Report discussing currently available machine learning (ML) medical diagnostic technologies for five selected diseases, emerging ML medical diagnostic technologies, challenges affecting the development and adoption of ML technologies for medical diagnosis, and policy options to help address challenges in the use of artificial intelligence (AI) technologies in health care (Part One). Part Two presents a framework for evaluating and promoting provider adoption of new AI-assisted diagnostic decision support tools (AI-DDS), centered on four integrated domains: 1) Reason to Use, 2) Means to Use, 3) Methods to Use, and 4) Desire to Use.

A letter report issued by the Government Accountability Office with an abstract that begins "Carryover balances in fiscal year 2012 were $2.2 trillion, of which about $800 billion had not yet been obligated. Answering key questions during review of carryover balances provides insights into why a balance exists, what size balance is appropriate, and what opportunities (if any) for savings exist. Given that a single account may support a single program or multiple programs--or that multiple accounts may support a single program--these questions can be applied when evaluating balances at either the account or program level. Examination of balances may assist decision makers in identifying opportunities to achieve budgetary savings or redirecting resources to other priorities. However, the complexity of the federal budget is such that a case-by-case analysis is needed to understand how best to achieve these financial benefits."

A letter report issued by the Government Accountability Office with an abstract that begins "U.S. Northern Command (NORTHCOM) and U.S. Pacific Command (PACOM) are updating their existing civil support plans to include a complex catastrophe scenario, as directed by the Secretary of Defense and the Joint Staff. However, the commands are delaying the identification of capabilities that could be provided to execute the plans until the Federal Emergency Management Agency (FEMA), the lead federal response agency, completes its regional planning efforts in 2018. NORTHCOM officials told us that the command's civil support plan would describe some general force requirements, such as types of military units, but that it will not identify specific capabilities that could be provided to civil authorities during a complex catastrophe. Similarly, according to PACOM officials, PACOM's plan also will not identify such capabilities. Still, defense coordinating officers--senior military officers who work closely with federal, state, and local officials in FEMA's regional offices--have taken some initial steps to coordinate with FEMA during its regional planning process to identify capabilities that the Department of Defense (DOD) may be required to provide in some regions. For example, a defense coordinating officer has helped one of the FEMA regions that …

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Defense (DOD) used various methods to identify needed changes to requirements for its upcoming pharmacy services contract. During acquisition planning for the upcoming TRICARE pharmacy services contract, DOD solicited feedback from industry through its market research process to align the contract requirements with industry best practices and promote competition. For example, DOD issued requests for information (RFI) in which DOD asked questions about specific market trends, such as ensuring that certain categories of drugs are distributed through the most cost-effective mechanism. DOD also issued an RFI to obtain information on promoting competition, asking industry for opinions on the length of the contract period. DOD officials told us that responses indicated that potential offerors would prefer a longer contract period because it would allow a new contractor more time to recover any capital investment made in implementing the contract. The request for proposals for the upcoming contract, issued in June 2013, included a contract period of 1 base year and 7 option years. DOD also identified changes to contract requirements in response to legislative changes to the TRICARE pharmacy benefit. For example, the National …

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Homeland Security (DHS) has made considerable progress toward obtaining a clean opinion on its financial statements but limited progress in obtaining a clean opinion on its internal control over financial reporting. DHS continues to rely on compensating controls and complex manual work-arounds rather than sound internal control over financial reporting and effective financial management systems. DHS is working to resolve the deficiencies that caused its auditors to issue a qualified opinion on its fiscal year 2012 financial statements and has a goal of achieving a clean opinion in fiscal year 2013. In addition, DHS has plans to resolve the remaining five material internal control weaknesses, with a goal of achieving a clean opinion on internal control over financial reporting for fiscal year 2016. However, DHS's auditors stated that they may have identified additional material weaknesses in fiscal year 2012 had they been able to perform sufficient work to enable them to express an opinion on the effectiveness of DHS's internal control over financial reporting. DHS will continue to face challenges in obtaining and sustaining a clean opinion on its financial statements and attaining …

A letter report issued by the Government Accountability Office with an abstract that begins "The DC Children and Youth Investment Trust Corporation (the Trust) provides information to prospective and current families of children participating in the District of Columbia (the District) Opportunity Scholarship Program (OSP) through a variety of outreach activities. To reach prospective OSP families, the Trust advertises through print, radio, and bus ads, as well as in newspapers and flyers posted in neighborhood libraries, recreation centers, and local government service centers. However, the Trust provides incomplete and untimely information about participating schools to OSP families. The participating school directory, which is published by the Trust, lacks key information about tuition, fees, and accreditation. The Trust published the directory 9 months after the start of the 2012-13 school year, too late to assist families in selecting a school for that year. Without such information, parents cannot make fully informed school choices. Additionally, the Trust awarded scholarships to students several months after many schools completed their admissions and enrollment processes, limiting the amount of time and choice in selecting schools. Most families GAO spoke with were generally happy with OSP but some were concerned about the availability of program information."

