annotation rules for central nervous system tumors [ 37 ]. One consensus statement article established expert consensus on CT, MRI, and MRI hepatobiliary-specific contrast image annotation for focal liver lesions [ 38 ]. An expert consensus was also created for colorectal cancer CT or MRI based on several elements, such as colorectal cancer definition and image performance, annotation categories, methodologies, precautions, annotation principles, annotation requirements, annotators, and processes [ 39 ]. For chest radiography, an AI image quality control algorithm was created to establish the terminologies and definitions of image quality control, common image quality control problems, image quality factors, chest film posterior-anterior photography specifications, image evaluation criteria, and design principles [ 40 ]. For building an AI ophthalmology image database, specifications and recommendations were established for the quality evaluation of incoming data types, data information, data quality, informed consent, and data sharing [ 41 ].

According to a consensus statement article, upper abdominal MRI was appropriate for body composition analysis because of standardized data acquisition and evaluation, subject preparation, magnetic resonance (MR) parameter setting, and comprehensive evaluation of MR image quality for AI systems that aimed for automatic body composition quantification [ 42 ].

Experts from all areas conducted special research and in-depth discussion on how to label and control the chest digital radiography data of pneumoconiosis, and reached a consensus on the collection, screening, quality control, labeling content, labeling methods, labeling rules, labeling process, and quality judgment of chest digital radiography data of pneumoconiosis [ 43 ]. There was a consensus statement article that explained the labeling rules, labeling process, and quality control of lung nodule CT [ 44 ]. Another consensus statement article put forward the construction process of a chest CT lung nodule data set [ 45 ].

One guideline article discussed the most relevant computational models for personalized medicine in detail, defining specific challenges and providing applicable guidelines and recommendations for study design, data acquisition, and operation, as well as for model validation and clinical translation, and other research areas [ 46 ].

Based on 5 projects in different medical fields, a guideline article iteratively optimized the procedures for constructing data sets, and developed a set of guidelines and good practices that should be followed when constructing new medical data sets [ 47 ]. To improve population health information, another guideline article developed a structured interdisciplinary method for the study of population health indicators using health data and machine learning technology [ 48 ].

In order to effectively promote the research and development process of AI ECG diagnosis, a standard article formulated the “Application Standard of Artificial Intelligence Diagnosis of ECG in Sichuan Province (for Trial Implementation),” expounding the normal standard and early warning standard of ECG labeling [ 49 ].

Classification 5: AI Ethics Governance and Applications

Four guideline articles and one standard article reported the application rules for ethical governance of AI [ 50 - 54 ]. There was a guideline article that discussed researchers’ use of a system framework to identify the ethical consequences of various research designs and algorithm choices, and it took epilepsy as an example, discussed the expected clinical scenarios that illustrate unexpected ethical consequences, evaluated the failure points in each scenario, and provided practical suggestions for understanding and solving ethical problems in the early stage of method development [ 50 ]. One guideline article mentioned that the current consensus on “ethical AI” should carefully examine the moral norms that claim to respect human rights and the need to emphasize the possibility of expanding socioeconomic inequality. The governance of AI design, development, and deployment needs a strong human rights framework to protect the public from the threat of harmful applications [ 51 ]. One guideline article drafted the ethical principles of using AI and the standards of AI practice in clinical radiology [ 52 ]. The World Health Organization issued a guiding document on the ethics and governance of AI in the health field; analyzed various opportunities and challenges brought by AI; and put forward suggestions on the policies, principles, and practices of using AI in the health field in an ethical way, as well as the means to avoid abusing AI to harm human rights and legal obligations [ 53 ]. A standard article discussed the application standard system framework and typical application scenarios of medical and health AI from the perspectives of basic common standards, AI basic technology, technical risks, product and service standards, application practice standards in the medical and health fields, safety ethics, and application evaluation standards [ 54 ].

