When patients can’t get their Social Security disability eligibility determination quickly because they can’t share their medical records, everyone loses. Every year, disabled Americans rack up thousands in medical bills and debt, waiting months for disability determinations. Health care organizations try to help their patients decrease their financial sustainability by providing uncompensated care when disability decisions are delayed.
The Social Security Administration’s claims backlog surpassed 1 million pending review as of 2022, which still sits at more than 1.1 million. The SSA’s chief actuary estimates that more than 30,000 people may have died in 2023 while their disability applications were waiting.
The solution comes in the form of interoperability between electronic health records — EHRs — and the SSA. Too often, EHRs can’t transmit medical records directly to the SSA, preventing timely disability determinations.
It’s not that the technology doesn’t exist. Health systems using Epic have shared complete and comprehensive records with the SSA instantly for more than a decade. A 2022 SSA inspector general report noted, “SSA prioritizes adding partners who use Epic electronic health record software because Epic provides broad support for the data elements the SSA needs to make disability determinations.”
Last year, Epic — which connects more than 1,500 hospitals to the SSA — facilitated the exchange of 2.5 million patient records with the SSA electronically. This reduced a potentially months-long medical record filing process to minutes for many patients.
Interoperable Health IT transactions remove the friction experienced by impaired claimants who would otherwise struggle to satisfy antiquated mailed-request ways to get their required evidence. Many states allow onerous fees for mailed records, and often, the claimants cannot afford to get the SSA a complete medical record.
We must not tolerate a practical barrier to the disability programs administered by the SSA, which serve as our best way to keep millions of disabled beneficiaries out of poverty.
Despite the potential benefits, fewer than 15% of medical records needed to review a complete disability claim come from interoperable EHRs and instead come through mail or fax. TEFCA, the government-sponsored nationwide health data exchange framework, can help other EHR vendors catch up. TEFCA has helped many hospitals exchange health records for treatments, public health and individual access. An expansion of TEFCA to include a new-use case for government benefits determinations, like Social Security disability eligibility, could have a profound effect on vulnerable Americans suffering from disabilities and the people who care for them.
With a use case for Social Security disability claims, every American health care organization on TEFCA could send medical records to the SSA electronically, regardless of their EHR. This would provide a better experience for the millions of Americans who submit disability claims, save the SSA money they spend on paper records, and reduce uncompensated care provided by hospitals nationwide.
The SSA commissioner has championed the electronic exchange of health care information, and the assistant secretary for technology policy at the Department of Health and Human Services has championed TEFCA.
Given the government’s commitment to the interoperable exchange of health information, there is an amazing opportunity for the two agencies to work together to advance a government benefit determination use case on TEFCA. With medical records seamlessly flowing between health systems and the SSA through the TEFCA framework, disabled Americans will more quickly get the benefits they deserve.
Editor’s note: David Camp is chief executive officer of the National Organization of Social Security Claimants’ Representatives. Ladd Wiley leads global public policy for Epic. They wrote this for InsideSources.com. Reader reactions, pro or con, are welcomed at AzOpinions@iniusa.org.
