Feds Want Wider Use Of Health Records Applet

Sep 25, 2012 (10:09 AM EDT)

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Millions more Americans soon will be able to download their personal health records by clicking on a simple "blue button" on the websites of their healthcare providers and insurance companies. The extent to which they do will be a gauge of consumer readiness for a Web application developed and first used by the federal government, an application that last month saw a milestone as its millionth user downloaded his health records using the technology.

The technology, called Blue Button, is a Web applet that enables the downloading of medical records as text or in PDF format--and soon, in machine-readable XML format--from backend databases. The Department of Veterans Affairs developed Blue Button and launched it in 2010 on the agency's My HealtheVet portal as a way of giving military veterans online access to their medical records.

The Centers for Medicare and Medicaid Services and the Department of Defense soon followed, and the White House and the Office of the National Coordinator for Health IT are promoting Blue Button as a technology that can provide access to medical records in the private sector. The White House's new Blue Button for America initiative recently brought in technology fellows as part of an effort to enable all Americans to download their own health records. Aetna, Humana, McKesson, United Health Care, and Walgreens are among the companies already pledging their support.

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The rapid uptake of Blue Button, with the one millionth user downloading her records last month, "shows you this country's latent need to access their own health data," said VA CTO Peter Levin, in an interview with InformationWeek. "If you have a parent, if you are a parent, or if you have a pulse you want to keep, you need access to health data, whether it's your child's immunization records or your parents' medications."

Just how far Blue Button can go in the private sector remains to be seen. According to a recent Deloitte survey, almost two-thirds of patients want their health records to be more easily accessible, and government programs to incentivize the meaningful use of electronic health records will soon have some requirements that patients be able to download and share health information. However, healthcare providers already make electronic records available to patients in a variety of formats, so Blue Button must compete with existing technologies. And issues around interoperability, privacy, and security remain.

Blue Button's supporters are forging ahead despite these concerns. The types of data available in a Blue Button file are expanding to include emergency room visits, in-patient stays, drug prescriptions, diagnoses, outpatient services, imaging, and lab results.

And Blue Button isn't a one-way street; patients can share data with their doctors and others in the healthcare chain. Aetna plans to let its members send data to their doctors through its website. And some doctor's offices can accept Blue Button data from iPhones, via Bluetooth connections to their office systems.

Companies such as United Health Care, with 34 million customers, represent a huge potential market for Blue Button's capabilities. The health insurance company began a Blue Button pilot project last year in Nevada and is now making the technology more widely available through its Web portal. "Blue Button is coming to represent not just a way to get records from the VA, but to represent the idea that all patients should be able to get their records," said United Healthcare's military and veteran services VP Chuck Officer.

Giving patients access to their electronic health records should lead to better health and, by extension, to fewer claims, Officer said. "If we want to drive down costs, we want to do this," he said, adding that Blue Button "makes great business sense."

Blue Button's simple, intuitive design could help spur adoption. "We believe that the more people see that logo, that symbol, the more adoption there will be," Officer said. In fact, the Blue Button approach is now being mimicked by the energy industry, which is developing a web applet called Green Button that provides energy usage information to consumers.

As more companies get behind Blue Button, maintaining interoperability becomes a more critical requirement. Health Level Seven International (HL7), the international health IT standards body, has adopted Blue Button as an "authoritative interoperability exchange format," and the VA, the Office of the National Coordinator for Health IT, and others are now building an XML-based standardized version of Blue Button data that coincides with the HL7 Consolidated Clinical Document Architecture standard.

The HL7 standard will make it easier to share information with and among health providers and to develop applications and services that aggregate Blue Button data from multiple sources and present data in a simple format. Levin said the industry is moving in a direction "that adds value to the data, that mashes it, that aggregates it, and that shares it not just between patient and provider, but between institutions." Blue Button leadership calls this the Automate Blue Button initiative.

There are a growing number of Blue Button applications. The Office of the National Coordinator for Health IT's Blue Button Mash Up Challenge and The Advisory Board Company's Patient Engagement Blue Button Challenge are underway, with winners to be announced in October.

Humetrix is among the companies participating. Humetrix is working on version 3.5 of its iBlueButton app for iOS devices, and an Android version is planned. The health IT company's smartphone apps can download Blue Button data from sources such as the VA and Aetna and let patients share the data with their doctors via Bluetooth or Wi-Fi over an encrypted channel.

Blue Button data in its raw form includes coded numbers representing, for example, pharmaceuticals. The next version of Humetrix's iBlueButton will query public databases to translate those numbers into drug names and potential side effects. It will also let patients note if they're experiencing those side effects.

Given the sensitivity of healthcare data, privacy and security are being closely watched. Levin declined to discuss the specific security measures VA has in place to ensure the safety of data, saying only that the agency takes "exquisite care in maintaining the security and privacy of the health information" that it possesses.

Companies supporting Blue Button must make similar commitments due to laws such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH). Humetrix's iBlueButton app uses an encrypted channel for downloads and requires users to log in and validate any transfer of information from patient to provider. In addition, the app automatically logs off if it's been idle for too long.

Many of these pieces still need to be put into place before Blue Button can live up to its full potential. There are 17 million potential users at United Health Care alone, but only 12,000 have used Blue Button so far. United Health Care plans to launch an awareness campaign. Said Officer, "We've also got to shift patients to think they're responsible for their own health."

Cybersecurity, continuity planning, and data records management top the list in our latest Federal IT Priorities Survey. Also in the new, all-digital Focus On The Foundation issue of InformationWeek Government: The FBI's next-gen digital case management system, Sentinel, is finally up and running.. (Free registration required.)