From a recent report by Social Security's Office of Inspector General (OIG):
Despite spending more than 10 years trying to increase the number of medical records received through health IT, SSA still receives most records in paper or ERE format. In the Fiscal Year (FY) that ended on September 30, 2020, SSA received only 11 percent of medical records through health IT.
SSA experienced a decreasing trend in adding new health IT partners from 56 in FY 2018 to 12 in FY 2021 (as of August). During this time, SSA reduced the number of staff and contractors involved in health IT outreach and did not fully fund projects to increase electronic medical evidence. Also, expanding the number of health IT records by adding new partners is not a unilateral decision made by SSA, as prospective partners must be willing and able to meet SSA’s technical requirements, and COVID-19 was a factor. In October 2021, SSA informed us it was (a) working on Memorandums of Understanding with 3 entities to exchange health IT records with over 30 large health IT organizations and (b) adding more staff to develop and implement strategies to expand health IT.
Challenges in expanding the number of health IT records include some partners’ inability to send sensitive medical records, acceptance of SSA’s authorization form to release records to the Agency (Form SSA-827), and medical industry-wide differences in patient-identifying data fields.
Additionally, SSA has had limited success analyzing medical records because MEGAHIT is limited to analyzing only structured data. MEGAHIT generated data extracts on only 7.3 percent of the 1.6 million health IT records SSA received in FY 2020. The extracts assist SSA disability examiners in making accurate disability determinations. Since 2018, SSA has been developing and testing the Intelligent Medical-Language Analysis GENeration application with new capabilities for reviewing medical records. As of August 2021, SSA was still testing and rolling out this application to its offices. ...
11 comments:
I dunno....hi-tech was supposed make life so much easier. Maybe SSA being light years behind technologically is a small part of the problem?
HIT is TERRIBLE. It strips out the native formatting making large documents almost impossible to navigate for any efficient or thorough review. It provides no table of contents and makes it more difficult to determine when visits start or stop and who exactly the visit is with.
I think HIT is useful and efficient. HIT strips out the multitude of pages of authorizations and consents, and does not include patient handouts and other wasted pages. And at the top of it, it tells you the page numbers where the encounters start, or other discrete sections of the document. Yes, the records lose their native formatting, but I for one do not think medical record native formatting is that terrific.
I wish govt would standardize medical visits on a form like they do electric current on FERC. (imagine a grid with all different fluctuations) Each report is so different on where is DOS or author or acute visit. So many just repeat boilerplate history -- carrying forward historic assessments. Standardization is what govt does do a good job at.
"And at the top of it, it tells you the page numbers where the encounters start, or other discrete sections of the document." It does not do that. HIT MER has no page numbering until they are marked for exhibits. I have actually requested this functionality. As bad as native formatting is, HIT MER is worse. With native formatting you can typically OCR the document and find something unique in the heading that you can use to jump between visits. HIT MER strips out this, i.e. service date, note type, or even an address.
So SSA received 1.6 million health IT records, which constituted only 11% of the total health records reviewed. That means roughly 14.4 million health records were received by the SSA.
Of the 1.6 million health IT records received, MEGAHIT was able to generate data extracts on only 7.3%, or about 117,000 records.
So 117,000 out of 14.4 million, or less than 1% total.
Just how many millions (billions) have been spent on this program?
The challenge with Health IT has been a leadership issue. Recent HIT leadership has been more interested in new technology rather than doing the work to improve the medical records and growing the volume of HIT partners. Funding was cut and shifted to technology that costs millions with no yield to date.
Because the format is absolutely horrendous and extremely difficult to read.
If the DDSs think that HIT is not valuable today, just wait. The stuff that systems is working on with a vendor and the coming MOUs are going to have the DDS sites throw fits. This new HIT system will be receiving a huge number of incomplete medical records. SSA HIT leadership is only concerned about increasing the volume of HIT MER, not the quality of information. This will cause a negative impact on the MER budget and increase case processing time as the need for follow-up duplicate MER will be needed to make decisions. This new program has cost millions and once in operation will cost millions more to the operational budget. Ultimately, it will cost the claimant to wait longer for a decision to be made.
HIT is very valuable to DDS. The defects are common in the other ways we get information too. Ever since hospitals started outsourcing their medical reconsider to large outside companies it has been hard to get missing information. For example if there is a missing PFS or audiogram or visual field we can no longer just call up medical records and ask them to send. Doctors treating a person have access to the person's medical records which is a good thing but when they keep copying and pasting the summaries etc from the prior files it creates confusion particularly in regards to dates
Doctors write their records "for my uses, not Social Security's," one doctor told me. Is the purpose of SSDI decisionmaking to determine which claimants have doctors that accurately describe their conditions? The word in the law is COULD. NOT DOES, COULD. The "Quality" of decisions seems geared toward legal defensible denials and NOT toward deciding accurately whether someone can work. The graphs of approval rates over last 12+ years shows this. To expect medical records to give everything the claimant needs to "prove" their case to a unreasonable sceptic requires willful ignorance of how doctors actually write records.
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