A $17.4 million program to speed up disability benefit decisions seems a humble effort at a time when billions of dollars have been set aside to spur health IT modernization.
Yet the Social Security Administration's electronic medical records initiative has potentially far-reaching implications. SSA in February awarded 15 contracts to a collection of organizations including health information exchanges, a university, healthcare foundations and one systems integrator. The initial thrust alone could yield dramatic results: contractors involved in the program believe the cycle time for benefits determination, a task that currently takes nearly three months, can be compressed to a matter of days.
But the SSA contracts could end up serving purposes well beyond its goal of records acceleration. Contract holders say the program will help them build-out health information exchanges (HIE) for data exchanges with a variety of healthcare organizations. And HIEs, technology vendors and participating providers will all gain experience working within the Nationwide Health Information Network (NHIN) standards set. Others see the grants as a springboard to improved financial health for fledgling exchanges.
Frank Baitman, the Social Security Administration's chief information officer, called the contracts a good deal for both the SSA and its grantees. "For us, we get the medical records more quickly and have a more useful medical record that will help us for disability determination," he said. "And they are going to have many other government agencies and providers they can exchange those records with."
Growth spurts
The new contracts expand upon a nationwide disability application SSA began testing three and a half years ago with Richmond-based MedVirginia, an HIE housing over 600,000 patient charts, 300 individual physicians and six regional hospitals. The idea: create a system that lets physicians electronically submit health records supporting an applicant's claim for SSA disability benefits.
Dave Perry, chief information officer at the LCF Research, an Albuquerque, N.M,. organization that holds a $1.1 million contract, said SSA's paper-based benefits determination process takes an average of 86 days. The MedVirginia pilot brought that time down to a week or less, he said. But the new contracts could further shrink the processing time to a day or two.
Cheryl Stevens, executive director of the Community Health Information Collaborative (CHIC), a Duluth, Minnesota- based SSA contract holder which promotes HIE, said the project, "is a huge savings if we can do this electronically" [SSA] took the right bite off the apple."
In doing so, the funding will not only help local and regional health networks manage disability claims, it will pave the way for additional applications, according to contractors, who plan to use the funding to enhance their HIE infrastructure as well as their participating providers' electronic health record (EHR) systems.
"If I am a provider and I've begun to exchange data for the purpose of submitting medical evidence for disability benefits determination, I have taken some very important steps that will allow me to do exchange in a much broader capacity," said Katherine Cauley co-director of Wright State University's Healthlink HIE, one of the SSA awardees. "That has me set to do any other data exchange I want to do across the NHIN."
HIE service providers also stand to benefit financially. Executives said the ability to exchange disability-related records will contribute to their exchanges' business sustainability, providing a new service that can generate revenue. And secondary applications that follow the SSA work could further boost their business models.
The Detroit-based Southeast Michigan Health Information Exchange (SEMHIE), which holds the largest SSA contract at nearly $3 million, plans to engage the business community in developing for-profit businesses that use a neutral exchange as a backbone.
"The first thing to realize is that the building of an HIE is not a (charitable) activity," said Michael Talley, treasurer of SEMHIE. "It is an activity or a service you can offer for a profit."
Bootstrapping the business
Stephens agrees. She said she hopes to enhance CHIC's financial well being by having "another product to offer our clients." The collaborative, founded in 1997, has been running in the black for years, she said, providing services such as coordinating a network for sharing immunization data in Northeast and North Central Minnesota.
Pieces of the organization's HIE service, called High-Bridge, are already in place. The HIE currently operates a record locator service, which encompasses 3.3 million patient records. The SSA contract will help the exchange toward its next phase of clinical data exchange, which had previously been barred by state law.
CHIC plans to charge exchange members annual membership fees to keep High-Bridge running and current on new standards. They are still working out the fee structure, but Stephens believes the amount could end up somewhere between $4,000 and $8,000 for a critical access hospital.
CHIC's business plan for the exchange, "shows we should be, in essence, sustainable by Fall 2011," she said.
At Wright State, annual subscription fees will also help fuel the financial plan for HIE. Most of its providers using the HIE lack their own EHR; consequently they use the system Wright State provides via subscription. As more providers acquire their own EHR systems, Cauley said, the exchange will expand its business model to include transaction fees as well as subscriptions.
"The business issues have to do with establishing a competitive but fair cost of transactions," Cauley said.
In Michigan, SEMHIE aims to have commercial firms develop for-profit businesses that use the exchange, which itself will remain a non-profit enterprise. The private companies running applications on the exchange will pay a portion of the fees they generate back to the HIE.
"We are engaging the private sector in setting up the business that will generate the fees," Talley said. "I don't want money from the government to sustain my HIE. I want the private sector to do this."
Continuity of care
CHIC also wants to use the funding to help its providers adopt NHIN standards. While the hospitals in its 39,000-square mile northern Minnesota market have a high EHR adoption rate, the systems were installed before the development of such NHIN components as a continuity of care document (CCD).
"The systems they have in place aren't capable of exporting CCD," which is an NHIN requirement, Stephens said.
The funding presents an opportunity for hospitals to either upgrade their EHR systems or purchase an interface engine to obtain CCD capability. Those updates would prep hospitals for sending electronic documents to SSA. But they will also ready providers for other forms of exchange and help them satisfy any meaningful use criteria associated with HIE participation.
"If you want to do any kind of health information exchange and meet meaningful use, you are going to have to exchange a CCD sooner or later," Stephens said. "The Social Security contract will help bring everyone to the next level and start people down the road toward meeting meaningful use."
At SEMHIE, the SSA contract marks the first step of a plan to develop an HIE architecture based on a service-oriented architecture (SOA)"a method for designing and integrating software"and to adopt a common security policy.
That foundation will support SSA's disability processing needs as well as serve as a launch pad for more applications. "The whole point is we need an architecture that allows us to add applicati
