Social Security goes live with first federal e-health information exchange

New system automates transmission of medical records for processing disability claims

The Social Security Administration (SSA) today said it has gone live with a disability claims processing system that was designed to reduce the time millions of Americans spend each year waiting for benefits to be approved — and that could mark the start of the rollout of national health information network.

The SSA uses individual medical records to decide on 2.6 million disability claims every year. As part of that process, the agency relies on doctors, hospitals and other health professionals to provide medical information about patients. By migrating from paper to electronic transmissions based on patient authorizations, SSA officials said that they can significantly reduce the time spent waiting for records to arrive.

New open-source software deployed at the SSA, combined with the use of a Virginia-based health information exchange's database, is expected to reduce the wait time for documents to minutes, according to Debbie Somers, a senior adviser in the Office of the Deputy Commissioner of Systems at the SSA. That process can take weeks or even months now, Somers said.

To put the new system into production, the SSA partnered with IT vendors IBM, Harris Corp. and Sun Microsystems Inc., the MedVirginia regional health information organization (RHIO) and several health care providers, including Beth Israel Deaconess Medical Center in Boston.

The technology partnership represents a first step toward the creation of the Nationwide Health Information Network (NHIN), a federal initiative that began 14 months ago and is a key part of President Barack Obama's health IT agenda.

The project at the SSA represents the first example of health care data being exchanged between a RHIO and a federal agency. The goal of the NHIN effort is to enable secure access to health care data and real-time information sharing among physicians, patients, hospitals, laboratories, pharmacies and federal agencies, such as the SSA and the departments of Defense and Veterans Affairs, regardless of location or the applications that are being used.

"It's been described as the local health information exchanges like MedVirginia would be like the local dial tone and the NHIN would be the long-distance carrier," MedVirginia CEO Michael Matthews said this week.

As part of the recently approved American Recovery and Reinvestment Act, the federal government has allocated more than $19 billion for health IT, including $17 billion in incentive funding for health care providers to roll out electronic medical records systems and develop methods for sharing the information contained in them among different organizations.

The SSA and its partners built a prototype data exchange system that was put into limited production last August with Beth Israel Deaconess, to test the process of eliminating manual requests for paper-based medical records.

The open-source software, called NHIN Connect Gateway and developed by Harris with help from Sun and other vendors, is being combined with MedVirginia's repository to provide for secure information exchanges, according to the SSA. Eventually, the gateway software will be used for exchanges between the SSA, the DOD, the VA, the Indian Health Service, the Centers for Disease Control and Prevention, the National Cancer Institute, and health care providers that sign up with MedVirginia.

The interface between the SSA's and MedVirginia's systems is based on IBM's Health Information Provider technology, which includes an Inter-Community Services component that relays messages between the MedVirginia network and other NHIN nodes and provides the ability to cross-reference patient ID numbers.

Matthews said that about 40% of veterans and 60% of active-duty military personnel and their family members receive health care from civilian providers. But a big problem, he added, is that civilian doctors often don't have access to treatment records at DOD or VA facilities, and vice versa. The NHIN could resolve that problem, he said.

Typically, when a U.S. citizen files for long-term disability, the SSA must physically mail a request for medical information to a health care provider. "It goes into a stack with hundreds or thousands of other requests at the provider, and we typically get medical records back in a couple of weeks or a couple of months, or not at all," Somers said.

After proving that medical data could be exchanged in a standardized format with Beth Israel Deaconess, the SSA then teamed up with MedVirginia, which acts as a central repository for sharing patient-approved medical information through a private network. MedVirginia collects hospital, lab and pharmacy data, and organizes it into a single, common electronic chart for individual patients. The organization currently has about 600,000 health records in its archive, according to Matthews.

The purpose of any health information exchange, Matthews said, is to enable disparate IT systems to share data so that the physicians responsible for treating a patient can get "the complete clinical picture of what's going on with that patient and therefore make the best treatment and clinical decisions" possible.

"We think that the connections across systems are just as important as the existence of the individual electronic health records themselves," he added.

Copyright © 2009 IDG Communications, Inc.

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