A letter report issued by the Government Accountability Office with an abstract that begins "GAO identified six key fee design decisions related to how fees are set, used, and reviewed that, in the aggregate, enable Congress to design fees that strike the desired balance between agency flexibility and congressional control. For example, narrowly limiting the activities for which fees may be used heightens congressional control over the funds; however, doing so can also reduce an agency's flexibility to reallocate resources as needs change and may increase administrative costs. Design decisions also have program management implications. For example, the frequency of fee reviews and adjustments affects the alignment between collections and costs. Failing to review fees regularly has sometimes resulted in large increases when fees are eventually updated, creating costly challenges. Understanding the implications of fee design is important to avoid such unintended consequences."

A letter report issued by the Government Accountability Office with an abstract that begins "In fiscal year 2012, the Department of Health and Human Services (HHS), HHS Office of Inspector General (HHS-OIG), and the Department of Justice (DOJ) obligated approximately $583.6 million to fund Health Care Fraud and Abuse Control (HCFAC) program activities. About 78 percent of obligated funds were from mandatory HCFAC appropriations (budgetary resources provided in laws other than appropriation acts), 11 percent of obligated funds were from discretionary HCFAC appropriations (budgetary resources provided in appropriation acts), and 12 percent were obligated funds from other appropriations that HHS, HHS-OIG, and DOJ used to support HCFAC activities. HCFAC funds were obligated to support a variety of activities, including interagency Medicare Fraud Strike Force Teams--which provide additional investigative and prosecutorial resources in geographic areas with high rates of health care fraud--located in 9 cities nationwide."

A letter report issued by the Government Accountability Office with an abstract that begins "Since 2008, the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS) has awarded five contracts to research organizations to update national workforce projections, but HRSA has failed to publish any new reports containing projections. As a result, the most recent projections from HRSA available to Congress and others to inform health care workforce policy decisions are from the agency's 2008 report, which is based on data that are more than a decade old. While HRSA created a timeline for publishing new workforce projection reports in 2012, the agency missed its goal to publish a clinician specialty report by December 2012 projecting the supply of and demand for health care professionals through 2025. HRSA officials attributed the delay in publishing this report to data challenges and modeling limitations. HRSA has also revised its timeline to postpone publication of two other health care workforce reports, as shown in the table below. HRSA officials said that the agency does not have standard written procedures for preparing a report for publication after final reports are delivered from contractors, which may impede its ability …

A letter report issued by the Government Accountability Office with an abstract that begins "Thirteen states reported that in fiscal year 2012 they paid a total of about $5.6 billion to limited benefit plans to provide mental health services to about 4.4 million adult Medicaid beneficiaries. States can enroll different populations--such as adults who are blind, disabled, or have developmental disabilities--in limited benefit plans, which could contribute to the variation in the number of adults enrolled and level of capitated payments made across the 13 states."

A letter report issued by the Government Accountability Office with an abstract that begins "Many emergency managers from the 27 major cities responding to GAO's questionnaire, although not all, reported that their city had assessed the risks of a terrorist attack using a radiological dispersal device (RDD) or improvised nuclear device (IND) and had ranked the risk of these attacks as lower than the risk of other hazards they face. Also, 11 of the 27 reported that they had completed RDD response plans, and 8 of the 27 reported that they had completed IND response plans. Some emergency managers for cities without specific RDD and IND response plans reported that they would rely on their city's all hazards emergency operations plan or hazard management plan if attacked. Most cities that had RDD and IND response plans reported conducting exercises to validate the plans based on federal guidance."

