Beth Israel Deaconess Medical Center (BIDMC): A Standard For Better Health Care
Beth Israel Deaconess Medical Center first began the process of medical records exchange with Social Security in 2008, a time when there was very little precedent. Without that precedent, Beth Israel faced a number of challenges. “From our side, we had to be able to take in a web service like an SSA request,” explained Robert Beckley, Interface Architect, “and then pass it along to our clinical system. One difficult part was protecting patient confidentiality. So our solution included a scan of the patient’s consent to release information with the medical record.”
Things have changed since then, “today we’re using the C32 standard [summary documents using HL7 continuity of care document component] to exchange data with a lot of institutions in eastern Massachusetts,” said Beckley. With the new system, too, the process of responding to records requests from Social Security has gotten much better. “Say someone came into a Social Security field office and applied for disability. Social Security would ask for our records on that person to help them make a disability determination. We’d go through our paper records, pull the records, copy them, and then overnight them to Social Security. This used to take about six weeks. Now it takes about nine minutes. Social Security enters a request, the system assembles the information, and the document gets to Social Security faster—all because it’s done electronically.” But it’s not just speed that’s been good for Beth Israel. “We are saving all the costs we used to spend on that manual process—the staff time and a lot of big piles of overnighted paper,” said Beckley. We also are able to keep eight separate, secured copies of every record, something you can’t do easily with a physical record. “It’s been working reliably since 2008, and we handle about 10-20 requests a day. This project was the first step on what will be a very rich and important part of medical care in the future,” Beckley continued.
The use of technology in electronic medical records exchange has helped the two organizations cater to patients better. “Connecting payers, providers and patients enhances quality, safety, and efficiency. The Social Security’s MEGAHIT project is a perfect example of using technology to enhance the patient experience while reducing administrative overhead. It was an honor to participate,” stated Dr. John Halamka, CIO, Beth Israel Deaconess Medical Center, referring to the partnership with Social Security.
Centra: Good for Patients, Good for PR, Good for Centra
Centra first got involved with Social Security's health IT program when they heard about a call for proposals under the American Recovery and Reinvestment Act (ARRA) initiative. The initiative sounded like a good idea. Centra was having to spend significant amounts of time handling paper to provide medical records to Social Security. Reducing that time would be important for patients and the business. Patients will gain a disability determination faster, which will help with overall patient benefits and care.
The system went live in May 2011 after a process that involved working closely with SSA's team of internal experts. In part because of the different types of data involved, a lot of learning occurred during the implementation. The results? Although paper records haven't been eliminated yet, the numbers have shrunk substantially and continue to shrink. "We've gotten far fewer calls from patients inquiring when their records will be sent since the launch," Ripley said. "For our patients getting coverage more quickly is a huge benefit." Centra has also enjoyed positioning itself with the leaders in electronic records exchange. "As hospitals move more and more to electronic medical records, paper is becoming obsolete," said Ripley.
"It was a great learning experience for everyone on our team," said Terri Ripley, Director of Systems and Programming and ARRA Coordinator for Centra. "SSA was wonderful." She also felt confident working with Social Security's expertise. "SSA was the first to accept a Continuity of Care Document," she said. "They are real leaders in this area."
Community Health Information Collaborative (CHIC): The Next Step in Records Exchange
“At Community Health Information Collaborative (CHIC), we were familiar with health information exchange (HIE),” said Melinda Machones, VP-HIE Services. “We felt that HIE was going to be essential to health care. When we started thinking about partnering with Social Security’s initiative to implement health IT in their disability program, we could see the potential benefits. It would help the patients and help the providers.
The first challenge for CHIC was to provide a Continuity of Care Document that met Social Security’s requirements. Given that this document is somewhat different for SSA purposes, the differences to the content of the medical information can have big effects on a disability claim, it was critical to get this stage right. Fortunately, CHIC’s experience with electronic records exchange, as well as the working relationship with Social Security, helped to ensure success. “We really worked well together,” said Cheryl Stephens, CHIC President and CEO. “Both sides recognized how important this project was, and how much it would mean for patients. The electronic exchange of health records is a much more streamlined way of doing business, too. We were committed to the privilege of being one of the early adopters of this program.”
The project went live in September 2011. “Things are continuing to improve and we’re getting great feedback on how well this is working,” said Machones. “The patients are seeing faster turnaround of their disability claims and providers are spending less time collecting paper records and sending them to SSA. This is a win-win-win for all parties.”
“We’re getting a lot of credibility from this project,” Machones continued. “It’s definitely a win for us and for our patients, too.”
