COMMITTEE ON WAYS AND MEANS
SUBCOMMITTEE ON HUMAN RESOURCES HEARING
USE OF TECHNOLOGY TO IMPROVE PUBLIC BENEFIT PROGRAMS
April 5, 2006
Statement for the Record
Martin H. Gerry
Deputy Commissioner for Disability and Income Security Programs
Social Security Administration
Mr. Chairman and Members of the Subcommittee:
Thank you for allowing me to discuss the Social Security Administration’s (SSA) effort to move from a paper-based disability claims process to an electronic one. Our disability programs provide income security to over 11 million Americans with disabilities through the disability insurance program and the supplemental security income program. Commissioner Jo Anne B. Barnhart has made improving the disability determination process one of her highest priorities throughout her tenure as Commissioner. Our new electronic disability process—eDib—is central to our efforts to make those improvements.
Shortly after she became Commissioner in 2001, Commissioner Barnhart asked for a detailed analysis of the entire disability determination process from the time that a claim is filed with SSA to the time that a review is under taken by a United States district court. This analysis showed that SSA’s reliance on old-fashioned paper files was limiting the Agency’s ability to efficiently manage this vital workload.
This review showed a disability determination process tied to a paper folder that grew larger and larger as the process continued. The disability determination process started with a call to our “800” number or a visit to one of SSA’s 1300 field offices. Claimants were asked to fill out several forms providing the necessary information. Six-part paper folders were established for each claim. These forms along with signed authorizations for release of records were filed in these paper folders and then mailed to the State Disability Determination Services (DDSs) - the state agencies charged with making initial disability determinations. DDSs then mailed a request for medical evidence to the treatment sources, who then mailed paper copies of their records back to them for review. A DDS might also contact third parties and arrange consultative examinations to obtain more evidence, also by mail and also on paper. After reviewing all the evidence and making an initial disability determination, the DDS would then mail the disability folder back to the SSA field office. All of the forms and documents obtained during the process were shipped and stored in a traditional paper folder.
A person dissatisfied with an initial determination made by a DDS could pursue an appeal through three administrative levels and the Federal courts.
At each point, the process would start over again: paper forms completed and mailed, requests for evidence mailed and paper replies reviewed, and paper files transferred between offices. All this mailing back and forth was time consuming and often resulted in important evidence, or even entire files, getting damaged or lost.
At the time of that analysis the Agency was on a 7-year timeframe to implement an electronic disability process that would replace the traditional paper folders. Seven years was too long to wait, so Commissioner Barnhart asked me and other members of her senior staff how soon we could roll out eDib if the necessary resources were provided and we told her two years. I want to thank the Members of this subcommittee who supported providing those resources, because with them and with a lot of hard work we in fact rolled out the electronic disability process in two years instead of seven.
Reaching this goal required the coordination of enormously complex computer systems. To make this new system work, we had to do an extraordinary amount of programming not just on SSA’s computers but on the different hardware and software used by the DDSs. This was and continues to be a monumental task. There were serious technical issues to overcome, especially in the early days. We aggressively worked to resolve all those issues. I want you to know that we are aggressively looking for and addressing problem areas.
Implementation of the electronic disability folder began in January 2004, and as of January 31, 2006, all 50 State DDSs have rolled out the electronic disability folder and more than half are working in a completely electronic environment for new cases.
I want to note at the outset that eDib does not replace the millions of paper files that SSA already maintains. We will be working with them to conduct post-entitlement eligibility actions, such as continuing disability reviews, for years to come. But with eDib, we are seeing the beginning of the end of paper files, and the burden and expense associated with them.
I would like to highlight for you the key elements of the new electronic disability process, and provide an overview of where we are with the rollout of that process.
Before I begin, I would like to especially recognize the people responsible for the successful implementation of eDIB – SSA’s dedicated employees and its partners in the State DDSs. The computer systems and software behind eDIB are incredibly complicated, and eDIB is a tribute to the talent of the men and women at SSA who analyzed the disability determination process, developed the software and hardware platforms, tested it and then rolled it out in a very controlled process.
