The IBM Center for the Business of Government interviewed Social Security Commissioner Michael Astrue for its show on WFED radio last week. You can hear and view the interview below. There is not much new to the interview. I am incredulous at Astrue's hope that health information technology improvements will cause the length of time needed to get a hearing before a Social Security Administrative Law Judge to decrease or that these improvements will even allow the elimination of reconsideration. I see no connection at all. The problem is lack of resources at Social Security. Speeding up the acquisition of medical records does little to help.
The potential benefits of Health Information Technology for the disability program are not so much in the reduced time to obtain medical records as from the ability of computer software to "understand" the contents of medical records. Images of paper records, which constitute the bulk of medical evidence on which the disability program now relies, are just pictures, and are not amenable to effective analysis by software. The hope is that as electronic medical records transition from pictures to data, computer software will be able to analyze medical evidence and "direct" adjudicators to the appropriate decisions. SSA is taking their first steps in this direction with their MegaHit initiative.
ReplyDeleteI wonder if delays caused by reps inabiltiy to complete the record prior to the hearing are considered in the stats regarding length of time for a decision to be issued.
ReplyDeleteMy guess is no. In my experience, on average, this adds about one week to a decision (1 in 10 cases, at least 2 months delay each time).
I understand Anon at 10:05 is simply giving the explanation, not defending it. But SSA's position is absurd.
ReplyDeleteUnder the current system, medical records are reviewed by an adjudicator. We can argue about the skills of the adjudicators, but most are at least experienced at reviewing medical records. We also know that in 99% of cases, there is no "correct" answer to whether the claimant is disabled. Different adjudicators come to different conclusions based on review of the same medical records.
So even the perfect "AI" program has the same limitations. It would be nice if adjudicators could be saved the time of reviewing medical records, but the computer is not going to adjudicate the claim. The adjudicator will still have to review the medical records to issue a defensible decision. The first court case in which SSA concedes that the decision-maker did not review the medical evidence, but instead followed the directions of a computer program, will get bounced back to SSA so quick it will make Astrue's head swim.
anon @ 1:10...
ReplyDeletesorry, but people don't appeal FF decisions. Computer analysis will be used to screen cases for possible FF decisions. It might be used to help make sense of medical information in UF decisions, but it won't make the final decision.
AI will never work. Unfortunately medicine is an art, not a science. Until you get robots examining and making diagnoses 100%correct all the time you can not treat medical records as a definitive source that doesn't require a human to analyze and arrive at conclusions as to what it all means.. Another waste of time and money.
ReplyDeleteTo Anon at 1:53> If in fact the intent is only to screen for OTRs, my concerns would be alleviated somewhat. Whether this can work, and whether it justifies the expenditure of very scant resources is another question.
ReplyDeleteI will add that the COSS had better rely on something more than reassurances that this will only be used for FFs. The COSS has burned his bridges with the representative community through his belligerent rulemaking style over the past 2 years. It is unlikely anybody in the disabled community would be willing to take his word for anything. It had better be in writing, and there had better be an absolute prohibition against using the program to support a denial, or short-circuit the need for review of medical evidence in a denial.
Charles, I don't understand your comment about the "improvements" allowing the agency to eliminate reconsideration? Does Astrue explain this in his comments? My take on it is that if you want to decrease the wait time, just do it - get rid of recon nationwide. I work in one of the prototype states, and our processing times are much less than other states because of this, I believe.
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