A letter report issued by the Government Accountability Office with an abstract that begins "Opportunities exist for the Department of Homeland Security (DHS) to enhance its visibility over collaborative field mechanisms (i.e., multiagency groups such as task forces, committees, and teams that enhance stakeholder collaboration to more effectively and efficiently achieve their missions) established by component agencies. DHS, at the departmental level, has limited visibility over the universe and operation of these mechanisms and does not identify information from them that could further enhance collaboration across DHS and inform future DHS decisions. In the absence of a single DHS regional/field structure, DHS components have created collaborative mechanisms to better integrate field operations by better coordinating their missions and sharing information. However, when GAO sought to identify these mechanisms, in conjunction with DHS, senior DHS officials stated that while they maintain regular visibility over component activities--which may involve these collaborative mechanisms--DHS does not collect information on the types of mechanisms and collaborative practices these mechanisms employ because the mechanisms operate under the components, and thus this information was not readily available at the departmental level. DHS officials stated that primary oversight over the mechanisms is the responsibility of the operational components …

A letter report issued by the Government Accountability Office with an abstract that begins "The Task Force agencies use the Action Plan to implement the Great Lakes Restoration Initiative (GLRI) and use an interagency process to enter into agreements among themselves to identify GLRI projects and with other stakeholders to implement GLRI projects. The Action Plan includes guidance for implementing the GLRI in five focus areas (such as invasive species and habitat and wildlife protection and restoration) that encompass the most significant environmental problems in the Great Lakes. Each focus area includes, among other things, long-term goals, objectives to be achieved by fiscal year 2014, and 28 measures of progress that have annual targets for fiscal years 2010 to 2014."

A letter report issued by the Government Accountability Office with an abstract that begins "The Nuclear Regulatory Commission (NRC) relies on its staff's professional judgment in implementing its processes for overseeing the safety of U.S. commercial nuclear power reactors. In implementing this oversight, NRC allocates specific roles and responsibilities to resident inspectors assigned to each plant, regional officials at one of four regional offices responsible for most oversight activities, headquarters officials, and the nuclear power industry. NRC also builds into its processes incentives for plant managers to identify concerns about reactor safety, report those concerns to NRC, and take prompt actions to correct them. NRC's processes for identifying and assessing findings and violations are based on prescribed agency procedures and include several points where NRC staff must exercise their professional judgment, such as determining whether issues of concern identified during physical inspections constitute findings or violations and the risk significance of any findings or the severity of any violations, among other things."

Testimony issued by the Government Accountability Office with an abstract that begins ""

A letter report issued by the Government Accountability Office with an abstract that begins ""

A letter report issued by the Government Accountability Office with an abstract that begins "Compliance reviews conducted by the U.S. Department of Agriculture's Farm Service Agency (FSA) to determine if farming operation members (individuals and entities) meet the payment requirements for being actively engaged in farming are hindered by broad and subjective requirements and difficulty in verifying individuals' evidence of claimed contributions. To be actively engaged in farming, an individual is to make significant contributions to that operation in personal labor or active personal management (or both). However, the definition of active personal management in FSA regulations is broad and can be satisfied by an individual performing at least one of eight services representing categories such as supervision of activities necessary in the farming operation. Also, FSA regulations allow farming operation members to make contributions of management without visiting the operation, enabling individuals who live significant distances from an operation to claim such contributions. An FSA state official said that the agency finds problems with management contributions more often for those who live significant distances from an operation. FSA officials have also noted that the requirements for what constitutes a management contribution are subjective. FSA's handbook states that it is …

A letter report issued by the Government Accountability Office with an abstract that begins "In fiscal year 2012, 24 major federal agencies had established many of the components of an information security program required by The Federal Information Security Management Act of 2002 (FISMA); however, they had partially established others. FISMA requires each federal agency to establish an information security program that incorporates eight key components, and each agency inspector general to annually evaluate and report on the information security program and practices of the agency. The act also requires the Office of Management and Budget (OMB) to develop and oversee the implementation of policies, principles, standards, and guidelines on information security in federal agencies and the National Institute of Standards and Technology to develop security standards and guidelines."

A letter report issued by the Government Accountability Office with an abstract that begins "For the fiscal year 2014 budget formulation process, the Internal Revenue Service (IRS) implemented a new process that uses templates to help screen, prioritize, and select new initiatives before detailed business cases are developed to support funding requests. The template information that GAO reviewed varied in detail and scope; for some, IRS guidance may have contributed to incomplete submissions to senior leadership. According to Office of Management and Budget Circular A-94, in order to evaluate and compare funding initiatives, decision-makers need to be aware of benefits, costs, and strategies related to achieving program goals. By improving guidance on the type of data to include, IRS could help ensure the templates are fully completed."