Douglas County Independent Practice Association (DCIPA): Old Experience, New Partnership
Douglas County Independent Practice Association (DCIPA) had extensive experience exchanging patient records with local hospitals in Oregon, before becoming a partner with SSA. In fact, an electronic health record was an essential part of the way they did business. “We find it important to exchange information electronically, especially at the local level,” explained Gilbert Florescu, IT Manager. “It greatly enhances the medical care in our local community, and that is really part of our focus.”
“Doctors love it,” continued Florescu. “Many times when a patient gets lab work done, the record is available before the patient gets a chance to see the doctor. We’ve heard from physicians that that connectivity really improves our community’s overall healthcare.”
Given its background and community commitment, DCIPA’s partnering with Social Security’s health IT program made sense. “We worked with a vendor for some of the technical part, including how things mapped to the database. It was a fairly smooth process. At the very beginning, a few test messages were rejected, but we figured those out very quickly. Between our in-house IT expertise and our vendor’s knowledge, exchanging records electronically worked. SSA was very easy to work with and very helpful,” said Florescu.
The project went live in May 2011 and has succeeded on many levels. “Before we had this process, we had a paper process, and from what I understand it took three or four months to get the paperwork done. Now it’s instantaneous, and offices don’t have to pull paper, fax, or whatever,” said Florescu.
Faster processes. Better patient care. Successful results. For DCIPA, it’s a partnership that works.
EHR Doctors: It Gets Even More Exciting from Here
As a company offering a specialized interface for health information exchange to health care providers and organizations, EHR Doctors was very interested in Social Security’s health IT program. “We like technology and being entrepreneurs,” said Gerard Reeder, CEO of EHR Doctors. “Sharing electronic records will mean that the public will get the help they need sooner,” he continued. “We feel that our partnership with SSA is a huge step toward that goal.”
In June 2011, EHR Doctors connected with Social Security to implement the health IT initiative in their disability process. The process wasn’t always easy, but working closely with Social Security’s team of technical experts was. “Our tech staff was able to reach out to SSA to get answers, and both sides worked really well together,” Reeder continued.
The industry is undergoing a huge transformation. Part of that evolution is the increasing reach and power of electronic records exchange. “We are witnessing the evolution of the health care process, and it is really exciting to be part of it. The best part of the process is that we are able to reach out and help so many people in so many different ways,” Reeder stated, referring to the faster electronic records exchange. This process trims down the amount of time it takes to obtain medical records substantially for deciding disability claims. Information sharing occurs seamlessly and instantaneously.
"It’s just going to get better from here," Reeder stated.
HealthBridge: Moving the National Conversation Forward
Established in 1997, HealthBridge is a non-profit organization that supports health information exchange (HIE) and information technology (IT) adoption. With over 15 years of experience, HealthBridge is one of the largest and most advanced HIE organizations in the United States.
As the Nationwide Health Information Network (now called eHealth Exchange) activities accelerated in 2008, HealthBridge received a $100,000 grant from the Office of the National Coordinator for Health IT. This grant allowed HealthBridge to collaborate with a team of federal agencies on how to share health records electronically. Eventually, this health IT project moved from demonstration into production. Around that same time, Social Security (SSA) issued a contract to exchange electronic medical records for adjudicating disability benefits.
“We knew that the ability to exchange Continuity of Care documents and summary records electronically was going to be a critical part of the future use of health IT,” said Trudi Matthews, Director of Policy and Public Relations at HealthBridge. “So we believed that working with SSA to develop those capabilities further would be a really smart way to go.”
HealthBridge faced challenges along the way, including getting requisite responses for queries, developing coding standards, and obtaining aggregated data from its medical providers. Through a joint effort with its partners, HealthBridge was able to acquire the needed data and successfully became interoperable with Social Security through the eHealth Exchange. “The best part was the ability to work with SSA to prototype these standards and specifications,” said Mike Mote, Vice President of Product and Service Strategy. “We were able to prototype this connectivity and will be using it for our continued connection with SSA as well as with a lot of other partners, and I think it shapes the national dialogue in a very forward thinking way.”
Social Security’s progressive commitment to becoming a leader in health IT impressed the HealthBridge team. “SSA was one of the first agencies to leverage electronic health records and HIEs to move forward the national conversation about how to use electronic health information in a value-added way,” said Matthews. “SSA had a lot of foresight and needs to be applauded in their willingness to invest in that.” Moreover, the HealthBridge team was excited that Social Security’s health IT initiative has a broad applicability across other types of use cases for medical data exchange. Matthews said, “It was really SSA’s work and early innovation with us that is helping us test and build this electronic capability all across the community going forward.”
