Do or Die

For years now, Social Security has been the overachiever, excelling where many federal agencies struggle-in using information technology. Social Security has brought home top marks in information management and computer security on report cards issued by Congress and by independent observers, including Government Executive's Federal Performance Project. The agency has basked in praise for adopting new technologies for its call centers, processing centers and Web site, which boosted customer satisfaction.

Congress has urged other agencies to be more like Social Security: "I am pleased to note that the Social Security Administration continues to be a shining example of sound leadership and focused attention," said Rep. Stephen Horn, R-Calif., at a congressional hearing in 2002. In the next breath, he chastised the Transportation Department for its "appalling" computer security. And in 1999, when Social Security achieved Y2K compliance before any other agency-and before some businesses-President Clinton held a ceremony at the White House. The agency seemed poised to become government's model of 21st century efficiency, a spic-and-span operation that could hold its own against even the private sector.

But Social Security has a stain on its record. The agency never has been able to devise an efficient way to manage its disability programs. Here, all the ugly stereotypes about bureaucracy apply-paperwork so unmanageable that workers have been caught dumping documents, backlogs so large that applicants sometimes die before they get benefits, rulings inconsistent enough to seem capricious, and administrative expenses that eat up far more than their share of the budget.

Social Security has tried to fix the system. Its most recent attempt, which began in 1992, centered on technology. The Reengineered Disability System, as it was eventually called, was a bold idea that promised to slash the backlog, speed payments and trim costs. But pilot tests revealed signs of distress. Design flaws and software defects caused delays and increased workloads. The agency abandoned RDS in 1999, after investing seven years and more than $70 million.

Now Social Security is trying again, with an $850 million technology makeover called Electronic Disability, or eDib, aimed at making the processing of disability claims paperless. It already has begun rolling out the technology. "We're past the point where we think we could fail," says William Gray, the agency's deputy commissioner for systems. If he's right, then Social Security will cement its position as the leader in federal technology.

But some fear eDib is RDS come back to haunt the agency. The Government Accountability Office has warned several times that the project could be headed for a meltdown. A July report called it "a highly complex and as yet unproven system," largely because it hadn't been tested from beginning to end to ensure its components would work together. GAO also said that pilot tests were limited and that Social Security had not fixed all the problems before it began installing the system.

The July warning gave Gray no pause. He already had weighed the risks and placed his bet. In 2002, not long after Gray became deputy commissioner, Social Security Commissioner Jo Anne Barnhart asked him how quickly he could build a paperless disability system if he had all the resources he needed. Gray said he could get the job done in 22 months, and he did-with help from SSA employees and from contractors, including Lockheed Martin and IBM. The agency temporarily changed the project's name to Accelerated Electronic Disability, to reflect the aggressive timetable.

Now Gray says he intends to keep another promise, to complete the national rollout by June 2005, a schedule he says doesn't leave room for end-to-end testing. The mammoth project, which consists of five systems and will require vast realms of data storage, has been rolled out in various stages nationwide. Ten states now have all five components in place. If eDib fails, it will tarnish Social Security's reputation.

A Broken System

To understand Gray's urgency, consider the case of Linda Fullerton of Rochester, N.Y. Like others who have applied for Social Security disability benefits, she describes the experience as "a nightmare." Fullerton suffers from a laundry list of autoimmune disorders and other diseases, which she believes were triggered by a brain infection that went untreated for months in 1996. As her illnesses progressed, work as a computer purchasing agent became unbearable. She was constantly fatigued and in pain. Her fingers and toes swelled and her skin became so sensitive to cold that she had to wear long underwear even in summer. "The air conditioning was killing me," she says.

By late 2001, Fullerton felt she could work no longer. She applied for benefits through Disability Insurance, one of two Social Security programs that assist the disabled. She had paid into the program since she was 16; now all those withheld dollars would become her safety net. She gathered stacks of medical evidence documenting the severity of her condition. "I really had my ducks in a row," she says. But she had no idea what she was getting into.

The chart running across these pages outlines how Social Security determines whether individuals qualify for Disability Insurance and Supplemental Security Income. About 2.5 million people apply for disability benefits each year, entering a maze of field offices, state Disability Determination Services and an adjudication system complete with judges and attorneys. Disability Insurance and Supplemental Security Income were created in 1956 and 1975, respectively. The former follows a traditional insurance model, covering workers who have paid into the system in case they become physically or mentally disabled. Supplemental Security Income, by contrast, is a needs-based assistance program for the blind, disabled and elderly. In 2003, Social Security paid nearly $100 billion in disability benefits through the two programs to more than 11 million people.

Soon after Barnhart became SSA commissioner-around the time Fullerton applied for disability insurance, in late 2001-an SSA analysis showed that it took an average of more than three years to move through the entire process, from application through three levels of administrative appeals. Almost half of this time resulted from backlogs. Most cases don't require all the steps outlined in the chart; some claimants get approved along the way and others give up. But a significant number do get stuck in the system's clogged pipes, mired for years in rejections and appeals before finally being approved.