Evaluation of Methodological Quality Using the AGREE II Instrument

In all 6 domains of the AGREE II instrument, the ICCs between the 4 reviewers were high (>0.7), indicating good general agreement between them.

On a 7-point Likert scale, the average overall assessment ratings for the 36 guidelines, consensus statements, and standards evaluated ranged from 2.2 to 5.5 (with 7 indicating that the item’s criteria had been fully met). Nineteen articles had an overall assessment score of 4.0 or above, while 5 articles had an overall assessment score of 5.0 or above.

Based on the AGREE II assessments, only 5 articles were approved without changes by the appraisers [ 22 , 27 - 29 , 53 ], and it was concluded that 31 articles required further methodological refinement.

Score details of AGREE II are presented in Multimedia Appendix 4 .

Percentage Quality Assessment of a Scaled Domain

Scope and purpose scores ranged from 52.8% to 106.9% across all studies, with an overall average of 81.2%. Stakeholder involvement scores varied from 20.8% to 101.4%, with a 51.6% average. The average score for rigor of development was 39.8%, with scores ranging from 11.5% to 82.8%. The average score for presentation clarity was 73.0%, with scores ranging from 6.9% to 116.7%. Applicability scores ranged from 29.2% to 102.1%, with a 57.6% average. The average score for editorial independence was 70.9%, with scores ranging from 8.3% to 108.3%.

Purpose and Scope

The overall aims were defined clearly for each of the studies, and the health goals and predicted outcomes of the recommendations were presented. All of the health questions covered by each study were also adequately defined and the targeted groups were sufficiently described in all but 2 studies [ 21 , 24 ].

Stakeholder Involvement

All but 8 articles [ 33 , 43 - 45 , 47 , 49 , 51 , 54 ] provided extensive information about the individuals engaged in the production of the guidelines or consensus statements, including their names, field of expertise, institution, and geographic location. All but 7 articles [ 22 , 27 - 29 , 31 , 34 , 53 ] did not include patient values and preferences in their creation. In most cases, the intended users were explicitly defined, with medical specialists and different types of health care practitioners included. Regarding target users, some of the articles were ambiguous [ 19 , 47 , 49 , 51 , 54 ].

Rigor of Development

Seventeen articles [ 24 , 26 , 30 , 34 - 40 , 42 - 45 , 49 , 54 ], particularly consensus statement and standard articles, did not describe their research process in sufficient detail.

Six guideline articles [ 21 , 22 , 28 , 29 , 34 , 48 ] that provided extensive systematic search methodologies also included detailed criteria for evidence selection. Except for 20 articles [ 23 , 30 , 32 - 35 , 37 , 38 , 43 - 54 ], the strengths and limitations of evidence were acknowledged in the other included studies. All articles, except for 5 [ 30 , 35 , 49 , 51 , 52 ], fully detailed the approach for creating recommendations. The guideline articles that incorporated the procedure in their methodologies used different ways of developing suggestions, with expert consensus, in-depth discussion, and feedback over numerous meetings used by 14 articles [ 20 , 22 , 23 , 25 , 28 , 29 , 31 , 33 , 41 , 42 , 50 - 53 ].

Although depth was lacking, 16 guideline articles considered health benefits, side effects, and hazards during the development process, and detailed the potential benefits and hazards of following the advice. Fourteen articles [ 19 - 22 , 24 , 26 - 29 , 31 , 34 , 35 , 37 - 41 , 53 ] included an explicit relationship between the recommendations and the body of supporting data. Five guideline articles [ 22 , 28 , 29 , 52 , 53 ] featured explicit declarations of expert external evaluation before publication, but 31 articles did not. In addition, 29 articles did not include any criteria or mechanisms for future changes. Eight articles [ 19 , 21 , 22 , 28 , 29 , 31 , 52 , 53 ] indicated steps for updating.

