The South East Michigan Health Information Exchange (SEMHIE) entered into an almost 3 million dollar contract with the Social Security Administration (SSA) in June of 2010 to develop a secure and efficient electronic platform for processing the medical records of Social Security Disability (SSD) benefit applicants. SEMHIE announced in late July of this year that it had completed the contract and that the Health Information Exchange (HIE) platform was finished and delivered to the SSA.
The HIE is an electronic platform through which patient information can be transferred electronically between medical facilities and individual healthcare providers and the SSA. SEMHIE health systems is the intermediary in these electronic exchanges of medical records for SSD applicants.
Through SEMHIE, physicians and health care facilities are able to submit electronic medical records (EMR) from their own databases to the SSA by linking with the Nationwide Health Information Network (NwHIN). This nationwide network has existed for some time, but the HIE now makes it possible for any healthcare facility or individual provider with the appropriate EMR system configuration to quickly, efficiently and securely transfer patient medical records to the SSA as documentation for an SSD application.
Although the HIE is complete and is currently being used by the SSA, it is still in its infancy, with only about 5 percent of claims being processed using the new system. The success of the new application processing platform depends largely on medical facilities and healthcare providers having the appropriate EMR systems up and running in their own offices in order to participate in the NwHIN.
Currently, without the HIE, the Disability Determination Services (DDS) staff throughout the nation must submit requests for additional medical records information to healthcare providers manually. Most of these requests for additional information are processed with paper forms. Most medical records are also delivered to the DDS in paper form. According to the SSA, more than 15 million requests are processed in this manner each year, and the current manual methods for processing these requests accounts for significant delays in the review and approval or denial of SSD applications.
While the implementation of the HIE changes nothing for disability applicants in terms of what’s required for completing and filing a claim for benefits with the SSA, it does have some profound implications for both SSD applicants and the DDS. Currently the average SSD application takes 457 days to be reviewed by the DDS. With the claims that are now being processed through the HIE, that review time has been reduced to just one to two weeks.
What this means for SSD applicants whose claims proceed through the HIE platform is a quicker determination on their eligibility for benefits, and for those who are found eligible, more rapid commencement of benefit payments. It also means those who are initially denied benefits can more quickly request a reconsideration review from the DDS or more quickly initiate an appeal with the SSA. All of this potentially decreases the wait time for a final determination on eligibility for benefits for SSD applicants, and a faster initiation of payments for applicants that are ultimately found eligible for SSD benefits.
For the DDS and the SSA, the use of this new system can mean more efficient daily operations and reduced administrative expenses. The backlog of SSD applicants can be reduced over time and the overall costs associated with the SSA’s disability programs can also be reduced as a result.
This may be a partial answer to the current financial crisis facing the SSA, and may be a means of making the entire system more efficient and more capable of servicing the needs of the American public. However, the success of the nationwide implementation of this new system hinges on individual healthcare facilities and medical practitioners participating in the NwHIN, so the nationwide roll-out and availability of SSD application processing through this new system is still a ways off.
