title: Collaboration in electronic medical evidence development: a case study of the Social Security Administration's MEGAHIT System.
abstract: BACKGROUND
  In January 2009, the Social Security Administration (SSA) began a collaboration with MedVirginia to send authorized requests for and receipts of patient health information using the Medical Evidence Gathering and Analysis through Health IT (MEGAHIT) application. This request and receipt used the Nationwide Health Information Network (NwHIN) for secure and interoperable Health IT standards-based transport of patient information.
  
  
  METHODS
  This case study, conducted from June to November 2009, represents the first production exchange of health information across the NwHIN. Interviews with 43 participants from a variety of organizations are reported across technical, organizational, and governance dimensions in terms of challenges, successes, and considerations for moving forward.
  
  
  RESULTS
  This case study reports on the technical, organizational, and governance dimensions of collaboration. In terms of technical success, the authorized medical evidence request and receipt took approximately 2 min, including Continuity of Care Document (CCD) rendering. Overall, this resulted in mean case-processing time savings of 30%. Organizationally, the production effort required collaboration among multiple stakeholders: SSA sought claimant health information, MedVirginia provided patient health information, and other parties, such as the Office of the National Coordinator (ONC), facilitated transport of patient information across the NwHIN. According to those involved, this limited production effort tolerated and even benefited from an ad hoc multiparty governance structure.
  
  
  CONCLUSIONS
  Multi-party collaboration can result in technical success, but achieving that success is dependent on a variety of organizational factors. This case study highlights the significance of and potential for requesting and receiving patient health information across the NwHIN. It will inform interested collaborating stakeholders as SSA engages additional providers in using MEGAHIT to collect health information via the NwHIN.
authors.affiliation: Kay Center for E-Health Research, Claremont Graduate University, Claremont, CA 91711, United States. Sue.feldman@cgu.edu
authors.forename: Sue S
authors.initials: SS
authors.lastname: Feldman
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Horan
mesh_terms: D003299:Cooperative Behavior; D014481:United States; D019131:United States Social Security Administration