Clarity of Presentation

All guideline articles, except for 1 [ 35 ], included recommendations that were explicit, straightforward, and immediately identifiable. Different options or hygiene issues were not listed in 3 guideline articles [ 21 , 35 , 38 ], and recommendations were not easy to identify in 4 guideline articles [ 21 , 35 , 37 , 38 ].

Applicability

Twenty-seven articles [ 19 - 29 , 31 , 33 - 42 , 44 , 46 , 48 , 50 - 53 ] mentioned the application’s facilitators and barriers in detail and offered guidance, resources, or both for putting the recommendations into action. Twenty-seven articles [ 19 - 29 , 31 , 33 - 42 , 46 - 48 , 50 - 53 ] took into account the potential resource consequences of implementing the recommendations. Twenty-two articles [ 19 , 22 , 23 , 27 - 29 , 32 , 33 , 35 , 38 , 39 , 42 - 53 ] included monitoring or auditing criteria for determining the effectiveness of their recommendations.

Independence

Twenty-five articles [ 19 - 21 , 23 - 26 , 28 , 29 , 31 - 34 , 36 - 41 , 44 - 46 , 48 , 50 , 51 ] explicitly stated their editorial independence. Furthermore, while 27 articles [ 20 - 26 , 29 - 34 , 36 - 46 , 48 , 51 , 52 ] specified competing interests, they failed to completely explain what interests were taken into account and how they were gathered.

Subgroup Analysis of Guidelines, Consensus Statements, and Standards

The average assessment score of AGREE II for the 14 consensus statement articles was 4.0 (range 3.0-5.1; 7-point Likert scale). The average assessment score for the 19 guideline articles was 4.2 (range 2.9-5.5).

The evaluation percentage rate results were defined as high quality when the score was >70% ( Table 2 ). For the 14 consensus statement articles, the average scores of AGREE II domains 1-6 were 77.1%, 50.1%, 38.5%, 63.0%, 53.4%, and 76.6%, respectively. This shows that domains 2 (stakeholder involvement), 3 (rigor of development), 4 (clarity of presentation), and 5 (applicability) all need to be improved.

For the 19 guideline articles, the average scores of AGREE II domains 1-6 were 83.6%, 55.4%, 44.1%, 78.9%, 64.1%, and 73.1%, respectively. This shows that domains 2 (stakeholder involvement), 3 (rigor of development), and 5 (applicability) need to be improved.

For the 3 standard articles, the average scores of AGREE II domains 1-6 were 84.7%, 34.7%, 18.2%, 81.9%, 36.1%, and 29.9%, respectively. This shows that domains 2 (stakeholder involvement), 3 (rigor of development), 5 (applicability), and 6 (independence) need to be improved.

Subgroup Analysis of Different Contents

The average scores of AGREE II were 4.5 (range 3.8-5.4) for articles involving disease screening, diagnosis, and treatment (classification 1); 4.6 (range 2.8-5.5) for articles involving AI intervention trial reporting guidelines (classification 2); 4.0 (range 3.0-4.7) for articles involving AI imaging development and collaboration (classification 3); 3.6 (range 2.4-4.5) for articles involving AI data application (classification 4); and 3.7 (range 2.2-5.3) for articles involving AI ethics governance (classification 5).

For articles in classification 1, the average scores of AGREE II domains 1-6 were 73.5%, 52.6%, 48.6%, 67.9%, 57.5%, and 73.6%, respectively, showing that domains 2 (stakeholder involvement), 3 (rigor of development), 4 (clarity of presentation), and 5 (applicability) need to be improved. For articles in classification 2, the average scores of AGREE II domains 1-6 were 81.5%, 74.1%, 55.2%, 73.1%, 60.4%, and 63.2%, respectively, showing that domains 3 (rigor of development), 5 (applicability), and 6 (independence) need to be improved. For articles in classification 3, the average scores of AGREE II domains 1-6 were 82.2%, 55.6%, 38.0%, 58.1%, 54.2%, and 92.5%, respectively, showing that domains 2 (stakeholder involvement), 3 (rigor of development), 4 (clarity of presentation), and 5 (applicability) need to be improved. For articles in classification 4, the average scores of AGREE II domains 1-6 were 83.1%, 44.4%, 31.1%, 74.2%, 53.3%, and 69.9%, respectively, showing that domains 2 (stakeholder involvement), 3 (rigor of development), 5 (applicability), and 6 (independence) need to be improved. For articles in classification 5, the average scores of AGREE II domains 1-6 were 88.3%, 52.5%, 40.9%, 93.6%, 71.9%, and 51.7%, respectively, showing that domains 2 (stakeholder involvement), 3 (rigor of development), and 6 (independence) need to be improved. The results are presented in Table 3 .

