Health IT Overview
The Health Information Technology (Health IT) program at the Social Security Administration (SSA) brings the speed and power of electronic medical records to the disability determination process. When a person applies for disability benefits, SSA must obtain and review a complete medical record to make an accurate determination. With Health IT, SSA can automatically obtain medical records in a matter of seconds to minutes to make a determination quicker than ever before. Claimants who are found disabled get the help they need faster. SSA’s healthcare organization partners may also benefit through reduction in costs, streamlining of operations, and positioning themselves as leaders in exchanging health data.
SSA Disability Programs
SSA pays disability benefits to people who are unable to work due to a medical condition. SSA’s disability programs are the largest of several federal programs that provide assistance to people with disabilities. Individuals who have a disability and meet medical criteria may qualify for benefits under one of two programs:
- Social Security Disability Insurance pays benefits to you and certain members of your family if you are "insured," meaning that you worked long enough and paid Social Security taxes.
- Supplemental Security Income pays benefits based on financial need.
Eligibility rules for Social Security's disability program differ from those of private plans or other government agencies. Social Security doesn't provide temporary or partial disability benefits, like workers' compensation or veterans' benefits do.
To receive disability benefits from SSA, a person must meet the definition of disability under the Social Security Act (Act). A person is disabled under the Act if he or she is unable to work due to a severe medical condition that has lasted, or is expected to last, at least one year or result in death. The person's medical condition must prevent him or her from doing work that he or she did in the past, and it must prevent the person from adjusting to other work.
Because the Act defines disability so strictly, Social Security disability beneficiaries are among the most severely impaired in the country. In fact, Social Security disability beneficiaries are more than three times as likely to die in a year as other people the same age. Over 56 million Americans, or 1-in-5, live with disabilities. Over 38 million disabled Americans, or 1-in-10, live with severe disabilities. SSA’s disability benefits provide a critical source of financial support to people when they need it most.
When a person applies for either program, SSA collects medical and other information about the claimant in order to a decision about whether or not they meet Social Security's definition of disability. SSA is one of the largest disability insurers in the world, requesting between 15 and 20 million medical records from almost 500,000 providers to make decisions on over 3 million disability claims annually.
SSA Disability Workflow
An individual can apply for disability benefits in one of three ways: in a field office, using the 1-800 national phone number, or online. When an individual applies for disability, SSA collects several key pieces of information: demographics, facts about his or her allegation(s) of disability, work history, and a full list of his or her medical treating sources. SSA also collects a patient authorization form (Form SSA-827). SSA is not a covered entity under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), but is covered under the Privacy Act. Therefore, a patient signs the SSA-827 to allow his or her healthcare providers to release information to SSA to adjudicate his or her disability claim.
Once the application is completed, the case is transferred to the state Disability Determination Services (DDS). The DDS is a federally funded state service that makes medical determinations on behalf of SSA. In the traditional (non-automated) workflow, the DDS reviews the case upon receipt and sends out requests for medical records to the treating sources listed via fax, mail, or ERE (Electronic Records Express), which is SSA’s secure web portal. The treating source receives the request, pulls the information requested, and sends it back to the DDS via fax, mail, or ERE website. Today, it takes an average of about 90 days to make an initial disability determination, where the majority of this time is waiting for medical documentation and evaluating the evidence.
SSA uses Health IT to automate parts of this process. Through Health IT, SSA sends an electronic request and patient authorization to the healthcare provider’s system via a national health data exchange network. Information is returned in a standardized Health IT format within seconds or minutes, rather than the days or weeks it may take when the traditional methods are used. Records are ready to review when the case is transferred to the DDS. This automation can result in a significant reduction in the time it takes to make a medical determination.
SSA Health IT Program
Since 2009, SSA has been successfully using Health IT to obtain electronic medical documentation for the disability determination process. Receiving medical documentation sooner and in standardized electronic formats enables claimants to receive quicker disability determinations by reducing the waiting time to receive records and enabling downstream analytics to support disability claims adjudicators. In fiscal year 2018 to date, the average processing time for initial claims with only records received via Health IT was 45 percent shorter than for claims with no Health IT records. For initial claims that were determined to qualify for disability benefits, the average processing time for claims with only records received via Health IT was 65 percent shorter than for claims with no Health IT records.
