Social Security e-health records requirements draw fire

Certification requirements for $24 million in Recovery Act contracts aimed at automating the Social Security Administration's medical disability program could slow technological innovation, according to Microsoft officials and health information technology specialists.

A solicitation for proposals that the agency issued on Friday -- intended to cut the time it has to wait for medical records to determine disability status -- is open only to providers whose technologies are certified or plan to be certified in 2010, Social Security officials said.

Currently, the Certification Commission for Healthcare Information Technology "is the only recognized certification program; however, other programs are planned for the near future," SSA spokesman Mark Lassiter said.

Critics of the nonprofit CCHIT contend its leaders are closely aligned with legacy IT vendors who helped found the organization in 2004. They argue the group's certification program focuses on old-fashioned two-way document exchange rather than also embracing the so-called continuity of care record (CCR) standard. The CCR aggregates data from multiple sources, such as records of past doctor visits, prior lab results and hospital administrative documents.

Under the Recovery Act, a new health IT standards committee must deliver recommendations on standards and certification criteria to David Blumenthal, the national coordinator for health IT.

Aneesh Chopra, the Obama administration's chief technology officer, who sits on the standards committee, said, "I would certainly acknowledge that today's marketplace for exchange is likely a balance between those who exchange between CCR and those who exchange" the format endorsed by CCHIT.

"The federal advisory committee is certainly engaged on that discussion," he added, noting that he, personally, is "aware of the importance of the topic."

Two health IT specialists on Tuesday sent Blumenthal a letter signed by officials from Microsoft, a consortium of major employers and health IT advocates, asking that he and the committee consider the full range of specifications in use or under consideration in the market, including CCR. One of the authors, David Kibbe, an adviser to the American Academy of Family Physicians, co-developed the standard and is chair of an international technical committee on health care informatics at ASTM International, a standards development organization.

Blumenthal still is reviewing the letter, according to a spokeswoman for the national coordinator's office.

Social Security's certification provision "is an unfortunate policy that excludes more efficient and more ergonomic models that are available in the market but have not been CCHIT certified," said Brian Klepper, who co-wrote the letter and is managing principal of Florida-based market research firm Healthcare Performance Inc.

"CCHIT, from my vantage point, looks to be innovating in its own approach to certification, and I would say that I applaud CCHIT leadership for pursuing avenues of improvement," Chopra said.

CCHIT in October will unveil several revised certification models -- one of which is more flexible and covers electronic prescription systems and other stand-alone systems for providers who want to integrate technologies from multiple sources, CCHIT officials said.

CCHIT Marketing Director Sue Reber disputed the notion that the commission is tied to special interests, noting that less than a third of its 258 work group members are from the vendor community. Roughly a quarter of its 21 commissioners represent companies that manufacture health IT products. "If they are represented, they have always been a minor representation," she added.

Carl Buising, executive director for health care at Microsoft's U.S. Public Sector Health, warned that requiring certification of specific features and functions can "cause excessive alignment to current standard capabilities," and thus "slow or even prevent technology and process innovation."

"We feel the HIT standards committee should not unnecessarily narrow the standards selection process" to those that support only comprehensive e-health records and document-centric health information exchanges, he said.

Other technology firms are satisfied with the certification requirement in Social Security's initiative.

Glen Tullman, CEO of health IT company Allscripts, said, "The government created a very effective organization called CCHIT to promote adoption using standards. And it is working." Tullman is a member of the CCHIT board of trustees.

"If we need to toughen the standards, broaden participation in CCHIT -- while it's already very broad -- or make other changes to CCHIT, let's do so within the existing structure," he added. "To start fresh or to make inclusion so broad that every system qualifies will not only slow adoption, but will limit the ability of [health IT] to deliver on the quality and savings we expect from it."

Officials at GE, which manufactures CCHIT-compliant technologies, said not only are certification criteria not a barrier to innovation, they actually enable it by focusing product development on value-added areas, while facilitating the exchange of data among different health organizations and products.

On Friday, Social Security announced the start of a competition for $24 million in stimulus contracts to streamline the processing of disability applications. The system is largely paper-based today.

Applications are on the rise due to the recession. For fiscal 2010, Social Security expects a 27 percent increase in submissions -- 3.3 million -- over fiscal 2008.

The agency typically makes more than 15 million requests a year for medical information from providers to determine the severity of applicants' medical conditions. Waiting for the information can take weeks or months.

Health care providers and health information networks that win stimulus funds will be paid to transmit records through the nationwide health information network. The so-called "network of networks" is a Health and Human Services Department program working to connect disparate e-health records systems across the country.

Earlier this year, Social Security became the first government agency to join a trial implementation of the network.