a Classification 1 includes articles involving disease screening, diagnosis, and treatment; classification 2 includes articles involving AI intervention trial reporting guidelines; classification 3 includes articles involving AI imaging development and collaboration; classification 4 includes articles involving AI data application; and classification 5 includes articles involving AI ethics governance.

Evaluation of Reporting Quality (RIGHT Statement)

Among the 35 individual items, 9 were reported more than 80% (1a, 1c, 4, 5, 6, 7a, 8a, 10a, and 13a) and 5 were reported between 60% and 80% (2, 3, 10b, 18b, and 19a). The mean domain reporting rates were as follows: section 1 (basic information), 79.2% (range 33.3%-100.0%); section 2 (background), 59.4% (range 25.0%-100.0%); section 3 (evidence), 42.8% (range 20.0%-80.0%); section 4 (recommendations), 37.1% (range 14.3%-85.7%); section 5 (review and quality assurance), 13.9% (range 0.0%-100.0%); section 6 (funding, declaration, and management of interest), 47.9% (range 0.0%-100.0%); and section 7 (other information), 35.2% (range 0.0%-100.0%).

Among the 35 RIGHT checklist items, compliance with item 6 (describe the aims of the guidelines and specific objectives, such as improvements in health indicators, quality of life, or cost savings) was the highest (100%), while compliance with items 7b (describe any subgroups that are given special consideration in the guideline), 12 (describe the approach used to assess the certainty of the body of evidence), and 13c (the strength of the recommendation and the quality of evidence supporting it) was the lowest (<10%).

Score details of RIGHT are presented in Multimedia Appendix 5 .

For the 14 consensus statement articles, the average rate of the RIGHT assessment was 45.5% (range 34.3%-62.9%). The rates for the sections ranged from 0.0% to 81.0%, and sections 2 (background), 3 (evidence), 4 (recommendations), 5 (review and quality assurance), 6 (funding, declaration, and management of interest), and 7 (other information) need to be improved.

For the 19 guideline articles, the average rate of the RIGHT assessment was 55.2% (range 37.1%-77.1%). The rates for the sections ranged from 26.3% to 82.5%, and sections 2 (background), 3 (evidence), 4 (recommendations), 5 (review and quality assurance), 6 (funding, declaration, and management of interest), and 7 (other information) need to be improved.

For the 3 standard articles, the average rate of the RIGHT assessment was 31.4% (range 25.7%-42.9%). The rates for the sections ranged from 0.0% to 54.2%, and all the sections need to be improved. Details are provided in Table 4 .

Subgroup Analysis by Content Classification

For articles involving disease screening, diagnosis, and treatment (classification 1), the average rate of the RIGHT assessment was 50.5% (range 40.0%-77.1%), and the average rates for sections 1-7 were 79.8%, 61.6%, 51.4%, 43.5%, 17.9%, 41.1%, and 35.7%, respectively, showing that sections 2 (background), 3 (evidence), 4 (recommendations), 5 (review and quality assurance), 6 (funding, declaration, and management of interest), and 7 (other information) need to be improved.

