National network to speed disability benefits

The Social Security Administration will soon begin using the Nationwide Health Information Network to reduce the time needed to determine eligibility for 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.”

NEXT STORY: DHS to aid security at Oscars

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.