Automated Decision Support
Description
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.
Detailed example
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.
AI / analytics pattern
Classical/Predictive Machine Learning: Models trained on data to make predictions or classifications based on identified patterns or relationships.
Automation level / stage
c) Deployed – The use case is being actively authorized or utilized to support the functions or mission of an agency.
Expected benefit
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.
Controls / human review
ATO: Not reported; PIA: Not published