This partnership further demonstrated the enormous poten-
A Link to NHIN
tial for collaboration between the public and private sectors. A
case study performed by the Kay Center for E-Health Research
showed a $2.1 million net cost recovery by MedVirginia directly
related to SSA disability determinations that resulted in Medi-
care and Medicaid coverage.
1 Through these partnerships, both
of which use the Health IT Standards Panel-approved C32 pro-
tocol (Continuity of Care Document, or CCD), the Social Secu-
rity Administration has achieved measurable improvements in
the disability determination process:
x Approximately 18 percent reduction in case-processing
time when a health IT partner is present (the total time
from when a case is received to when it is determined. So-
cial Security can allow a claim as soon as it has supporting
evidence but must review records from all sources before
denying a claim.)
x Approximately 15 percent of claims concluded with a dis-
ability decision when the only source of information was
a CCD obtained through the Nationwide Health Informa-
x Approximately 3 percent of claims with health IT medical
evidence were decided within 48 hours—an improvement
of 90 days from the average SSA initial case-processing
The standards designed to enable secure exchange of medical
information have allowed entities to adopt health IT in a meaningful way. In this manner, SSA’s model has paved the way for
the future use of health IT across the nation.
In February 2010 Social Security awarded an additional
$17.4 million in competitive Recovery Act–funded contracts
to healthcare providers and HIEs across 13 states. Designed to
help stimulate the adoption of health IT, the contracts stipulate
that awardees must receive electronic requests and send back
electronic medical records through NHIN, with a target production date of September 2011.2
The health IT-enabled disability determination process still
supports claims filed through various channels, including
phone, Web, and in-person submission. Upon receiving a claim,
the Social Security Administration shares the authorization to
release medical records and demographic information with
the medical provider listed in the claim. NHIN facilitates the
exchange of data between Social Security, state disability determination services, and provider organizations to ensure that
necessary and complete information is received.
To establish a link to NHIN, these providers utilize CONNECT,
the federally developed, open source software solution that interfaces with Social Security’s MEGAHIT application.
MEGAHIT—short for Medical Evidence Gathering and Analysis through Health IT—automates the process of requesting and
receiving electronic health records from each of Social Security’s partners. MEGAHIT initiates requests for disability claimants’ records to associated providers, who generate medical
evidence of records in the form of a CCD transmitted via NHIN
back through the application.
MEGAHIT then applies business rules to the incoming information to provide preliminary analysis and guidance for disability determinations. MEGAHIT also converts this information into an SSA-standardized, human-readable document and
places this information into the claimant’s electronic folder for
a disability examiner’s further evaluation.
The growing number of operational HIEs speaks to the value
of SSA’s work in health IT. In fact, the benefits of this program
carry over to organizations that become future partners with the
Social Security Administration.
Specifically, SSA’s health IT–enabled process leads to improved patient satisfaction, reduced uncompensated care, and
reduced administrative costs associated with medical record
submissions. In addition, its partners can replicate successful
exchanges via NHIN with other users of that exchange protocol. To that end, SSA continues to reach out to geographically
diverse partners and medical providers to raise awareness of
health IT capabilities and health information exchange.
This includes SSA’s work on a 2009 Congressional mandate, in
which the agency is engaged in a joint initiative with the Department of Veterans Affairs and the Department of Defense to
exchange electronic health data through NHIN. The project will
allow SSA to receive medical information more quickly for service memers who may be eligible for Social Security benefits.
Furthermore, continued collaboration on the Federal Health
Architecture will further contribute to alignment of health IT
standards and optimized use of health IT investments.
By maintaining a prominent role in the health IT arena, SSA
has made architectural, technological, and strategic decisions
that benefit its claimants, disability programs, and partner providers and ensure accurate payments. Additionally, health information managers can expect to benefit from ever-increasing
efficiencies in handling requests for information from Social
Kitt Winter would like to acknowledge the contributions of Division of Health Information Technology staff in the preparation
of this article.
1. Feldman, Sue S., and Thomas A. Horan. “Using the Nationwide Health Information Network to Deliver Value to Disability Claimants.” January 26, 2010. Kay Center for E-Health
Research, Claremont Graduate University. www.cgu.edu/
2. “Social Security Awards Nearly $20 Million in Recovery
Act Contracts for Electronic Medical Records.” February 1, 2010. News release. www.ssa.gov/pressoffice/pr/
Kitt Winter ( firstname.lastname@example.org) is director of the Division of Health Information Technology, Office of the Chief Information Officer, at the Social Security Administration Bob Hastings is a social insurance technical expert in
the Office of Health Information Technology and Electronic Policy, Office of
Disability Programs, at the Social Security Administration.