Automated Decision Support

Overview

Development stage

DeployedSource: c) Deployed – The use case is being actively authorized or utilized to support the functions or mission of an agency.

High-impact designation

High-impactSource: a) High-impact

Impact justification

Not reported

Start date

Not reported

Withheld from public reporting

Not reported

Mission

Topic area

Government Benefits Processing

Operational functions

Summarization, Claims and case processing Derived by keyword rules; see methodology

Problem the AI is intended to solve

Identify medical evidence for claims processing. Automated Decision Support (ADS) is the utilization of technology to maximize operational efficiency by reducing administrative tasks to produce desired outcomes. These tools will improve the efficiency of the existing claims process, reduce future claims backlog, and will result in faster, more accurate and consistent decisions for Veterans and beneficiaries. ADS is not intended to replace trained claims processors – it provides tools to assist with development tasks at a time when VBA is receiving more claims than ever before.

Expected benefits

Automated Decision Support (ADS) automates some of the up-front time-consuming development activities of retrieving information and identifying potentially relevant VA Schedule of Rating Disabilities (VASRD)-related evidence of record. It accelerates the ordering of exams and assists in marking claims as Ready for Decision (RFD). This can lead to faster and more consistent decisions for Veterans and unlock VBA’s ability to uncover data trends.

System outputs

Depending on claim criteria, ADS may produce the following five documents: - Automated Review Summary Document (ARSD) - Summarizes relevant medical and service information from Veteran documents with page numbers and hyperlinks to the original source documents. It also explains the ADS outcome. - Health Data Repository (HDR) document - Indexes Veteran medical records data from VistA sources (VAMC and Community Care visits) - Standard Commercial-Off-The-Shelf (COTS) Integration Platform (SCIP) document - Indexes Veteran medical images from VistA sources - Electronic Health Record-Text (EHR-Text) document - Indexes Veteran medical records data from EHR sites - Electronic Health Record-Image (EHR-Image) document - Indexes Veteran medical images from EHR sites ADS also takes action in the Veterans Benefits Management System (VBMS) to update end product (EP) status, order or draft Compensation & Pension (C&P) exams, and add notes. No final benefits decisions are made by ADS and no payments are initiated by ADS.

Technology

AI classification

Classical / predictive MLSource: Classical/Predictive Machine Learning: Models trained on data to make predictions or classifications based on identified patterns or relatio…

System name(s)

Not reported

Custom-developed code

Yes

Public source code

Not reported

Sourcing

How it was built

Contract and in-houseSource: c) Developed with both contracting and in-house resources

Vendor (as reported)

Not reported

Vendors (standardized)

None on the standard list

A vendor is the supplier named by the agency. It does not identify the underlying model or AI technology.

Data and privacy

Involves PII

Not reported

Privacy Impact Assessment

Not reported

Authorization to Operate

Not reported

Demographic features

Not reported

Training and evaluation data

Not reported

Federal Data Catalog

Not reported

Governance

0 of 8 minimum-practice questions answered. A blank answer means the agency reported nothing; it does not mean the practice is absent.

Potential impacts and how they were identified

Not reported