In expanding the number of health practices and network providers it is electronically linked to, the Social Security Administration is confronting one of the laws of networks: the multiplication of interfaces, formats and specs to manage.
SSA announced yesterday a set of 15 contracts with health information exchanges, providers and health IT firms to set up links over which clinics could send the agency the electronic health records of people seeking disability claims.
Jim Borland, SSA's special advisor for health IT, said the multiplication of links would make it essential for the HIE partners to use widely accepted health IT standards to resolve variations in the way providers document patient data.
"It's one of the challenges that we're looking forward to tackling," he said in an interview.
Until now, SSA has tested the application on a limited scale, working with Richmond-based health information exchange, MedVirginia. But the addition of HIEs across the country may add tens of thousands of providers to the network who will use a variety of approaches for reporting patient data.
"That's why it's so important that we get structured data because we need to be able to pull that information together from multiple sources and consolidate it," Borland said.
To do that, SSA will standardize on the Continuity of Care Document (CCD) standard from Health Level 7 to communicate a patient's summary clinical data, he said.
CCD is a markup standard intended to specify the encoding and structure of a patient summary document for exchange.
Whether the HIE performs the integration work or SSA does it internally, the information has to be integrated into a single CCD that covers multiple providers.
Borland believes that demonstrating the ability to transmit clinical information to SSA information via the CCD will fulfill the requirement for meaningful use among providers seeking incentive funds under the health IT stimulus plan.
"We're at this point perfecting the process," Borland said. "But we've proved that it has value to providers as well as to the government."
The bet is that SSA won't need to award another round of contracts because the meaningful use incentives will be sufficient to move providers off of paper and onto EHRs.
"Then the business case is compelling enough that people will want to transition from sending us paper and faxes to sending us a (CCD) directly out of their EHR," Borland said.
Among the 15 contracts awarded by SSA this week, one went to the California Regional Health Information Organization (CalRHIO), which is mired in questions about its future.
The five-year HIE is facing closing shop following a failed attempt last month to have itself be designated as California's governance entity for HIE services in the state.
The intent of the CalRHIO board is to merge with another California health IT organization, Borland said. SSA awarded CalRHIO the second largest contract, valued at $1.6 million.
Although Borland said he did not know the specifics of the situation, SSA has included requirements in the contract by which the vendor must demonstrate the ability to perform the activities before proceeding.
"These are fixed price, performance-based contracts, so no dollars flow to anyone until they can demonstrate the ability that they can send us the information," he said, adding that SSA would not let CalRHIO proceed on the contract until they resolve their status.
