The Social Security Administration is looking to speed up disability claims adjudication by allowing Americans to consent to their medical providers sending the agency digital copies of their health records through a data sharing superhighway.
In April, Epic — the largest electronic health record vendor for U.S. hospitals — announced that its health system customers are connected to SSA through the Trusted Exchange Framework and Common Agreement, or TEFCA. Through that superhighway, dozens of hospitals and clinics can send digital medical records to SSA, eliminating the need to fax documents to the agency and slashing disability claims processing times by up to 50%.
Jacksonville, Florida-based Baptist Health is among the first Epic customers to start sharing electronic health records with SSA through TEFCA.
Baptist Health has sent SSA several thousand electronic medical records since it started sharing data with the agency through TEFCA at the end of July, Aaron Miri, the health system’s chief digital and information officer, told Nextgov/FCW.
Because of TEFCA, Baptist Health has reduced the number of staff dedicated to processing medical records for SSA to essentially half a person, Miri said in an interview. Before TEFCA, three staffers were manually sending SSA medical records through fax machines and checking that the agency actually received the information, he said.
“We’re seeing time saved, we’re seeing accuracy [of medical records] go up, we’re seeing happy patients,” Miri said. “It’s just positive, positive, positive.”
Dozens of Epic customers in California, Oklahoma, Washington, Arizona and other states have also connected to SSA through TEFCA.
Epic expects more than 550 hospitals and nearly 20,000 clinics will use TEFCA to exchange data with SSA by the end of the month, and all of its customers to eventually migrate to TEFCA, a company spokesperson told Nextgov/FCW.
SSA has connected to 84 health care entities and made 60,595 data requests through TEFCA as of August 13, according to an agency official familiar with its health information technology strategy.
SSA obtaining electronic medical records for disability claims adjudication is not new. The agency has received health information from medical providers through Carequality and eHealth Exchange — two other health data sharing superhighways — for years. But TEFCA has several advantages compared to those pathways.
Medical providers can use their existing connection to the TEFCA rather than starting new legal agreements to connect with the SSA, the Epic spokesperson said. They also no longer have to constantly provide SSA with an updated list of their facilities because TEFCA has a directory SSA can use to identify facilities, they added.
Over 65% of Epic customers are currently sharing records with SSA across TEFCA, Carequality and eHealth Exchange, they said.
But SSA is agnostic whether medical providers use TEFCA or another pathway to share data, so long as patient consent is part of the equation and they share adequate information for disability claims adjudication, the agency official said.
SSA is working with TEFCA Qualified Health Information Networks, or QHINs, besides Epic, which would give more medical providers the ability to send the agency digital health records, according to the agency official.
“eClinicalWorks and NetSmart are actively in various stages of development and testing with SSA today,” they clarified. SSA has a seat on the TEFCA governing council,Nextgov/FCW previously reported.
The Epic spokesperson said the company wants all medical providers — regardless of whether they use Epic software — to electronically send medical records to SSA. But that could prove difficult to achieve.
Many behavioral health, specialty and rural providers do not use electronic health records, meaning they continue to rely on manual record request processing, noted Jennifer Burdick, a divisional supervising attorney at Community Legal Services of Philadelphia. Department of Health and Human Services data backs up that assessment: thousands of substance use and mental health treatment facilities continue to use paper charts instead of software to maintain patient records.
Even though TEFCA promises to speed up claims adjudication for thousands of Americans, disability advocates have warned Americans are finding it hard to access SSA disability benefits. That’s in part because SSA is pushing online servicing and has introduced AI onto its phone lines, according to a Disability Rights Education & Defense Fund report published in March. SSA contested claims that disability benefits are becoming harder to access and touted a decline in its initial pending backlog in a previous statement to Nextgov/FCW.