Overview of eDib
eDib starts with the submission of an application for disability benefits to SSA. Once this application is received field office staff enter information that used to be collected on several paper forms into a central Electronic Disability Collect System (EDCS). The information gathered to make a disability determination is stored in an electronic folder organized along the lines of the traditional paper folder. Forms that were once printed and signed by hand are created and stored in the electronic folder. The data are automatically shared with the DDS systems in a way that eliminates the need for re-keying. So far, over 12.9 million claims have been processed through EDCS.
The contents of the electronic folder can be accessed by field office staff, quality assessment reviewers, and State and Federal adjudicators (and support staff) from anywhere in the country without the need to physically transfer the file. This provides greater flexibility and protects against lost or damaged folders.
Electronic Disability Collect System (EDCS)
With eDib, SSA offers an option to those comfortable with using the Internet of starting the application process on-line. By visiting www.socialsecurity.gov, claimants can provide or start to provide the information on their medical, work, and education history necessary to adjudicate their claims. At a minimum, this option familiarizes claimants with what is needed to determine their claims, and optimally, it makes for a much more efficient disability determination process once the claimant does visit the field office to complete the application. Since the first Internet applications were taken beginning August, 2002, SSA has taken over 500,000 disability claims over the Internet.
All of the information provided by the claimant either over the Internet or in person at one of our field offices is automatically entered into EDCS. During the field office review of the application, EDCS ensures that the SSA claims representative obtains all necessary information from the claimant through a system of alerts. While resolving these alerts take extra time, EDCS results in better documented claims and makes for more efficient processing during subsequent steps of adjudication. In addition, this information is electronically stored and propagates to other computer applications later in the process, avoiding the need for re-keying the information.
100 percent of SSA’s field offices are using EDCS, and over 97 percent of initial claims are taken using EDCS Approximately 20,000 disability claims a day are taken in this manner.
Electronic Disability Folder
One of the most important aspects of eDib is the electronic disability folder and the flexibility it offers SSA in managing the disability workload. Specifically, an individual’s electronic disability folder can be accessed at any time by decision makers with authorized access. Multiple users in multiple locations may view the information they need even though they do not physically have the folder. I cannot overemphasize the importance of the flexibility afforded by the electronic disability folder, and I further want to emphasize that it is being done in a secure environment.
For our decision makers, the heart of eDib is the electronic disability folder. We worked hard to make sure that the information in the folder was presented in a manner that was familiar and easy to understand by our decision makers. In the electronic folder, there are sections for payment information, queries, non-disability development, medical records, and so forth. Despite the underlying technical complexity, on the surface the electronic disability folder looks fairly simple, is organized along the same lines as the traditional paper claims folder, and contains both information from EDCS and images of medical records.
Medical evidence enters the electronic disability folder in two ways. Those medical sources that maintain traditional paper files can either send the records to SSA electronically by facsimile or through paper documents. The paper documents must be scanned into an electronic format and then entered into the electronic folder. SSA has secured the services of a contractor to take care of the bulk of the scanning while SSA and DDS offices have the capability to do on-site or low volume scanning. For the growing number of medical sources that maintain their records electronically, electronic medical evidence may be forwarded to the electronic disability folder via a secure Internet website or bulk transfer facility.
Already, the electronic claims folder is the official Agency record in more than half of the DDSs. The medical information we capture electronically is the world’s largest repository of electronic medical records, with over 36.5 million records. SSA’s goal is to move toward more electronic submissions. As part of its efforts to encourage medical providers to submit medical evidence electronically, SSA has conducted several outreach programs to the medical community to allay privacy law fears that medical professionals have concerning the provisions of HIPAA, the Health Insurance Portability and Accountability Act of 1996.
Once medical evidence is received, eDib allows SSA to electronically capture, index, route, store, and retrieve medical evidence. The electronic disability folder offers adjudicators a wide array of tools that enables them to view, annotate, bookmark, paginate, categorize, and work with evidence electronically. For example, as an adjudicator reviews the medical evidence in the electronic disability folder, he or she has the ability to mark and highlight key pieces of evidence, making it easier to refer back to that evidence during the disability determination process.
