D1 — Process Intelligence Brief
Five governance gaps at a regional Veterans Health Program managing readiness assessment across 12,000 active beneficiaries. Three gaps carry the highest priority rating — all three create immediate regulatory and liability exposure. PDIO Deliverable 1 of 4.
Executive Summary
This brief addresses five governance gaps at Veterans Health Program, a regional program producing approximately 4,800 readiness assessment touchpoints per month across primary care, behavioral health, and occupational medicine.
The most urgent gap is readiness assessment governance. Three commercial AI tools are currently in use with no audit trail, no confidence scoring, and no model versioning. Outputs cannot be traced to the model version, input data, or confidence level that generated them. This creates liability exposure and prevents quality improvement. The assessment methodology also relies heavily on self-reported data and episodic clinical encounters — missing the continuous signal streams that predict readiness degradation before it becomes a clinical event.
The second critical gap is environmental exposure integration. Deployment-related air quality exposure history is not systematically connected to readiness scoring. The NASA Environmental Readiness Index (ERI) and Human Environmental Health Index (HEHI) methodology — licensed by Cromtec under Earthdata licenses DN-2469, DN-2604, DN-2610, DN-2611 — requires structured environmental intake data that is currently captured for only 18% of the beneficiary population.
The third critical gap is behavioral health escalation governance. No escalation protocol exists for AI outputs that contradict clinical judgment — there is no documented chain of authority for resolving AI-human disagreements. Both gaps must be closed before ATLAS deployment.
Process Inventory
Veteran Readiness Assessment Governance
Clinical / Operational
Per assessment cycle (monthly)
Primary Care Provider
Three commercial AI tools in use with no audit trail, no confidence scoring, no model versioning. Outputs cannot be traced to the model version, input data, or confidence level that generated them.
Environmental Exposure History Integration
Clinical
Per patient + ongoing
Environmental Health Specialist
Deployment-related air quality exposure history not systematically connected to readiness scoring. NASA ERI/HEHI methodology cannot be applied without structured environmental intake.
Behavioral Health Escalation Governance
Clinical
Continuous — event-driven
Behavioral Health Provider
No escalation protocol exists for AI outputs that contradict clinical judgment. No documented chain of authority for resolving AI-human disagreements in behavioral health contexts.
Biometric Monitoring Coverage
Safety / Operational
Continuous
Primary Care Coordinator
Biometric monitoring data capture rate: 34% — significant gap. Continuous signals required for NASA ERI/HEHI readiness modeling are unavailable for 66% of the beneficiary population.
Command Readiness Reporting
Operational
Weekly / On-demand
Medical Officer of Record
Readiness determinations are not systematically documented with chain-of-command acknowledgment. Authority chain documentation required by DoD AI governance requirements is absent.
Signal Environment — 10 Active Signals
Biometric Signals
| Signal ID | Signal | Source | Sampling | Normal | Warning | Critical | Process |
|---|---|---|---|---|---|---|---|
| VH-001 | Physical Fitness Assessment Score | Fitness Assessment System | Per assessment cycle | ≥ 80/100 | 65–79 | < 65 | PROC-001 |
| VH-002 | Body Weight Index | Clinical encounter records | Per clinical encounter | BMI 18.5–24.9 | BMI 25–29.9 | BMI ≥ 30 or < 18.5 | PROC-001 |
| VH-003 | Resting Heart Rate | Biometric monitor (where available) | Continuous / daily | 60–80 bpm | 81–100 bpm | > 100 or < 50 bpm | PROC-004 |
Behavioral Health Signals
| Signal ID | Signal | Source | Sampling | Normal | Warning | Critical | Process |
|---|---|---|---|---|---|---|---|
| VH-004 | PHQ-9 Depression Screen | EHR (structured behavioral health) | Quarterly / triggered | Score 0–4 (Minimal) | Score 5–14 (Mild–Moderate) | Score ≥ 15 (Moderate–Severe) | PROC-003 |
| VH-005 | PCL-5 PTSD Screen | EHR (behavioral health module) | Quarterly / triggered | Score < 33 | Score 33–49 | Score ≥ 50 | PROC-003 |
| VH-006 | Substance Use Screening (AUDIT-C) | EHR (clinical encounter) | Annual / triggered | Score 0–3 | Score 4–7 | Score ≥ 8 | PROC-003 |