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Labor (DOL) is in the early stages of implementing several of the 2010 report's recommendations, but implementation of the remaining recommendations has not occurred. The agency has begun to take steps to respond to three of the report's six recommendations: improve interagency collaboration, create an advisory subcommittee for Native American veterans, and conduct a needs assessment. To increase collaboration, DOL has conducted several listening sessions with tribal leadership and begun collaborating with agencies that serve veterans, including the Department of Veterans Affairs (VA) and the Department of the Interior's Bureau of Indian Affairs, to learn more about how to better serve Native American veterans. With regard to an advisory subcommittee, DOL is developing a proposal to establish a subgroup for Native American veterans on its existing veterans' employment and training advisory committee, and is considering appointing a representative from the Native American veterans' community to serve on that committee. To assess need, DOL has identified a potential source for data within DOD that provides race and ethnicity and address information for returning veterans that could help better target visits to tribal land, but …

A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Defense (DOD) provided information on all 12 required reporting elements in its fiscal year 2012 prepositioning report; however, 3 of these elements were only partially addressed. For example, DOD provided a list of non-standard items slated for inclusion in its prepositioned stocks but did not include a specific plan for funding those items as required by the law. Federal internal control standards state that decision makers need complete and relevant information to manage risks and achieve efficiency and effectiveness goals. However, GAO found that DOD's report contained some inconsistencies in information across the services as well as several inaccuracies and omissions. For example, DOD's report included funding information for 6 or 7 fiscal years for most of the services but only 2 fiscal years for the Navy's stocks. Service information was also presented in different formats in the report, which makes it difficult to compare data. Because the Joint Staff did not provide specific guidance to the services to ensure consistency when requesting data, the services adopted separate approaches to reporting information to the Joint Staff for compilation in the report. In addition, …

A letter report issued by the Government Accountability Office with an abstract that begins "Contracting is a prevalent means of providing transit services. About 61 percent of the 463 transit agencies responding to GAO's survey reported they contract out some or all operations and services, while the rest reported that they do not contract out at all. According to GAO's survey, paratransit (services for the disabled), demand response (also known as dial-a-ride), and commuter rail service are most often contracted out, and fixed-route bus, heavy rail, and light rail service are most often operated by the transit agency. Operations are most frequently contracted out, followed by maintenance services. Transit agencies most consistently cite reducing costs as a factor influencing their decision to contract. Contracting can reduce costs because contractors' workforces are more flexible, with more employees working in part-time positions, and lower insurance costs, among other things. Transit agencies also frequently cited starting new service, improving efficiency, and allowing for more flexible service as reasons for contracting. State laws are generally not a reason for contracting, according to GAO's survey. Transit agencies that do not contract most often cited one of these three reasons: desire to maintain control over operations, …

Testimony issued by the Government Accountability Office with an abstract that begins "GAO has reported that Congress needs to modify the U.S. Postal Service's (USPS) retiree health benefit payments in a fiscally responsible manner. GAO also has reported that USPS should prefund any unfunded retiree health benefit liability to the maximum extent that its finances permit. Deferring funding for postal retiree health benefits could increase costs for future ratepayers and increase the risk that USPS may not be able to pay for these costs. Key considerations for funding postal retiree health benefits include:"

Correspondence issued by the Government Accountability Office with an abstract that begins "The United States Postal Service's (USPS) mail carriers--who delivered mail to nearly 132 million delivery points nationwide in fiscal year 2012--can be injured while delivering mail in a number of ways, for example by being bitten by a dog or being involved in a vehicle collision. According to USPS officials, there were 32,213 reported injuries in fiscal year 2012, 11,717 (36 percent) of which were related to mail delivery. According to USPS's 2012 data, the most frequently reported cause of injury for routes that are primarily conducted on foot is dog bites, while the most frequently reported cause of injury for delivery on rural routes--which is often conducted in vehicles--is vehicular collisions. Additionally, USPS's data indicate that most injuries that occurred from 2009 through 2012 on mail delivery routes were caused by falls and dog bites. Falls to the ground were among the most common circumstances leading to injury that resulted in either restricted work activity or days away from work, but repetitive motions were the most common cause of long-term occupational illnesses regardless of severity or route type."