Inland Northwest Health Services (INHS): Taking a Long-Standing EHR Program to New Heights
Over fifteen years ago, Inland Northwest Health Services (INHS) based in Spokane, Washington, organized a community-driven effort to adopt electronic medical records. Doctors, hospitals, and community representatives united behind the project, which was intended to improve health care for a fairly unique population. "We serve an area between the Cascade mountains in the middle of Washington State through northern Idaho," said Nancye Lahue, Director of Meditech Department, Complimentary Systems and Government Project for IRM, the technology division of INHS. "There are a lot of rural hospitals. In an emergency situation, someone might present at the rural hospital and then be transferred to Spokane. With an electronic health record (EHR) exchange, patients' records are readily available to providers, regardless of where or when a patient arrives to their hospital facility." Even for non-emergency situations, patients needing advanced or continuing care often travel to Spokane, with a need to provide and coordinate their medical records from "back home." As time went on, the project grew, reaching out to more and more healthcare providers and integrating their EHR systems.
As a way to continue to grow and serve the providers and patients of the region, INHS partnered initially with a systems integrator and Social Security on a new project that would make electronic health records available for disability determination. "Given our history and expertise, there were no surprises on the technology side," Lahue continued, "We worked closely with Social Security and our systems integrator; the key to success was communication." The system went live in August of 2011.
"Our region's high EHR adoption rate has happened over time," says Lahue, reflecting on the exchange initiative's place in INHS history. "It's been a very rewarding journey." According to her, the best part is seeing the EHR process extended to the disability determination process. Records are collected, collated into a single document and sent off for disability determination without the delays and processing time of paper records. "Streamlining the [disability determination] process is a wonderful idea that is benefiting the public." That idea is now becoming reality.
Today, disability determination claims are being processed in a more timely manner allowing patients to get the services they need. Providers of care are seeing a reduction in administrative costs to help sustain their services. "Information being sent electronically reduces the amount of time from weeks and months to days," said Lahue. "This project is supporting quicker disability decision-making and benefiting so many people."
Kaiser Permanente: Helping to Elevate Care
“At Kaiser Permanente, we have a longstanding interest in health information exchange,” said Seth Selkow, Director of HIE Engagement. “In 2009, we were involved in the initial pilot of the national initiative that demonstrated a successful electronic interoperability capability. Since then we have been increasing the capability of our platform and HIE team,” Selkow continued. “The primary driver is to help elevate care for our members.”
“Implementing HIE capabilities with Social Security to facilitate disability benefit decisions for Kaiser Permanente members is really the natural next step in the evolution to communicate and share medical information,” said Selkow. “The first thing that emerged was the great partnership that we have with Social Security. The two teams work well together and Social Security was very responsive and provided excellent support throughout the implementation activities.”
“The communication is a little different with Social Security exchange, which really exposes that the national standards are flexible and provides an insight into what is possible with these exchanges. A lot of progress has been accomplished in the industry and this partnership is a way to demonstrate that,” Selkow continued. “We put these exchanges in place to benefit our members, so that when they show up their information is there, in a format that can be trusted.”
“The benefits of this exchange are already realized within Kaiser Permanente. Because this helps alleviate manual processes, staff are able to focus on other initiatives that might benefit the patients as well,” said Selkow. “The focus is on our members who are trying to get a benefit decision to collect Social Security at a difficult time in their life,” Selkow continued. “We really want to ensure that our members receive the best care and service that they possibly can; the partnership with Social Security contributes significantly to this goal.”
Marshfield Clinic: Saving Time, Helping Patients
When Marshfield Clinic in Wisconsin learned about Social Security's health IT program to support the disability determination process, the possibility of becoming a partner immediately appealed to them. Not only did Marshfield Clinic have years of experience with electronic records exchange, company leadership believed that expanding their electronic record exchange capabilities was a major step in improving efficiency and the patient experience. Sharing more and more electronic records with Social Security to support the disability determination process made a lot of sense.
"Standards are fluid right now," said Melissa Owens, Manager of Interoperability Development. "And the process is still pretty new. So we used a third party systems integrator to get started. This allowed us to get off the ground quickly, but also meant we could continue to focus on our core business of getting claims processed for patient care." In August 2011, the data exchange with SSA went live.
Marshfield Clinic faced a few challenges along the way. Steve Warren, the Clinic's Director of Health Information Management, pointed out that one major obstacle was reconciling the difference in state and federal law for medical information requirements. However, with the assistance of Social Security, this problem quickly resolved itself. "This initiative is growing," said Warren. "There's a real sense of commitment. That means that it's easier now to break down some of the old barriers and bring about change.