Finally, SSA has taken the forms used in the disability determination process and converted them into an electronic format. The use of electronic forms provides decision makers convenient access to them and ensures that they are always using the latest, most up-to-date version. The forms can be filled out on-line, electronically signed by the employee completing the form, and easily filed in the electronic disability folder.
eDib also improves SSA’s ability to manage quality assurance. eDib’s Disability Case Adjudication and Review System automates all aspects of the disability quality review function. Specifically, the system identifies cases for review, interfaces with the electronic disability folder, tracks processing, and provides reviewers with electronic versions of forms needed for the quality assurance review. eDib also provides electronic routing between the quality assurance office and DDS, replacing the old folder mailing process. Access to the electronic disability folder offers reviewers greater flexibility, which will allow SSA to transition to a quality assurance system that relies on both in-line and end-of-line reviews and will provide more timely and efficient feedback on quality.
Office of Hearings and Appeals (OHA) Improvements
At OHA, eDib required the development of the Case Processing and Management System (CPMS) to replace an outdated system that required manual data entry. CPMS eliminates much of the manual data entry, and provides improved case control and better management information. In addition, CPMS provides Administrative Law Judges with the ability to access the electronic disability folder.
In addition to CPMS, OHA has rolled out the use of digital audio recording equipment and software in all our hearing offices, replacing the outdated analog cassette recording equipment that has been in place for over 20 years. Although most digital recordings are being stored on compact disc, we are beginning to store digital recordings in the electronic folder.
All of these steps in the eDib process are being rolled out carefully and quickly. Roll-out was staggered to ensure that SSA was able to provide each DDS with the support necessary for successful implementation. After initial roll out in a DDS, the number of DDS decision makers working with electronic folders gradually expanded as the DDS developed expertise with the process. To date, all of the 50 States have implemented the electronic disability folder. Nationally, over 92% of DDS staff adjudicate cases in an electronic environment.
We have developed a certification process, called the Independence Day Assessment (IDA), to determine when each State is ready to use eDib exclusively as the official Agency record and no longer maintain paper folders for new cases. In January of 2005, the Mississippi DDS became the first DDS in which new disability claims are processed in a totally electronic environment. We currently have more than half of the State DDSs in a fully electronic environment, with the remainder scheduled to be IDA certified by the end of calendar year 2006.
At OHA, all but five hearing offices now have the equipment to conduct video hearings. From October 2005 through February 2006, SSA conducted approximately 15,000 video hearings. CPMS has been rolled out in all of the hearing offices and is being used to control case flow and provide management information. In addition, 75% of our hearing offices have been trained on using electronic disability folders and are working electronic cases. To date, the volume of hearings involving electronic disability folders has been low (approximately 3,200 as of February 2006), but the initial response from OHA’s administrative law judges, and claimants and their representatives has been positive.
This year, I expect each of the DDSs and OHA to be using electronic disability folders on a regular basis, and I expect all 50 states to be fully IDA certified by the end of calendar year 2006. The President’s FY 2007 administrative budget of $9.496 billion for SSA would provide the resources to allow SSA to make the necessary technological investments in eDib to maintain service levels and continue to improve the way we do business in the disability process.
As I noted earlier, eDib allows adjudicators in the disability determination process to view an individual’s claims file anywhere in the country. This flexibility affords SSA a new opportunity to make changes to improve the administrative efficiency of the program. Let me share with you a real-life story that makes obvious the necessity of eDib. In the aftermath of Hurricane Katrina – while issuing almost 74,000 immediate benefits payments for displaced persons and setting up response units at the Houston Astrodome and other evacuation centers—SSA provided further relief. Of the 5,000 cases in the New Orleans office of the Louisiana Disability Determination Services, 1,500 had already been stored electronically through eDib. These records were immediately transferred to other offices to be processed. Ultimately, we gained access to the building, packed the remaining 3,500 folders in 400 boxes, and carted those down six flights of stairs by flashlight.
In closing, I believe that eDib is vital. Thank you for the opportunity to discuss this important initiative. I would be happy to answer any written questions that you may have.