National network to speed disability benefits

The Social Security Administration is about to become the first agency to use the emerging Nationwide Health Information Network, and it expects NHIN to dramatically reduce the time it takes to determine if people are eligible for supplemental disability benefits.

On Feb. 28, the agency will begin using the network to evaluate Virginia residents’ requests for those benefits. SSA will send the queries to MedVirginia, a group of health care providers based in Richmond that already has a system for exchanging information electronically. Eventually, the Health and Human Services Department will make many such exchanges part of the national network.

NHIN is designed to connect patients, providers and others involved in health care. However, many providers are reluctant to move onto the network because of the expense and time involved in making the transition from paper to digital records. So SSA is building a business case to convince them of the long-term benefits.

Switching from a paper-based process to an electronic one will allow SSA to obtain medical information more quickly, said Debbie Somers, senior adviser to the agency's deputy commissioner for systems. By applying that digital process to a network of providers rather than establishing connections to each one individually, SSA can further speed the process and begin paying benefits much faster.

People who are terminally ill, permanently disabled or unable to work for at least a year must wait as long as several months to find out if they will receive supplemental disability benefits through SSA. Meanwhile, bills pile up for the family.

The lengthy paper-based process for collecting medical information from physicians and hospitals about an applicant’s condition has been a major bottleneck in the disability process, Somers said. About 3 million people file for disability benefits each year, and many states wait for that disability determination before they approve Medicaid and other services for the applicant.

With NHIN, SSA will be able to obtain in less than a minute the medical information it needs to make a determination, Somers said. Last fall, when SSA tested an information-sharing system with Beth Israel Deaconess Medical Center in Boston, the turnaround time was 42 seconds.

“It gives you chills to think about it,” she said. “At this point, that is one facility, one state, so it’s a limited amount of data. But we know it’s doable.”

NHIN will help SSA broaden its efforts to share data electronically. It would be overwhelming to set up point-to-point connections with the country’s 7,000 hospitals, Somers said, but the new network allows the same information to flow via a single Internet gateway.

“What SSA has built is a foundational element that will help bring value to the NHIN because we’ve gone beyond use of information for treatment,” Somers said. “Now a provider can look at some other benefits.”

In its use of NHIN, SSA is thinking beyond medical data for treatment, payment and operational activities. Families might want to have immunization records sent electronically to their children’s schools, or they might want to review elderly parents’ medical records to make sure they are receiving the care and treatment they need, she said. The same data could have many uses, ranging from approving veterans’ disability benefits to supporting workers’ compensation claims.

The North Carolina Healthcare Information and Communications Alliance, a nonprofit organization of 200 providers, industry organizations and technology companies, could be next in line to join NHIN. SSA also is working with Kaiser Permanente to determine implementation dates for that organization.

As the agency develops new business rules, it will evaluate their effectiveness and identify areas for improvement. It will also continue to look for ways to standardize data to further streamline patient records. "We also expect to see changes in the cost because we are able to do things electronically,” Somers said.

SSA follows the requirements of the Health Insurance Portability and Accountability Act when obtaining patients’ authorization to query providers for their medical records. For NHIN, electronic records follow a standard format, so that certain data will always be in certain fields, which means a computer can assist in searches and analyses, Somers said.

NHIN collects summary medical records from providers and transmits them to SSA, which uses the information in various ways, said Ginger Price, the NHIN lead in HHS’ Office of the National Coordinator for Health Information Technology.

In the past year, HHS has sponsored trial implementations of NHIN in which federal agencies and health information exchanges have helped define and test core services, Price said. Those services are the ability to query a record, compile a summary patient record and send that information back to the person who requested it.

Other agencies, such as the Defense and Veterans Affairs departments, are keeping an eye on SSA’s activities and have expressed interest in switching to NHIN toward the end of the year, Price said.

In a report released in December 2008, the Government Accountability Office cited SSA's decision to expand its use of technology for obtaining the health records of disability applicants as an idea that “holds promise for achieving even greater efficiencies in medical collection for disability cases in the long run.”

But obstacles remain. Industry standards and protocols must be further developed "before the process can be replicated widely,” wrote Daniel Bertoni, director of education, workforce and income security at GAO. And there are issues related to the electronic authorization procedures designed to protect the privacy of patients’ medical records, he said.

MedVirginia has conducted demonstrations and trial implementations to ensure that it can transmit data securely from one entity participating in the national network to another, said Michael Matthews, MedVirginia’s chief executive officer. In addition to health information exchanges, participants in NHIN include the Centers for Medicare and Medicaid Services, the Indian Health Service, VA and DOD.

For SSA, when a patient seeking disability benefits identifies one of MedVirginia’s providers as a site where he or she received treatment, the organization searches its databases for a match, Matthews said. Once MedVirginia establishes that a patient with the stated name and date of birth exists in its databases, SSA could request a clinical summary. When MedVirginia confirms that the proper patient authorization has been obtained, it reformats the record into the summary document and sends it to SSA via NHIN.

SSA runs the data through its algorithm, which prompts the computer to look for certain procedures, diagnoses and codes that would be factors in a disability determination, Matthews said, adding that MedVirginia had to structure its data to fit the algorithm.

“We have 600,000 charts, and some of those are extensive, with radiology reports, lab results, operative notes and patient summaries,” he said. Nevertheless, MedVirginia has demonstrated that it can perform the transaction in less than a minute.

“We’re the first, but through that gateway, they will be able to connect with anyone who is a participant in NHIN and produces data formats and [adheres to] interoperability standards,” Matthews said.

To do its part, MedVirginia integrates the databases of its providers through its technology partner Wellogic, of Cambridge, Mass.

Now that MedVirginia is using the network, it might encourage other health care providers to sign on, Matthews said.

For example, NHIN could allow VA and DOD to share data with civilian health care providers who treat veterans and members of the military. About 40 percent of veterans receive care outside VA’s system, and 60 percent of active-duty service members receive care outside DOD’s system. Yet the civilian doctors don’t know what’s happening on the government side, and VA and DOD don’t have access to what’s happening to their patients when they go to civilian providers.

MedVirginia has demonstrated that government and private systems can share information, Matthews said.

“The evidence is compelling,” he said. “We can’t afford to waste any more time in proof of concept. We’ve proven the concept, and now it’s time to move on to production and implementation.”