"The results have been impressive. Marshfield Clinic expected benefits from getting rid of the paper involved in the traditional disability determination medical records request process. What they didn't anticipate was the time savings that came from no longer having to scan and fax large amounts of data. Processing time to respond to Social Security's medical records requests dropped from 30 days to a few minutes. "That got people the help they needed much faster," said Annette Pyke, Marshfield Clinic's Manager for Release of Medical Information. Added Owens, "This really put us ahead of the industry. We're also in a great place to interface with the standards as they continue to grow and change."
And best of all? "This is one of the most low-maintenance processes we have," said Warren. "It just runs. We applaud the SSA for all they've done and continue to do—this is an ongoing relationship."
MedVirginia: The Right Thing to Do is Right for Many Reasons
As the original pilot partner with the Social Security Administration to automate the exchange of electronic health information over the NwHIN into the disability determination process, MedVirginia recognized that the project was groundbreaking. "This complex project had some very aggressive deadlines," said Michael Matthews, CEO of MedVirginia and a recipient of the 2010 eHealth Advocate of the Year Award. "There was skepticism in the industry, as no one had seen this work done in an actual production environment." Nonetheless, MedVirginia committed itself to the project because it believed that electronic records exchange would make a dramatic difference to patient care. "We were passionate about improving health records for our patients," Matthews continued. "Not only was it the right thing to do, it was a way forward for the company." To make the project happen, MedVirginia went so far as to modify its business processes in order to incorporate health IT with Social Security.
The day-to-day challenges of implementing a large IT project soon were in evidence. A strong partnership from the beginning made things easier. "SSA was very driven and this was very encouraging," said Matthews. "Every time a barrier came up, they got everyone together to break through it, and Social Security's leadership gave this project its highest support and priority. I absolutely felt like every ounce of effort we were putting in was being matched by our partners. This was just an extraordinary project, very intense and rewarding."
"We weren't sure when we were going to see results," admitted Matthews. Yet, in just two and a half years, Matthews estimated the health IT partnership generated more than $6,000,000 in enhanced revenue for MedVirginia partner Bon Secours Richmond Health System, driven by improved insurance coverage that accompanied expedited disability determinations. Patients also realized quicker processing of their disability claims and got the coverage they needed faster than ever before. These effects are expected to grow as more providers join the MedVirginia network. "We are proud to be a leader in the health IT partnership with SSA," says Matthews. "We're eager to see this program continue to expand and develop."
LCF Research: Leading Health Information Exchange in New Mexico
As one of the original Nationwide Health Information Network (NwHIN) Trial Implementations contract awardees, New Mexico Health Information Collaborative (NMHIC) helped to develop the NwHIN standards, services, and policies. Created by LCF Research, a non-profit entity, NMHIC is the health information exchange (HIE) for the state of New Mexico. Upon discovering that Social Security was looking for health IT partners, NMHIC seized the opportunity. “We saw this opportunity as a natural progression of leveraging our Trial Implementations work to enable us to move into a production NwHIN environment,” said Mark Butler, IT Project Manager at LCF Research.
Once awarded the contract, NMHIC verified the Continuity of Care Documents (CCD), making sure that the content and structure conformed to standards. There was also a parallel path of on-boarding to the NwHIN, which included interoperability testing. NMHIC overcame initial CCD content and NwHIN messaging issues and was enthusiastic about the collaborative success. “It was very gratifying when we finally met the major milestones of the contract,” said Butler. “A lot of hard work went into developing the technology to exchange health information over the NwHIN, so when we completed a major milestone, everyone shared a great sense of accomplishment.”
NMHIC and Social Security’s Health IT team shared a positive experience collaborating with one another. “It was great to work with the SSA health IT staff,” said Butler. “There were many people that helped us along the way and were very interested in helping us succeed.”
From an HIE perspective, NMHIC believes that this partnership with Social Security will be an advantage to New Mexico patients and involved stakeholders. “Expanding the opportunity for our stakeholders to participate in electronically exchanging information in the disability determination process will be beneficial to both patients and healthcare providers,” said Butler. “Healthcare providers may be able to reduce the amount of uncompensated care they provide since disability applicants may obtain quicker access to public health benefits.”
Oregon Community Health Information Network (OCHIN): Bringing Disability Determination to an At-Risk Community
The Oregon Community Health Information Network (OCHIN) has long focused on providing electronic record support to health care providers, with a special emphasis on "safety net," rural, tribal, and small practices. After more than a decade, they have the infrastructure, the skills, and the capabilities for advanced electronic records exchanges. As a result, OCHIN was eager to partner with Social Security to work on a NwHIN pilot project to provide medical evidence electronically for disability determination; especially given the at-risk and vulnerable populations that OCHIN providers often serve.