For articles involving AI intervention trial reporting guidelines (classification 2), the average rate was 55.2% (range 42.9%-62.9%), and the average rates for sections 1-7 were 88.9%, 54.2%, 40.0%, 27.0%, 66.7%, 75.0%, and 55.6%, respectively, showing that sections 2 (background), 3 (evidence), 4 (recommendations), 5 (review and quality assurance), and 7 (other information) need to be improved.

For articles involving AI imaging development and collaboration (classification 3), the average rate was 60.0% (range 45.7%-68.6%), and the average rates for sections 1-7 were 90.0%, 65.0%, 48.0%, 43.8%, 10.0%, 75.0%, and 66.7%, respectively, showing that sections 2 (background), 3 (evidence), 4 (recommendations), 5 (review and quality assurance), and 7 (other information) need to be improved.

For articles involving AI data application (classification 4), the average rate was 41.8% (range 25.7%-68.6%), and the average rates for sections 1-7 were 72.6%, 56.3%, 32.9%, 30.4%, 0.0%, 39.3%, and 19.0%, respectively, showing that sections 2 (background), 3 (evidence), 4 (recommendations), 5 (review and quality assurance), 6 (funding, declaration, and management of interest), and 7 (other information) need to be improved.

For articles involving AI ethics governance (classification 5), the average rate was 54.9% (range 25.7%-74.3%), and the average rates for sections 1-7 were 63.3%, 67.5%, 52.0%, 60.0%, 30.0%, 20.0%, and 60.0%, respectively, showing that all sections need to be improved. Details are provided in Table 5 .

For 3 types of classifications of articles involving guidelines and consensus statements in this review (disease screening, diagnosis, and treatment; AI imaging development and collaboration; and AI data application), background, methodological design, sources and evaluation of evidence, formation method and strength of recommendations of evidence, and promotion and application of the guidelines of recommendations of evidence are key areas for improvement, with further clarity also needed on disclosure.

For guidelines and standards on the reporting of trials of AI interventions, the main areas for improvement are background, sources and evaluation of evidence, and formation method and strength of recommendations of evidence. For guidelines and standards on AI ethics governance and applications, the main areas for improvement are background, sources and evaluation of evidence, formation method and strength of recommendations of evidence, funding, declaration, management of interest, etc. The findings and recommendations for different types of articles are presented in Table 6 .

b AGREE II: Appraisal of Guidelines for Research & Evaluation II.

c RIGHT: Reporting Items for Practice Guidelines in Healthcare.

Summary of the Findings

In recent years, medical technology, AI technology, and their combined application have been rapidly developed. With the expansion of medical data, application of medical images, improvement of AI algorithm models, and optimization of software and hardware devices, more AI technologies have started to be applied in health care scenarios to assist in making decisions on diagnosis and treatment. More medical institutions, internet companies, and nascent AI companies have started to seek cooperation with each other and have vigorously developed medical AI products, and more hospitals have been actively involved in collaborative research projects on medical AI. As a result, the field of medical AI has attracted many top scholars in terms of guideline development and scientific research, and some guidelines, expert consensus statements, and standards have been published in international journals in the field of medical AI.

To ensure that health care practitioners make well-informed decisions about the use of AI and have access to more reliable evidence-based resources, this study presents a systematic review of 36 articles published in English and Chinese between 2019 and 2022, evaluating them for methodological and reporting quality.

This study included 14 consensus statement articles, 19 guideline articles, and 3 standard articles, which were classified into 5 categories based on their content: (1) Disease screening, diagnosis, and treatment; (2) AI intervention trial reporting guidelines; (3) AI imaging development and collaboration; (4) AI data application; and (5) AI ethics governance and applications.

The average scores from the assessment of methodological quality using the AGREE II tool ranged from 2.2 to 5.5 on a 7-point Likert scale. The mean reporting quality rate using the RIGHT tool was 49.4%, ranging from 25.7% to 77.1%. Guideline articles scored higher than consensus statement articles and standard articles. There were higher proportions for the classification of AI intervention trial reporting guidelines than for the other classifications. Domains 2, 3, and 5 of the methodological quality tool and sections 2, 3, 4, 5, 6, and 7 of the reporting quality tool are most in need of improvement.

