Last February, the Social Security Administration and MedVirginia, Virginia’s Regional Health Information Organization, began exchanging health information to help determine Social Security disability benefits. Early results of this collaboration demonstrate the business value for health IT, said Jim Borland, special advisor for Health IT at Social Security.


Not only does Social Security benefit, but so do all of its state agency partners that assist in the disability determination process, he said. More importantly, with regard to health IT adoption, healthcare providers benefit from a reduction of administrative costs associated with pulling patient data and the potential for a reduction in their cost for uncompensated and charity care. “Because we can make disability determinations faster, we can get our claimants access to Medicare and Medicaid health insurance faster, which reduces uncompensated care from a provider’s perspective,” Borland explained. “We view this as a strong business case all the way around for folks to join in partnership with us to use interoperable EHRs (electronic health records).”


While Borland stressed that three months’ worth of data is not enough to derive conclusive ROI, early numbers are compelling. Between the go-live date of February 28 and May 8, Social Security, through the Virginia Disability Determination Services (DDS), made 421 automated requests to MedVirginia. In 333 cases, the Virginia DDS received “substantial” medical evidence from MedVirginia, he said.


“That percentage is very high as compared to what we would expect from the general population of medical providers from whom we request medical information. It’s a very good response rate,” Borland said. Marty Prahl, Health IT architect for Lockheed Martin, a partner of Social Security, noted, “The medical information coming back in the form of a Continuity of Care document has provided tremendous value to disability examiners who review the information for disability claims.”


A key benefit from requesting and receiving medical evidence in an automated, electronic form using business rules is the reduction of the six-to-eight week timeframe of the traditional manual process to “a matter of minutes,” Borland said. While a normal mean processing time for a case in the Virginia DDS is about 84 days, in cases where electronic medical records were received the mean processing time is 25 days, he said.


The automated process has led to an improvement in service to claimants. “They’re getting decisions on their claims faster; there is certainly a quality of service improvement as a result of this project,” he said.


Going forward, Social Security will focus on two areas. Social Security is looking to expand the number of healthcare providers and health information exchanges, and state disability determination services that are currently using MEGAHIT, its Medical Evidence Gathering through Health IT application. Of the up to $40 million of its American Recovery and Reinvestment Act funding that Social Security was authorized to spend for health IT, Social Security will use $24 million to expand the use of its MEGAHIT project. Social Security expects to release the RFI and RFP this summer and make awards by late 2009 or early 2010, Borland said.


Social Security will also continue its efforts to identify parts of the disability process internally that can be made more efficient through the use of health IT. “We update medical evidence at various steps in our disability determination process as well as during continuing disability reviews,” he said. “We think there are applications of health IT that can make other parts of the disability process more efficient.”


Social Security’s vision of its health IT efforts and MEGAHIT project is analogous to electronic wage reporting, Borland said. Today, 82 percent of W-2 forms are received electronically.


“It’s going to be a process by which we ramp up closer and closer to fully interoperable shared, structured electronic health records, much as we ramped up to e-wage reporting,” he explained. “If we’re at 82 percent of all medical information being gathered electronically through structured, interoperable EHRs in 10 years, I think this agency will be much more efficient.” Borland is hoping that the incentives within the HITECH Act will drive physician adoption of interoperable health records, which would then enable them to interact with Social Security and provide Social Security with structured medical data.


“We believe that Social Security– because of our technical leadership in health IT – is in a position to prove the business case for health IT,” Borland said.