"Some of our members were very concerned about the conversion from a paper based process to an electronic process," said Mike Matull, OCHIN's Data Integration and Interface Team Manager. "They were concerned about the release of information process and the shift from long standing paper processes. SSA did a really good job of outlining the project goals, and helping with our outreach and education. Once we actually started to exchange records with the new system, the membership very quickly demanded that the electronic process replace the paper process as quickly as possible."
The system to exchange electronic health records with Social Security went live in May of 2011. "The real advantage is that our population is getting help faster, and that's crucial for a lot of them," Matull said. "We see this eventually expanding to across OCHIN's entire membership. While I can't get into specific numbers, I can tell you that this project is the clearest case of a positive return on investment (ROI) of any IT project I've been involved in."
Regenstrief: Generating Efficiencies in Healthcare
With its beginnings in health information technology in the early 1970s, the Regenstrief Institute has over 40 years of experience pioneering enhancements in this field. The Regenstrief Medical Record System, first developed during this decade, was one of the earliest electronic medical records (EMR) systems. Led by current president and chief executive officer William Tierney, M.D., Regenstrief’s partnership in Social Security’s health IT initiative aligned two organizations with concurring goals.
“Using health IT to streamline determination of disability helps Regenstrief fulfill its mission of improving the quality, safety, and efficiency of health care services,” said Brian Dixon, Ph.D., Research Scientist at Regenstrief. “We are proud to partner with SSA on a project so closely aligned with Regenstrief’s vision of a leaner, smarter health system. We immediately recognized the potential value.”
Regenstrief was a part of the original architecture team that developed the first version of the Nationwide Health Information Network (NwHIN) Exchange, for which it received an award from the Office of the National Coordinator (ONC). “We saw this as a natural progression to use what we built under ONC, and put it into use,” said Dixon. “It was rewarding to demonstrate that what we created is not just a theoretical architecture, but actually something that can apply to the healthcare system in a way that is replicable.”
Because Regenstrief has a range of providers and networks participating in the Indiana Network for Patient Care, their health information exchange (HIE) created in 1993, the health IT team did not need to develop a lot of underlying infrastructure and was able to leverage existing HIE data. While the project had its share of technical and coding challenges, Regenstrief is excited to be a part of Social Security’s health IT initiative. “As an educator and developer of health IT, we believe this project absolutely supports our core mission and business,” said Dixon. “We can learn from it and share the lessons learned.”
The Regenstrief Institute is confident that this partnership with SSA will support greater collaboration and future innovation in the field of health information technology. “Hopefully this partnership will allow us to work together with SSA in addressing other challenges and initiatives in healthcare,” said Dixon. “The nice part of this process was that it created opportunity for collective learning and operation.”
“Everybody wins,” said Regenstrief CEO Dr. Tierney. “The process of collecting healthcare information is easier, less time-consuming, and less costly.”
Wright State: On the Frontier of National Health IT
After Wright State Boonshoft School of Medicine’s Center for Healthy Communities developed a regional health information exchange (HIE), IT specialists from the Wright State Research Institute joined forces to demonstrate their national capability. Bringing large-scale IT experience from the industry, the Research Institute’s specialists collaborated with Boonshoft’s team of functional experts to implement the exchange. Wright State Physicians and Centennial Family Medicine kicked off the initiative as the HIE’s first provider groups.
Partnering with Social Security was a step towards meeting Wright State’s goal of creating a national footprint. “We are at the forefront of changing an industry and implementing a national solution that is ultimately going to change the way healthcare works,” said Aaron Miller, Project Manager at Wright State Research Institute. “It will change the way people interact with their physicians and the way we interact with our payers.”
While setting up to exchange records with Social Security, the Wright State team was surprised by the reliance on different types of scanned documents by healthcare providers, in spite of the growing prevalence of electronic health records. “What we’re learning from health information exchange holistically will help position our organization for future IT work,” said Mark Wysong, Researcher at Wright State. “It will help us to lead creating new products in intellectual property as we look toward the future of a fully integrated realm of health information technology.”
Wright State’s team is enthusiastic about the potential of health IT and their involvement with Social Security’s initiative. “To be on the frontier of an emerging discipline and add value to this project is rewarding,” said Miller. “It’s a good feeling to watch it evolve and say we were involved from the beginning. We’re able to reap the rewards from an organizational perspective.”
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