As of July 2019, SSA has 165 partner organizations, including healthcare organizations, Health Information Exchanges (HIEs), and other federal agencies, which includes over 21,100 healthcare facilities. Medical records collected from these partners via Health IT currently represent about 10 percent of documents received. Today, SSA electronically receives information over the eHealth Exchange, a national health data exchange network that began in 2009. SSA was the first federal agency to exchange information over the eHealth Exchange with our first Health IT partner, MedVirginia. SSA is also a general member of two other such networks, CareQuality and CommonWell Health Alliance. A pilot is planned for FY 2020 for SSA to connect to organizations on CareQuality using the eHealth Exchange.
Value to Medical Records Holders and Patients
Organizations that utilize health IT to partner with SSA could see lots of benefits and cost savings.
First, healthcare organizations that partner with SSA may see smaller costs for uncompensated care. Patients who may qualify for disability benefits can’t work and may not be able to pay for their medical care. Organizations who provide care for these patients often incur uncompensated care costs due to the financial strain of these patients’ predicament. Faster approvals of disability benefits may lead to payment for care that would otherwise be uncompensated. An approval of disability benefits provides monthly cash benefits to the claimant and often leads to healthcare coverage through Medicare or Medicaid. In 33 states and D.C., an approval for disability benefits under the Supplemental Security Income program can lead to immediate coverage under the state’s Medicaid programs. In some cases, this coverage can lead to retroactive payment for healthcare treatment received by this patient. Furthermore, when a patient receives healthcare coverage, the treating healthcare organization may be able to provide the charity care that would have been used by the disability claimant to other patients.
Second, organizations may see savings on health information management labor costs. Because the Health IT channel is automated, the labor and supply costs of releasing information to SSA via Health IT may be lower than for traditional methods (e.g., mail, fax, web portal). These costs may include time required to open and log traditional requests for medical documentation, locate and pull medical records, and compile and mail medical documentation, as well as the cost of paper, printer, toner, and postage required for handling paper-based records.
Third, SSA pays $15 for each successful transaction through Health IT. This flat rate is based on a national weighted average of state payment rates. These payments are automated and sent as a daily aggregated electronic funds transfer (EFT) rather than individual checks, reducing the operational overhead to receipt and reconcile these payments.
Finally, for the patients, a faster disability determination not only gets them faster access to monthly cash benefits and healthcare coverage, but it can also mean improved access to healthcare, better financial standing, and ease of mind. Many disability claimants who cannot work due to their disability may struggle to pay the rent or mortgage, put food on the table, take care of themselves or their families, and pay for their medical care. In many instances, these patients have limited healthcare coverage or none at all. These chronically or terminally ill patients may delay their treatment or use the emergency department as their primary care, thus increasing the chance that their condition may worsen and put further stress on themselves and the healthcare system. An approval of disability benefits may mean the difference between a patient living in poverty or not.
Overall, by using Health IT to share electronic health information with Social Security, all involved stakeholders can benefit.
How to Become a Health IT Partner
SSA will ask you to complete a Clinical Content Checklist (Checklist) to indicate the types and format of data that your organization can provide electronically. Clinical notes, lab results, procedures, information that typically may be marked as sensitive (e.g., substance abuse, HIV, and mental/behavioral health records), as well as several other types of content, are required to adjudicate a disability claim. It should be noted that a large portion of disability claims are mental/behavioral in nature, which requires SSA to request information that may be marked as sensitive or confidential in the electronic medical record.
SSA will also ask that your organization complete a Facility List. The facility list includes a list of all the treating locations (inpatient and outpatient) that fall within your organization. SSA uses this list to populate our internal phonebook, so that when your patients identify one of your locations on their disability application, we will know where to send you a request via Health IT.
Finally, SSA will ask that your organization complete a Fiscal Package. Because SSA pays for Health IT transactions via electronic funds transfer, we will request information so we can properly route payments to you.
