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7 July 2009

Confidential Atos guidance obtained by Benefits and Work reveals the shocking extent to which the secret LiMA software controls the fate of benefits claimants.

Doctor and computerAn  ‘Automatic Descriptor Choice and Justification’ system can complete and score the whole personal capability assessment mental health test before the health professional has even considered it, whilst whole sections of a physical health report can now be set to ‘normal’ with a single mouse click.

Benefits and Work has obtained a copy of the LiMA personal capability assessment examination technical manual issued in May 2007, which the DWP claim is the most recent one.  There may have been even greater degrees of automation introduced whilst upgrading the software for ESA medicals

The 60 page document, complete with screenshots, gives a clear picture of how the examination process has become even more automated since earlier versions of LiMA were introduced.  

The core of the LiMA system is a collection of standard and variable phrases which the health professional selects and LiMA then uses to choose descriptors and justify it’s choices.

Standard phrases are ready made in LiMA, the health professional just clicks on them.  For example:

‘The client has no problems with shopping.’

Much of the report can be created just using these ready made phrases.

The health professional can also choose from a number of variables to create simple or more complex phrases:  For example:

‘Client lives with [||LivesWith||].’

The ‘Lives With’ options will allow the  construction of sentences such as:

‘Client lives with wife.’

Health professionals can also enter free text where the appropriate information is not available within the software.  But they are warned to try to use the supplied phrases whenever possible because ‘LiMA cannot understand the meaning of free text, so it will not be able to use that information to help you choose an appropriate descriptor or to construct your justification.’

In other words, it will take the health professional longer to create the report and, as most are paid per examination, they will earn less money.

Where the health professional is carrying out an examination of, for example, your leg they are advised that ‘If only a small part of the examination was abnormal, it is often quickest to first click on the ‘Normal’ button to set all the findings to normal, then click on ‘Findings’ so that you can record the few abnormalities.’

The obvious danger with this approach is that the health professional may set all the findings to normal and then omit to change one to show that there was in fact a problem with that function, such as bending your knee.  A doctor in a hurry, trying to maximise their income, could easily make such a mistake.

Once the health professional has entered information about such things as daily living, observed behaviour and examination findings they are presented with a list of physical descriptors to choose from.  

However, LiMA will already have removed all the descriptors which it’s ‘database of logical rules’ have told it do not apply.  In many cases this will mean that the health professional is not offered a choice of descriptors at all, but presented with the text of the descriptor that LiMA has chosen.  The health professional can click an ‘Override EBM [Evidence Based Medicine]’ button if they choose, but they must then justify why they have done so.

Health professionals are told that ‘You should think carefully before overriding the EBM rules, and should do so only on those occasions where there is a good reason as to why they would not apply in this case.’  

A similar ‘Automatic Descriptor Choice and Justification’ system is used for the mental health descriptors.  In most cases LiMA chooses whether to say Yes or No to each mental health descriptor in the personal capability assessment and gives the evidence to support its choice from the daily living and mental health examination section.  

Only where it considers there is not enough conclusive evidence either way, will LiMA leave the choice to the health professional.  In these cases, the health professional looks at the evidence LiMA has assembled to justify a Yes answer and to justify a No answer and then decides which should apply.  They can add more evidence if they choose.

It is clear that as LiMA software has progressed, the role of the health professional has become more and more limited. Indeed, where no physical examination is required the claimant could almost be left to answer a series of multiple choice questions on a computer screen by themselves and achieve a similar, or perhaps more accurate, result.  
Medical examination by secret software – we are not allowed to know the ‘rules’ used by LiMA for reasons of commercial confidentiality - may make sound business sense, whether it makes sound medical or ethical sense is another matter entirely.

Members can download a copy of the LiMA PCA Exam Technical Manual from this link.

 

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