Recommendations for Improving the Quality of AI Guidelines, Consensus Statements, and Standards

The development of guidelines must adhere to a strict systematic technique. Strict criteria must be developed to assure the quality of the guidelines. The main phases for guidelines, consensus statements, and standards are essentially the same: subject selection, evidence synthesis, recommendation creation, peer review, publishing, implementation, and updating [ 55 ]. However, in the 36 included studies, the forming methods were not ideal. The methodological quality of these documents needs to be improved in several categories, particularly rigor of development, stakeholder involvement, applicability, and reporting quality (background, evidence, recommendations, review, quality assurance, funding, declaration, management of interest, and other information). However, basic information, including scope and purpose, is already of a good standard.

Background for AI Guidelines, Consensus Statements, and Standards

Based on the results of the RIGHT assessment, the topics in the articles involving guidelines and consensus statements need to be more clearly described; need to cover the medical problems that the AI would be applied to (eg, disease screening, diagnosis, etc), the aims and specific objectives (eg, how AI applications are regulated), and the principal objectives or any subgroups covered by the recommendations of the guidelines (eg, clinical practitioners, medical data, or a certain type of AI technology); and need to identify the primary users of the guidelines (eg, technicians, clinicians, etc).

Methodological Design for AI Guidelines, Consensus Statements, and Standards

Based on the stakeholder involvement and rigor of development domains in AGREE II and section 5 (review and quality assurance) in RIGHT, the guideline developer should determine the targeted objects, technology, and population, and consider their preferences or development status. A reasonable evidence selection process, such as a systematic review, survey, or voting, should also be determined by the guideline developer with clear criteria stated for picking evidence, conducting surveys, or voting. At the same time, the guideline’s external evaluation scheme, comprising the list of evaluation experts and the treatment process for evaluation opinions, should be determined. After the draft guideline is finalized, it should be sent to specialists in relevant fields for review and made publicly available on the internet for public comment. Finally, the collected opinions should be evaluated and used to amend the guideline, and a mechanism should be put in place for updating it.

Sources and Evaluation of Evidence for AI Guidelines, Consensus Statements, and Standards

Based on the rigor of development domain in AGREE II and section 3 (evidence) in RIGHT, there are several areas for improvement. This might include stating the key questions for the recommendations in PICOS (Patient/Population, Intervention, Comparison, Outcome, Study design) or other formats as appropriate and indicating whether the guideline is based on a new systematic review conducted specifically for the guideline. The entire process of reference retrieval, including period, database, keywords, etc, should be provided in detail for the systematic review. Evidence inclusion and exclusion criteria should be established and followed, and formal techniques or methodologies (such as the GRADE [Grading of Recommendations Assessment, Development and Evaluation] system) should be used to assess the strengths and limitations of the evidence.

Formation Method and Strength of Recommendations of Evidence for AI Guidelines, Consensus Statements, and Standards

Based on the rigor of development and clarity of presentation domains in AGREE II and sections 4 (recommendations) and 5 (review and quality assurance) in RIGHT, the guideline should include a full description of the process used to create the recommendations, including how consensus was established and obtained. The guideline should also clearly state the grade of evidence, recommendations, and intensity of any suggestions, as determined by methods such as GRADE. The benefits and hazards of using AI in the medical profession should be explored, and there should be an explicit link between the recommendations and the supporting research. If the users of AI guidelines are intended to include different populations, or cost and resource implications are considered, the different advice for management of the AI issue should be clearly presented. The document should also indicate how the draft guideline underwent review and how this was used to inform the quality assurance process described in the methodological design.