The information required for the Checklist and Facility List can be found in Form SSA-680, described below. These materials will be provided in Excel formats to organizations that reach out to us.
Today, organizations wanting to take advantage of Health IT with SSA need to be members of the eHealth Exchange. Once an organization is a member of the eHealth Exchange and has completed the administrative steps outlined above, testing can begin.
SSA first performs two Content Testing steps using the Checklist you supplied to ensure the available content meets SSA’s requirements for disability adjudication. The first step is Sample Document Testing. During this step, SSA collects sample documents and runs them through validation tools. We ensure that the various types of documents you indicated on the Checklist adhere to industry standards. The second step is Verification Testing. During this step, we ask you to provide electronic medical records for patients that have an active initial disability claim. We compare paper-based medical records that we have already received for these patients from the facilities you indicated on the Facility List to the electronic copies of the records. We ensure all necessary information to make a determination is available in the records collected in the Health IT format. It should be noted that some organizations may not require Content Testing if their Electronic Health Record (EHR) has previously met SSA’s requirements.
Then, SSA performs Connectivity Testing. Many of the interoperability testing steps are completed by the organization during the process to join the eHealth Exchange. SSA offers each potential partner the option to perform Partner-to-Partner Testing, but this step is not required. This testing occurs within the validation environment of the eHealth Exchange to ensure our systems can connect. SSA does require all our health IT partners to undergo Probationary Testing. During this step, we test in the production environment with active patients to ensure the configuration is correct. This testing takes approximately 1-2 weeks to complete. Once Probationary Testing is complete, SSA coordinates a go-live date with your organization and with the DDS on which to begin interoperating. SSA maintains monthly, then quarterly, meetings with all of our active partners.
Description of Resources
- Interoperability Implementation Guide for eHealth Exchange – This guide provides an overview of the eHealth Exchange workflow messages that will occur between SSA and the Health IT partner. This document intends to provide an understanding of the flow of web service transactions that SSA uses with its partners and the information contained within those transactions.
- Content Implementation Guide – This guide provides information about SSA data requirements as they relate to the HL7 Consolidated Clinical Document Architecture (C-CDA) standards. The healthcare participant should use this implementation guide to assist in generating a well-formed CDA document that meets SSA needs.
- Form SSA-680, Social Security Administration Health IT Partner Program Assessment - Participating Facilities and Available Content Form – This form provides SSA with a basic understanding of a potential partner organization’s available EHR content. SSA evaluates a potential partner’s completed form for both the accessibility of health information and the content value of their EHR for SSA’s disability adjudication processes. SSA provides the Clinical Content Checklist and Facility List as Excel files to organizations that reach out to begin conversation on becoming an SSA Health IT partner.
- Using the Nationwide Health Information Network to Deliver Value to Disability Claimants – This case study was completed on one of our early partners, MedVirginia (a regional Health Information Exchange), and one of their providers, the Bon Secours Health System, to assess the actual value of interoperating with SSA. The study estimated an annual $2 million recovered in what would have otherwise been uncompensated care as a direct result of the increased speed of SSA’s disability determinations through Health IT.
- SSA Disability Programs: https://www.ssa.gov/benefits/disability/
- SSA Health IT Program: www.ssa.gov/hit
- Form SSA-827, Authorization to Disclose Information to the Social Security Administration: https://www.ssa.gov/disability/professionals/ssa827_informationpage.htm
- Department of Health and Human Services (HHS) Office of Civil Rights (OCR) Guidance on Form SSA-827: https://www.ssa.gov/disability/professionals/documents/HHS-OCRfeedback.pdf
- Federal Register for Health IT Transaction Rate: http://www.gpo.gov/fdsys/pkg/FR-2010-01-11/html/2010-225.htm
- eHealth Exchange: https://sequoiaproject.org/ehealth-exchange/
- Integrating the Healthcare Enterprise (IHE): https://www.ihe.net/
- Health Level 7 (HL7): http://www.hl7.org/
- Healthcare Information Technology Standards Panel (HITSP): http://www.hitsp.org/
- Office of the National Coordinator (ONC) for Health Information Technology: https://www.healthit.gov/