2_use_case_name: HSRD IIR 19-069 Optimizing Renin Angiotensin System Blocker Use among Veterans with Kidney Disease
3_agency: Department of Veterans Affairs
3_abr: VA
4_bureau: VHA: Veterans Health Administration
8_topic_area: Health & Medical
10_commercial_ai: None of the above.
11_purpose_benefits: Intended purpose: clinical summarization of narrative clinical notes within the electronic health records among patients with CKD to give providers a summary of relevant terms (side effects, adverse events) noted in those notes (exact phrase matches, pointer to document) along with medication and chronic condition information (not using AI) delivered to primary care providers before a clinic encounter to assist in clinical decision making.
12_outputs: Narrative note that goes into the patient's record with the PCP as an additional signer with a summary of why they qualify for the clinical summarization (CKD), when the ACE/ARB was stopped, documentation of notes and phrases/sentences that are relevant to decision making (exact text from note).
16_dev_stage: Implementation and Assessment
17_impact_type: Neither
18_date_initiated: 6/1/2017
19_date_acq_dev_began: 6/1/2018
20_date_implemented: 10/1/2024
22_dev_method: Developed in-house.
24_hisp_support: Yes
25_hisp_name: Veterans Health Administration
27_public_info: No
28_iqa_compliance: not applicable (not disseminating information to the public)
29_contains_pii: Yes
30_saop_review: Yes
31_data_catalog: No
33_agency_data: VHA clinical notes during routine conduct of care.
34_data_docs: Documentation has been partially completed: Some documentation exists (detailing the composition and any statistical bias or measurement skew for training and evaluation purposes), but documentation took place within this use case’s development.
35_demo_features: Other
35_question_type: none, the tool explicitly looks for side effects from ACE ARB medications or any discussion proximal to a mention of an ACE or ARB class medication.
37_custom_code: Yes
38_code_access: Yes – agency has access to source code, but it is not public.
40_has_ato: Yes
41_system_name: The primary application that supports this is CirrODS, maintained in VA-TRM, was originally developed for different patient population but has been adapted to this use case, and is a minor application under the VA Innovations Office ATO.
42_dev_tools_wait: More than 12 months
43_infra_provisioned: No
45_compute_request: Other
45_question_type: We have in house computing resources allocated to be able to conduct the AI processing required to sustain the tool.  We are not required to request it.
47_timely_resources: Other
47_question_type: We obtained the compute require multiple years ago in preparation for needing it for this project and others.  Please note that we do not use GPU resources as these clinical summarization tools are not LLMs, as the development of the NLP tools predated the escalation of LLM technologies.
49_existing_reuse: Re-use production level code from a different use-case: This use case re-uses production level code and/or internally developed code libraries for model development from existing AI systems or repositories inside the agency.
50_internal_review: Documentation has been developed: Complete documentation detailing model performance across a range of benchmarks, architecture, relevant features and information regarding the appropriate use of the model for predictive tasks has been created.