Social Security Administration (SSA) officials recently reaffirmed their commitment to expanding the agency’s Health Information Technology (Health IT) program to “more effectively and efficiently obtain medical records.” However, to successfully modernize, the agency must first confront long-standing technical obstacles that have impeded progress.
The SSA remains heavily reliant on outdated methods for retrieving medical records. A recent report from the SSA Office of Inspector General determined that nearly half of all medical documents used to evaluate disability benefit claims are still sent by mail or fax. Initial claims processed using these manual methods take, on average, over a month longer to complete—delays that carry real costs for applicants and highlight the urgent need for system-wide reform.
Continued reliance on physical paperwork reflects a deeper challenge with the agency’s digital infrastructure. While healthcare providers across the country already maintain electronic records, there aren’t enough “transmission lines” to deliver that data instantaneously to the SSA and the state Disability Determination Services (DDS) agencies responsible for medical evaluations. Just over 10 percent of records are transmitted through modern health IT software. Even when electronic connections are possible, submissions can be rejected due to formatting that doesn’t meet SSA’s specific technical requirements. This forces SSA and DDS staff to spend valuable time and resources manually scanning and uploading physical documents to their digital systems—an inefficient use of resources that slows down the process.
Other issues compound the time-intensive evaluation process. Records are commonly stored as TIFF image files, forcing staff to sift through static images instead of searchable, text-based documents (basic functions like keyword search are no longer possible). Furthermore, the authorization forms that applicants must sign for SSA to access their medical records expire after one year. When cases stretch beyond that window—like when initial decisions are appealed—staff must expend additional effort to secure updated signatures, adding another source of delay.
Tackling these additional burdens can improve the integrity and timeliness of SSA’s medical evaluations. Yet, meaningful progress depends on the agency’s ability to seamlessly receive digital records while upholding privacy protections for applicants (For instance, a victim of domestic abuse being able to limit access to that particularly sensitive information). The current process remains cumbersome and hinders better outcomes. SSA can strengthen its modernization efforts by building on the existing digital infrastructure developed by the U.S. Department of Health and Human Services (HHS) and by re-evaluating its own digital acceptance standards.
The current process
To collect the medical records needed to evaluate disability claims, the SSA must coordinate with health information exchanges, medical groups, applicants, and their representatives through multiple channels. Health records can be uploaded by health providers and representatives through SSA’s online platform, Electronic Records Express, or automatically retrieved via MEGAHIT, a software tool that connects to Health IT systems. Despite these digital options, use of mail and fax remain nearly as common. In practice, a single disability claim may require records to be retrieved through all four methods, as illustrated in the figure below.
When SSA sends out requests for medical records, agency examiners follow up with sources if no response is received within 10 to 20 days. It’s common for records to take a month or longer to arrive, and in some cases, extended wait times are necessary to ensure full documentation is received. Regardless of whether the documents are sent via paper or digitally, SSA often converts medical records into TIFF images – a format known for its large file sizes and lack of searchability – or non-searchable PDFs. As a result, caseworkers are required to review static images rather than interact with structured, searchable data such as spreadsheets. Although SSA has recently invested in tools to support document analysis, its current storage and review system can limit the speed and depth of medical evaluations.
SSA is actively working to automate more of its Medical Evidence of Record (MER) collections by connecting additional provider networks to its digital infrastructure. Nevertheless, progress remains slow. Digital records can only be transmitted if the sending organization is both willing and able to comply with SSA’s technical standards, meaning the agency must individually assess and establish contracts with each health information network it seeks to integrate. These agreements can be time-consuming and have been complicated by staffing shortages at SSA (including among the teams focused on expanding use of health IT).
Part of the solution: HHS infrastructure
SSA could leverage existing infrastructure established by the U.S. Department of Health and Human Services (HHS) – known as the Trusted Exchange Framework and Common Agreement (TEFCA) – to streamline records-sharing between health information systems.
