Regenstrief Institute to help improve disability determination through health information technology

INDIANAPOLIS –- The Regenstrief Institute has been awarded a Recovery Act contract to help the U.S. Social Security Administration and Indiana healthcare providers shorten and improve the process of making disability case determinations through automation. Work is scheduled to begin March 31.

The process of acquiring medical information for an SSA disability claim involves numerous requests to multiple healthcare providers treating the individual seeking disability benefits. This process can take weeks or even months following an application for benefits. Physician offices, hospitals and others health care provider must gather the individual’s recent medical information and submit it via fax or U.S. mail.

The Regenstrief Institute, an international leader in heath information technology, created and operates the Indiana Network for Patient Care (INPC), a secure statewide health information exchange that providers use to help improve the quality, safety and efficiency of care that their patients receive. Improving the disability determination process complements other functions of the INPC, including surveillance for influenza outbreaks and access to a patient’s diverse medical records when providing emergency care.

“We will leverage the capability of the INPC to quickly and efficiently collect the information requested electronically by SSA, with the specific authorization of the person applying for disability benefits, and securely transfer it to the government so the disability decision process can be completed more rapidly. This will make that process more efficient – both because it will be faster and also because the medical data compiled will be more complete. It also will take the time and expense of going to many different providers, assembling the necessary records and filling out forms off the shoulders of patients and decrease the need for providers to search for and send records manually,” said Brian Dixon, MPA, project manager for Regenstrief’s SSA contract.

To effectively make decisions regarding applications for disability, the SSA needs the same kind of medical information that physicians utilize when making diagnoses, treatment, and referral decisions. Healthcare providers in Indiana rely on the INPC to securely and privately share clinical data which is utilized daily to support healthcare services throughout Indiana.

“Facilitating the processing of patients’ disability claims is another example of how healthcare providers throughout Indiana have worked together with the Regenstrief Institute and Indiana Health Information Exchange to ensure that their patients’ healthcare information is used to enhance their care,” said J. Marc Overhage, M.D., Ph.D., director of medical informatics at the Regenstrief Institute, Regenstrief Professor of Medicine at the Indiana University School of Medicine, and president and C.E.O. of the Indiana Health Information Exchange.

Disability benefits determination is a large-scale process. The SSA expects to receive more than 3.3 million disability benefits applications in fiscal year 2010, a 27 percent increase over the 2008 fiscal year. Annually, more than 15 million requests for medical records are sent to healthcare providers.

When you apply for disability, your claim is sent to a state agency that SSA hires to made the medical determination of  whether you are disabled. In many states this is called the Disability Determination Service,  DDS, while in Indiana the current name is the Disability Determination Bureau, DDB. It is these State workers that decide your claim.

The National Association of Disability Examiners, NADE, describes itself as:

a professional association whose purpose is to promote the art and science of disability evaluation. The majority of our members work in the state Disability Determination Service (DDS) agencies where 15,000+ employees adjudicate claims for Social Security and/or Supplemental Security Income (SSI) disability benefits. As such, our members constitute the “front lines” of disability evaluation.

A recent issue of The NADE Advocate, Volume 26, Number 1,  provides insight into why SSA may make the wrong decision in your case.

The growing complexity of the Social Security and SSI Disability Programs, coupled with the need to produce a huge volume of work, justifies even more the need for adequate resources in order to provide the service that the American public has come to expect and deserve from SSA. It takes an average of two years for a newly hired disability examiner to become fully trained and proficient to the point they can function independently and contribute to the process of making timely and accurate disability decisions. Thus, decisions not to replace productive personnel when they leave can take two or more years to correct even after new hires are made. NADE has long maintained that it is critical for SSA to be provided with the resources needed to hire and train new staff that can perform these duties. Low salaries, hiring restrictions and the stress of the job have contributed to high attrition (12.3%) in the DDSs. (Emphasis added)

Constantly having to replace 12.3% of the workforce and it taking two years before they can function independently, plus the stress of the job to get the work out fast, combined with low pay, may be a reason that DDB makes the wrong decision so many times.

The important point for you is that you should not be discouraged when your claim is turned down at the initial or reconsideration stages. With approximately 65% turned down on initial application and approximately  93%  turned down at Reconsideration,  you should take the steps necessary to increase your odds of winning. You will need an experienced attorney in Social Security claims to help you increase your odds in what NADE calls a “growing complexity of the Social Security and SSI Disability Programs.”

Unlike many attorneys, I will begin to help you with your case before your file your claim.  Read When Should I Hire An Attorney For My Disability Case? for my reasons why. What are you doing to increase your odds of winning?

In January of 1968, in the second season of Star Trek, Captain James T. Kirk invites the mobster Jojo Krako to play a card game of Fizzbin. Krako, who plays a lot of card games, accepts even though he does not know the rules. Kirk deals the cards. Kirk and Spock then begin to turn over the cards of Krako’s hand. His hand reveals face cards (King, Queen, Jack). Krako is excited as he says he has a good hand. Kirk then tells him that in Fizzbin a King is bad, a Queen is bad, and a Jack is bad. In fact, Kirk says, Kirk’s hand of  low cards is the winner and Krako has lost. When I saw the program, it was obvious to me that Kirk was making up the rules as he went. There was no way that Krako could win because he did not know the rules. If you want to purchase the DVD so you can see the whole episode, click here Star Trek DVD

Many claimants go about their Social Security Disability claim in the same manner. They do not know the rules and believe anything that anyone at Social Security says. If someone from the Disability Determination Bureau says that you have to go to an examination by one of their doctors, how do you know any different?

Other times a claimant is like Jojo Krako because something in the process is so familiar that they do not question it–they do  not realize that under the rules of this game, a King is not a good thing to have. A good attorney who has had years of experience dealing with Social Security will be able to tell you the rules and warn you ahead of time about them so that you can make the best presentation of your case.

Do you know all the rules of Social Security Disability? How big of a gambler are you with your case?