Environmental & Readiness Signals
| Signal ID | Signal | Source | Sampling | Normal | Warning | Critical | Process |
|---|---|---|---|---|---|---|---|
| VH-007 | Deployment Air Quality Exposure History | Military exposure registry + EPA historical AQI | Once + rolling updates | AQI avg < 50 (deployment period) | AQI avg 51–100 | AQI avg > 100 for > 14 days | PROC-002 |
| VH-008 | Toxic Exposure Flag (PACT Act) | Military service records (DoD DEERS) | Once (record-based) | No qualifying exposures | Possible qualifying exposure (requires review) | Confirmed qualifying exposure (burn pit, Agent Orange, etc.) | PROC-002 |
| VH-009 | Current AQI (facility location) | EPA AirNow API | Hourly | 0–50 (Good) | 51–100 (Moderate) | > 100 (Unhealthy) | PROC-004 |
| VH-010 | NASA ERI Composite | NASA FIRMS + EPA + NOAA (Earthdata DN-2469, DN-2604) | Daily composite | ERI < 0.40 | ERI 0.40–0.65 | ERI > 0.65 | PROC-002 |
Decision Authority Map
| Role | Decision Scope | Response Window | Escalation Path |
|---|---|---|---|
| Primary Care Provider | Routine readiness assessments, medication management | Per encounter | Medical Officer of Record → Commanding Officer |
| Medical Officer of Record | Readiness determinations, fitness-for-duty | Within 48 hours of trigger | Commanding Officer → DHA |
| Behavioral Health Provider | Mental health escalations, PTSD/depression management | Within 24 hours of critical screen | Chief of Behavioral Health → Medical Officer of Record |
| Environmental Health Specialist | Exposure assessment, ERI integration, PACT Act documentation | Within 5 business days of referral | Medical Officer of Record |
| Primary Care Coordinator | Care coordination, referral management, biometric monitoring enrollment | Within 3 business days | Primary Care Provider → Medical Officer of Record |
NASA ERI / HEHI Integration
ATLAS-M incorporates the NASA Environmental Readiness Index (ERI) and Human Environmental Health Index (HEHI) methodologies under formal technology license. These frameworks — originally developed for satellite-based Earth science at Goddard Space Flight Center — are applied to integrate environmental exposure data with human biomarker signals for veteran readiness assessment.
The integration produces a composite readiness score that accounts for both individual health status and environmental conditions — a capability not available in any other commercial health AI platform.
Cost of Inaction
Missed readiness degradation (ungoverned AI outputs — 3 tools in use)
$300,000–$500,000+3 commercial AI tools with no audit trail. One missed readiness assessment leading to premature return to service creates medical liability + compensation exposure. Source: VA OIG reports on readiness documentation gaps.
PACT Act compliance gap (environmental exposure not integrated)
$200,000+PACT Act claims requiring exposure documentation not systematically captured. Retroactive documentation costs + litigation exposure per unresolved claim. Source: VA PACT Act implementation estimates 2023.
Behavioral health escalation gap (no AI-human resolution protocol)
$150,000+Single adverse outcome from escalation gap: liability exposure + DoD audit finding. AI-human disagreement resolution gap flagged by DHA AI governance review. Source: DHA AI Policy 2023.
Biometric coverage gap (34% capture rate)
$100,000+Delayed detection of readiness degradation due to missing continuous signals. Each missed early intervention requiring later clinical escalation. Source: IMCOM Vision POC Plan 2024.
Next Steps
- Client reviews D1 and confirms the process inventory, authority structure, and signal readiness assessment. Specific attention to: authority gap assignments for behavioral health, PACT Act exposure documentation status, and biometric monitoring coverage roadmap.
- Upon D1 approval → Cromtec proceeds to D2 (Governance Design Specification). D2 will specify governance rules, signal configurations, three-tier authority chain design, and DHA/IMCOM alignment documentation.
- D2 delivery timeline: 10 business days from D1 approval. Environmental data enrichment program begins in parallel — target 60% biometric capture rate within 6 months.
Anonymized · Real Engagement · CROMTEC.AI · Patent TPP96862 · NASA Licenses DN-2469, DN-2604, DN-2610, DN-2611
See what ATLAS would produce for your organization.
This D1 brief is the first of four ATLAS deliverables for defense and veteran health programs. Start a conversation.