For Fullerton, the convoluted process brought unexplained delays and conversations with state employees unfamiliar with her case. "Depending on what time of day you call, you're going to get 10 different answers," she says, her voice full of the fury that only poor customer service can evoke. Fullerton was shocked when the New York state agency that initially reviewed her case rejected the claim. Only by filing a Freedom of Information Act request for her records did she learn that the agency had listed depression as the primary diagnosis, ignoring her physical disabilities. Fullerton finally received benefits a year and a half after applying. She had just exhausted her pension and all of her savings. "I was destitute," she says.

Modern Realities

No one thinks Social Security's system for assessing disability claims works. At her confirmation hearing in October 2001, Barnhart told the Senate Finance Committee: "I do not seek this position to manage the status quo." The vow has become a sort of mantra for Barnhart, who has since repeated it in at least a half-dozen congressional hearings. Bad as things are, she says, they will get a whole lot worse unless something is done. Before taking the reins, she served four years on the Social Security Advisory Board, an independent body known for producing insightful papers. One such report, published in January 2001, warned of a monsoon of disability claims as baby boomers age, a trend that already has started. The sharp growth in claims "threatens to overwhelm a policy and administrative infrastructure that is already inadequate," the report found.

But Barnhart has a plan. She hopes to finalize regulations in early 2005 for what she calls her "new approach" to disability. Her strategy, which includes measures to speed decision-making, relieve backups and improve the consistency of decisions, has generated flashes of optimism in the disability community-mixed, of course, with skepticism stemming from the history of failed attempts to fix the process. (Social Security employees nicknamed the folks from headquarters "Baltimorons" because of past reform efforts that didn't account for day-to-day realities of claims processing.)

"The linchpin for my new system," Barnhart says, is eliminating paper through eDib. The makeover's success is a prerequisite for many of her ideas. A paperless system would allow Social Security to shift workloads when one office becomes overwhelmed. It could sort cases that appear to be clear-cut and forward them to an office that would expedite decisions. It could centralize medical expertise and allow for teleconferencing and provide storage of audio recordings of hearings. It would eliminate the costs and delays of mailing and copying millions of files, which typically grow to be several inches thick.

Some of the most important changes sound like things the agency already should have accomplished over the last decade. "What it means is no more lost cases," Barnhart says. Still, it's hard to overestimate how big a change eDib will be for a system that has lagged far behind the pace of technological innovation. When Paul Barnes began working for Social Security as a claims representative in 1968, he wrote disability claimants' information by hand on what was then called Form 401. "About the only thing that had changed before eDib was the number of the form, which became 3368," says Barnes, now the commissioner for the Atlanta region, where Form 3368 almost always is completed online.

Weighing Odds

There's no question that taking the disability claims process paperless involves risk. "You have to think of the magnitude of what we're building here," Gray says. The agency projects that when it's fully operational, eDib will be the world's largest repository of medical records. It will require 150 terabytes of memory-enough to store the entire print collection of the Library of Congress about 15 times. No other system has so many users conducting so many transactions on such a large database, says Brett MacIntyre, an IBM vice president working on eDib.

To Gray and Barnhart, the decision to move forward without the end-to-end testing GAO recommended was simple. Doing the testing "would have been a less risky approach," Gray says. "It just would have provided the same poor level of service for three more years," as cases trickled through the various levels of administrative review. Besides, Gray was confident in what they built. The agency spent nearly $20 million on laboratories to test the eDib components, and then conducted pilot testing. "To me, the risk that I took is not nearly as big as the risk of doing nothing," Barnhart says.

The so-called Baltimorons finally may have their revenge. John Hutto, a senior attorney with SSA's Office of Hearings and Appeals in Hattiesburg, Miss., was one of the first to be trained on eDib. He was skeptical initially, but impressed by the project. "It's been an unusual experience as a 26-year government employee to see something done right from the get-go," Hutto says. And John Heard, an attorney from San Antonio, Texas, who represents disability claimants, saw an eDib demonstration at the Office of Hearings and Appeals in Tupelo, Miss. "I came away from that thinking this can work," he says.

Still, eDib remains a work in progress. GAO listed software glitches and system shortcomings that it urged the agency to fix before rollout. Users have complained about slow loading times, excessive mouse movement and not being able to view one document while drafting another, a problem that may require the use of two monitors. Worse, in August, the South Carolina Disability Determination Service reported to the agency that since it implemented eDib in late March, "all areas of the DDS have experienced and continue to experience delays related to the new process, which result in an overall increase in processing time and decrease in production."

The statement recalled the breakdown of RDS, but Gray's plan from the beginning has been to build a flexible system, then bring offices online gradually and fix problems as they occur. The agency says many of the problems South Carolina reported already were scheduled for correction, and the rest are being addressed.

The success of eDib will depend on the response of Gray's team to all the micro-crises and unforeseen complaints. "The real measure of any new initiative is the long-term implementation," says an administrative law judge from Colorado who spoke on the condition of anonymity. "Judging that is impossible because it requires a prediction about how well and how quickly the problems will be overcome. Doomsayers and Pollyannas both are just guessing." One thing is clear even outside headquarters: The agency will move forward with eDib. "This is a do-or-die proposition," Hutto says. "It is going to happen."