Greetings from Philadelphia and NOSSCR’s Annual Fall Conference. Thought those of you practitioners not fortunate enough to take the 12 hour train ride to Philly might like to know what Bill Gray, Deputy Commissioner for Systems at OHA, had to say about the e-dib program. What follows are my raw notes of his talk and some of his answers to follow up questions. Disclaimer: These notes may be unfit for human consumption. They are not complete, they are somewhat disjointed, they may be inaccurate, they contain abbreviations and shorthand. They haven’t been editted. But hopefully they’ll give you a flavor of what was said.
Mr. Gray is responsible for overseeing all the IT that supports SSA’s programs. Since January 2002, he has led SSA’s effort to convert the paper claims process to an electronic claims process. He lives in Columbia, MD and is considered to be one of the top 10 technical managers in US government. (Given that we’re talking about the largest bureaucracy on the face of the planet, I hope he’s in the top 5).
Mr. Gray says that SSA started rollout of e-Dib in Mississippi in 1/04. They’ve now rolled out e-dib in 22 states. First part of e-dib is the application process. June 2005 is the target date to complete implementation nationwide. 182,000 people have filed claims over the internet. SSA surveyed them (I assume a sample) and 97% rate their experience as good, very good or excellent, which pleases SSA.
The second piece of e-dib is EDCS (Electronic Disability Collect System). Every FO in the country is using EDCS. Getting much better product up front. More complete information and answers. Medical decisions can be made more quickly. The electronic folder is centerpiece of e-dib. It houses everything that is currently in the paper folder. 22 states currently have access to the electronic folder.
When DDS sends a health care provider a medical records request letter, a bar code identifying that provider is placed on the letter. When the HCP fulfills the request, it returns, with the medical evidence, the cover letter with the bar code on it. Records are then automatically associated with the correct file. The HCP can return files in several ways. They can send it to a centralized scanner. If rec’d before 12:00, the records will be transmitted to DDS by the end of day; otherwise, by 12 noon on the following day. It can be sent electronically, either by fax–in which case it is captured elecronically and sent to directly to the e-folder–or by uploading to SSA’s secure website. SSA is setting up relationships with large medical providers like Smart Corp to have them send records electronically.
Last component of e-dib relates to the HOs. SSA has built a new CPMS (Case Processing and Management System) which all OHAs now use. SSA is also providing the infrastructure for the HOs to fully process the e-folder. Five states have that capability now–Miss, SC, NC AL, and Illinois.
OHA can conduct video teleconferencing (VTC) and will get digital recording ability.
Goal of e-dib is to finish rollout to FOs and DDSs by June 20005 and to all HOs by end of ‘05.
Today DO has electronic folder but also maintains a paper folder. SSA wants a completely electronic process. SSA will eliminate paper folders beginning in Mississippi on 1/26/05, then go to other states. SSA has conducted first hearings in a fully elec. process. Well on way to accomplishing goals.
Other stuff:
3368 Form: When you go to SSA’s website to complete this form, you’ll notice that it wasn’t designed for somebody who would use it over and over. It has lots of help & information screens, and takes longer to get through. For somebody who uses this over and over, SSA needs and wants to build a streamlined i3368 process. Working with third parties to do that. SSA hopes to have this ready by 2/05.
3441 Form: This is on the SSA website; however, Forms 501 or 561 are not yet up. Next year we’ll try to get these on the web. Appeals process should be completely electronic.
Hearing preparation:
SSA plans to make the efolder available on CD. Can still send it on paper if you don’t have CD capability. When you get CD, the CD comes with instructions. There’s help about what diff categories mean, naviagation tips, how to look at images and the kind of viewer you need to view the docs as well as information about free download sites for these viewers. The demo screens Mr. Gray displayed looked pretty straightforward.
Exhibit list is on next screen. This screen shows the exhibit number, name of document, decision dates, number of pages in the document, whether the doc was received before, during or after the hearing, and whether it was stamped into the record.
You navigate the the medical records from an HCP via thumbnails in left column.
Images can’t be changed, but you can select sections of the document using standard cut and paste operations Also has right click mouse menu with "Send Text to Word" option.
How do you submit additional evidence? Four methods:
Contract scanning
On-site casual scanning
Faxing
Secure website
Send paper to OHA, and it will be scanned.
Fax it to HO and it will be electronically captured and sent to e-folder.
Use secure website. Each user will be given a PIM and a password. You can fax it to secure website. Date is encrypted. SSA will then upload into elec. file. Website is currently used by DDS. SSA wants to make it conducive to reps needs. Will have meeting soon with reps to work on this.