Promotion and Application of the Guidelines of Recommendations of Evidence for AI Guidelines, Consensus Statements, and Standards

Based on the applicability domain in AGREE II and section 7 (access, suggestions for further research, limitations) in RIGHT, the guideline’s promotion and implementation strategy, which includes the target people, objects, technology, and data, should be developed. The potential benefits and hazards of implementing the recommendations, as well as the expenses and resources required to promote the guideline should be included, along with information on how the recommendations can be implemented, and the parameters and methods used by AI applications. Moreover, mechanisms should be put in place to ensure responsibility and accountability for AI systems and their outcomes. Furthermore, an adequate accessible redress should be ensured, especially in critical applications [ 56 ]. Finally, because AI is developing so quickly, it is important to specify where the guideline and its related materials can be found, as well as the limitations and suggestions for further research, and plans for keeping the document up to date.

Disclosure and Management of Conflicts of Recommendations of Evidence for AI Guidelines, Consensus Statements, and Standards

Based on the editorial independence section in AGREE II and section 6 (funding, declaration, and management of interest) in RIGHT, guideline documents should pay attention to providing precise information on conflicts of interest. For example, each team member should submit a conflict of interest disclosure statement, which can be used as a reference for guideline developers and include a declaration of employment, research grants, and other research support, among other things.

Trends in the Application of AI in Health Care

In addition to the 5 AI application classifications identified in this review, AI applications in health care currently include intelligent guidance to patients to find the most appropriate departments and experts for consultation, clinical intelligence to assist in decision-making, early warning of clinical behavior, patient prognosis analysis, intelligent rationalization of treatment recommendations, and prediction of personal health or disease status. In the future, AI may also be used for more profound therapeutic areas, such as brain-machine interfaces (also known as brain-machine fusion perception), and to reconstruct special senses (eg, vision) and motor functions in paralyzed patients.

Possible Challenges of AI

The 14 studies identified for classification 4 (AI data application) showed that data, arithmetic power, and algorithms are 3 core elements of AI, bringing new challenges for the implementation of AI in health care. The challenges of data include data quality, data annotation, data storage, data security, etc. To improve the learning efficiency of AI applications, a large amount of data annotation work is necessary, giving rise to more relevant guidelines and expert consensus statements. Due to the special nature of health care and health care systems, application system standards within different countries, regions, and hospitals are not uniform, making data collection irregular and imperfect. The challenges of massive data governance, technical robustness, and safety will also become increasingly important factors affecting the implementation of AI products, along with ethical approval, human oversight, privacy, transparency, nondiscrimination and fairness, societal well-being, and costs as important influencing factors [ 56 ]. This means that there is a great need for higher quality and more instructive guidelines to address a range of challenges.

Future Research Directions for AI

Although the development of AI still faces many challenges, countries and industries are increasing their investment in AI applications owing to the significant potential advantages of AI technology in improving productivity, reducing costs, and improving service quality. The rapid year-on-year growth in the number of scientific and technical papers published on medical AI in recent years indicates that AI has also become a key research area of interest for experts and scholars. Research directions include deep learning, machine learning, biomedical engineering, automation, oncology, complementary diagnosis, and adjuvant therapy. In the future, increasing research evidence on medical AI will emerge, which will be more helpful for the development of AI guidelines, writing authoritative guidelines for more types of AI health issues, and making more standardized guidance recommendations.

To our knowledge, this systematic review is the first to use the AGREE II and RIGHT tools to evaluate AI guidelines, consensus statements, and standards. We reviewed and summarized articles involving international guidelines, consensus statements, and standards on the use of AI in health care published in recent years, as well as the main research directions. We also provide suggestions for methodological and reporting quality improvement for different types of documents. The rapid development of AI technology will see it being increasingly widely used in various fields, such as medical imaging, disease screening, and data learning, and this paper has also discussed future development trends, benefits, and potential hazards of AI applications in health care. We hope that it provides a scientific research and application reference for colleagues involved with AI in health care, and will help improve the quality and reporting of medical AI guidelines and provide a much needed foundation for improvements in the quality of research and practice [ 6 ].