In 2023, HHS launched this digital framework to enable secure health information sharing for approved purposes like treatment and government benefit evaluations. Qualified health information networks nationwide that meet TEFCA’s technical and privacy standards receive certification, allowing these vetted networks to send, receive, query, and automatically integrate data from one another with confidence. This growing directory is enabling patients and their doctors to more easily access their records from a range of provider locations. For example, veterans receiving care outside the Veteran Affairs system can have their medical records retrieved and reviewed by new healthcare providers with greater ease.
Early results are encouraging. The HHS has started enrolling health information networks that meet its standards, with over 4.5 million documents shared via TEFCA exchange in October and November 2024. Those records-shared capabilities are continuing to grow. Epic Systems, the health IT company which controls about a third of the electronic health records (EHR) market and holds medical documents for 280 million individuals, announced that it is transitioning all of its clients onto TEFCA by the end of 2025. What’s more, nearly three-quarters of hospitals participating in health information networks are familiar with TEFCA and intend to participate.
Recommendations to maximize TEFCA
Expanding the use of TEFCA to automate medical record retrieval for disability benefit evaluations will require two key reforms. First, the SSA must actively adopt the use of TEFCA as a standard pathway for collecting medical evidence. Second, HHS must ensure that all health information networks are integrated with TEFCA and equipped to process records specifically for government benefit determinations, not just traditional healthcare requests. This second step may require organizations to enhance their systems and help their clients adapt to meet these new requirements.
Some IT companies like Epic already perform this technical function, allowing health networks to instantaneously facilitate transmission of patients’ records to SSA for eligibility evaluations–so far, to apparent success. “Previously, each of these requests would have required our staff to seek out the records themselves and send those along to the SSA,” said Julie Morrison, a Director at Reid Health, one of Epic’s clients, “This new program removes that step and makes it so there are fewer hurdles between our patients and the help they need.”
Reconsidering SSA’s data standards
While expanding connections with health IT networks is essential, it is not sufficient on its own to maximize digital transfers. There are also differences in clinical data architecture to consider. The way that health IT providers format records may not align with SSA’s expectations for receiving these data payloads.
Health IT firms are struggling to meet SSA’s standards, leading to few documents being processed digitally. When a health network fails to fill out the forms 100% correctly, SSA won’t accept their digital record transfers. The rationale behind this approach is that incomplete digital records would then force SSA to revert to slower methods like mail and fax to retrieve missing information. By restricting the acceptance of digital records until health networks can ensure full compliance, SSA aims to minimize the need for repeated requests that could delay processing.
Still, some industry experts argue that SSA is setting excessively high standards for data payloads, limiting the number of available digital medical records it receives. They contend that the agency is prioritizing process over outcomes. While widely used health data formatting requirements are applied by SSA, its standards are actually stricter than in the private healthcare sector. Unless a health network’s electronic health records reliably contain 100% of the information requested, SSA refuses to approve the network for automated digital sharing. Consequently, digital records with sufficient information (e.g., 60%) to assess a subset of claims are being rejected. Disability examiners must then wait for paper records via mail and fax, slowing those evaluations down.
Conclusion
HHS has been steadily expanding a secure digital infrastructure for records-sharing, backed by major IT firms. SSA should take full advantage of this momentum to improve its records retrieval process. HHS should also ensure that health information networks participating in TEFCA are functionally equipped to support a range of use cases—including government benefit determinations—not just traditional clinical exchanges.
At the same time, the benefits of expanded digital connections will remain limited unless the data standards used by health information networks align with those of SSA. The frequent disconnect between the two creates inefficiencies in processing health records and increases reliance on manual work. In a number of cases, SSA’s own internal processes may be exacerbating the issue.
While these administrative challenges warrant closer scrutiny, it is clear that the current system is unsustainable. Claimants are the ones who suffer, facing longer wait times and prolonged uncertainty. To provide faster and more reliable decisions, SSA must broaden its digital partnerships and enable health IT providers to seamlessly share records. Most importantly, the agency must prioritize outcomes over rigid procedures.