Mr. Gray shows a slide of Judge Foley at the Charlotte OHA conducting an e-Dib hearing.. Claimant sits at a table parallel to the ALJ’s desk. The claimant, the VE and the rep all face the ALJ. The claimant sits in the middle between two monitors. VE on one side with monitor and keyboard, Rep on the other with monitor and keyboard. The rep controls what she sees on monitor. ALJ can refer to exh. number, but VE and Rep must manipulate their terminals independently to display that exhibit.
HOs now doing VTC. Each HO will have standard TVs, doc camera (to view a doc you place under camera), and a fax machine to exchange med evidence. 15 lines can participate in a VTC. Also audio lines.
Next change you’ll see is digital recording (DR) equipment. Mailing and storing tape cassettes is a problem. With DR, audio is stored right in the e-folder. Anybody with access to folder can review recording. SSA just awarded a contract for installation of equipment in first of the pilot sites. Goal: DR in all HOs in 18 months.
Q & A:
What happened with CPMS is we rolled it out between May and August to all HOs around country. We did this so quickly so that we would have a consistent mgt. info system so that some wouldn’t be using HOTS, and the other CPMS simultaneously. We had slowdowns and performance problems for a couple of weeks. Accelerated procurements for additional processing power alleviated those problems. Now things run smoothly. SSA is meeting with FOs, HOs, asking for changes and feedbacks. We’re having regular releases to address issues raised by ALJs and others. You’ll see it changing.
As long as you have a CD reader, you’ll be able to use the CD.
How to confirm that you submitted something electronically? If you file across the internet, at end of process, there is a screen that comes up that attests that you agree with the information you supply. You can print a receipt on local printer. B/c we’re not waiting for app.through mail, that app is live right then. When you file RH, it is effective immediately, it goes directly, electronically, to OHA.
It is going to take a few years to get all paper files out of the process.
What about pro se claimants? We can print out file for them. We are also equipping private rooms so that if they want to review file on computer, they can. We will help them use the CD.
You cannot bring your own laptop to the hearing. We’ll give you a new CD the day of the hearing. We’ll also give you another CD if you submit evidence at hearing or post-hearing that includes this evidence.
Currently all docs are in TIFF format. SSA is looking at PDF. He doesn’t know what audio format they’re currently using.
Any plans to transfer current hearing tapes to digital? No. They know current growth projections but can’t manage growth if they also do retro scanning.
Everything is backed up!! One of the first things we did was build the infrastructure for this. Have had to use it. Worked well.
3368 is for SSI and T2. An online app for T16 is in the works. We didn’t think audience in SSI population would be broad enough to justify expense. SSA now doing planning analysis–probably won’t happen in 2005, may happen in 2006.
Will file show status of claim? We’re looking at that right now. No internet access to e-folder for security reasons.
Doesn’t know when the digital recording will be put on CD. (In Nancy’s remarks after Mr. Gray’s talk, it sounds like it would happen "very soon" after the hearing.)
As far as he knows, there will be no charge for CDs. He intends to check on this. I suppose no news is good news.
VTC out of reps office? You’d have to have your own VTC equipment, but we could work with you.
What about regs that prohibit attorney from siging app? Signature proxy issue is being looked at as a policy issue rather than an infrastructrue issue. No timeline given.
If you’re sending medical evidence without a request from SSA–we have to look at how to get indexing information in. Remember, we’re trying to get diff. kinds of info to diff. parts of e folder. Will be working with reps to make this process work.
CD can’t be copied to your harddrive currently.
E-dib is stopping at the hearing. Post-hearing paper is the second phase.
What about sending hearing decision, award letters, electronically? We are doing a pilot on secure e-mail for our business partners. Once done (should be running in next 6 months) that will "open the doors" to sending decisions or award letters electronically. Hasn’t considered the federal court’s PACER system.
I"m leaving the comments section open on this post for any questions or corrections you’d like to make.
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This is excellent. I hope that you’ll continue to post more Notes from Philly.
Any mention of HIPAA compliance?
David: Best I recall, it wasn’t mentioned.
I suggested to a committee member that we need to have the Social Security disability regulations changed so that HD has its own criteria since right now the criteria for organic brain disease are being substituted inappropriately.” This is so true! I’ll have a future post on this subject.
well well, seems SSA is finally modernizing itself. Unfortunately about 10 years too late, this is the 21st Century not the 20th.