Limitations

Only 7 Chinese and English databases were included in the search strategy, and finally, only English and Chinese articles involving guidelines, consensus statements, and standards were included, which may cause limitations owing to restricted research sources and languages.

An important limitation of this systematic review is that it relied on studies published in few journals with high impact factors. Thus, there are disparities between some of the guidelines and others in terms of quality and authority, and the findings may not be fully representative of AI guidelines, consensus statements, and standards published around the world. Moreover, the articles included in this paper were considered as articles involving guidelines, consensus statements, or standards according to the definitions by the authors and journals themselves. Thus, the authority of the definitions may be limited owing to differences in quality and differences among the authors and journals.

Furthermore, we found that some items in the AGREE II and RIGHT tools are not fully applicable for evaluating medical guidelines related to AI, particularly those that use expert consensus statements and standards. As the clinical content of guidelines, consensus statements, and standards was not evaluated, no conclusions concerning the clinical appropriateness of the recommendations could be reached.

Conclusions

Our systematic review identified 36 articles involving guidelines, consensus statements, and standards on the application of AI in health care. The main areas for the development and application of AI guidelines are disease screening and diagnosis, reporting of trials of AI interventions, AI image development and cooperation, AI data application, and AI ethics governance and applications. The application of AI in health care was generally encouraged in these articles, including the development of more standardized and standard algorithms, quality control of AI data, and clinical application of AI data for certain diseases. However, the quality of the included articles that we identified was not uniform, and there were differences in the methodological and reporting quality of guidelines for different research content. Most of the deficiencies were concentrated in domains 2, 3, and 5 of the AGREE II tool for methodological quality and sections 2, 3, 4, 5, 6, and 7 of the RIGHT tool for reporting quality.

Health care providers face challenges in gaining knowledge about the safe and effective use of AI. If the suggestions made for methodological and reporting quality improvements are followed, we believe that health care providers will have better access to higher quality guidance. This will be important if AI meets its potential for more powerful data induction and learning capabilities, which could significantly improve the application capabilities of medical imaging, disease screening, and diagnosis. We recommend that AI guidelines be further standardized in the future to improve the ability of AI deep learning and the ability of medical structured data service and sharing, and to strengthen the collection and fusion analysis of multicenter and multimodal medical data, allowing practitioners and scholars to cooperate in the best way to promote scientific research and clinical application.

Acknowledgments

The study was supported by the National Natural Science Foundation of China (grant number 82004213) and the Project of Sichuan Provincial Department of Science and Technology (number 2021YFH0191).

Data Availability

All data needed to evaluate the conclusions in the paper are present in the paper and the multimedia appendices.

Authors' Contributions

YZ and MC are co-corresponding authors. YW and NL are co-first authors. YZ, NL, and MC conceived and designed the analysis. YW and MW collected articles involving guidelines and consensus statements. YW, MW, ZD, and SM performed the data analysis and assessment of guidelines and consensus statements. YW, LC, and NL drafted the manuscript. LC and NL defined the research method. YZ and MC supervised the whole research process. All authors read and approved the final manuscript.

Conflicts of Interest

None declared.

Search strategies of the databases.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist.

Characteristics of the included guidelines and consensus statements.

Score details of AGREE II (Appraisal of Guidelines for Research & Evaluation II).

Score details of RIGHT (Reporting Items for Practice Guidelines in Healthcare).

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Abbreviations

Edited by A Mavragani; submitted 04.02.23; peer-reviewed by M McCradden, WD Dotson, F Alvarez-Lopez, Y Zhu; comments to author 27.03.23; revised version received 21.08.23; accepted 26.09.23; published 22.11.23

©Ying Wang, Nian Li, Lingmin Chen, Miaomiao Wu, Sha Meng, Zelei Dai, Yonggang Zhang, Mike Clarke. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 22.11.2023.

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