2_use_case_name: Identify cancer patients symptom burden, including symptoms supported by embedded mental health.  
3_agency: Department of Veterans Affairs
3_abr: VA
4_bureau: VHA: Veterans Health Administration
8_topic_area: Health & Medical
10_commercial_ai: Searching for information using AI.
11_purpose_benefits: Mental Health is important for cancer patients and could be barrier for effective and timely cancer care. Approximately one-third of persons with cancer will develop a mood or anxiety disorder. Mental health of Veterans with cancer is a priority for the VA National Oncology Program. We have been tasked to develop and implement a health information technology tool that will facilitate the effectiveness and efficiency of mental health providers embedded in cancer clinics, such as the one embedded in the Oncology clinic in the Durham VA. One of the challenges he faces is to identify patients that are most likely to benefit from the intervention. We aim to use AI to extract patients’ symptom burden information including the symptoms related to mental health needs from clinical notes and surface them for the embedded mental health provider. 
National oncology program embedded mental health specialists and nurse coordinators will review the information, allowing them to efficiently identify Veterans that may benefit from additional support for symptom management or mental health. This could allow embedded mental health specialists to monitor cancer patients among veterans at a higher risk level more closely and provide the most appropriate level of care. It could also potentially help veterans have increased cancer treatment engagement and quality of care, which are essential for cancer patients’ disease prognosis.  

12_outputs: Information on patient symptom burden including symptoms related to mental health needs of cancer patients, this will be highlighted and output along with the clinical documents that are used to extract the information for the nurse coordinators to review. We do not anticipate this AI to be either safety impacting or rights impacting. The output does not serve as a principal basis for a decision. Coordinators are expected to review the output and corroborate its veracity using source information obtained from the EHR. The system resides completely within approved VA IT boundaries that are fully compliant with FISMA and HIPAA rules with availability and reliability set by OI&T. The information that the algorithm uses for input and its output relates to patient and disease features related to cancer diagnoses as well as descriptions of symptom burden and therefore are unlikely to perpetuate inequalities related to protected characteristics. They are unrelated to educational benefits, housing grants, loans, risk assessment for insurance, job training programs, employment services, vocational rehabilitation, or hiring. It does not impact claims and benefits processing. While the system is envisioned to increase the efficiency of providers identifying information elements related the Veteran’s cancer diagnoses and symptom burden documented in the EHR, these elements are not envisioned to be related to race, nor creating or promoting disparities. On the contrary, by improving efficiency, we believe the system will allow more Veterans to be supported, decreasing any existing inequities. It will also allow providers spend less time gathering information and more time interacting with Veterans, improving their ability to connect with the Veteran, learn about them, and provide Veteran-centric support. The system will make it easier for providers to locate information about Veterans related to their symptom burden, however it will not be used for diagnosing disease, recommending treatment plans nor as a tool to monitor a patient’s health. It will not be used for health assessments or interventions, manage or dispense medications, or to automate labs. It will not make any decisions for the provider but will make it easier for the provider to identify information elements of interest while supporting Veterans. The system will also be entirely redundant, meaning providers will still use information from the EHR to perform their workflows, both to find information about Veterans and to document their interactions. Providers will be able to fall back to EHR workflows should the system is unavailable for any reason.
16_dev_stage: Acquisition and/or Development
17_impact_type: Rights-Impacting