Get a group of tech-savvy physicians and electronic medical records experts in a room, ask them about the way forward, and the subject of the Blue Button is sure to come up.
The Blue Button is “about taking personal control of your health information, if you want to do so,” said Christopher Rasmussen of the Center for Democracy and Technology. It is “basically an information exchange between the provider and patient.”
At its heart, the Blue Button initiative is about health data — your health data. Right now, unless you are an extremely meticulous note-keeper, most of your health data — physicians visited, diagnoses, lab tests, recent prescriptions and more — are housed by doctors and health insurers, on computers and servers and, in some cases, in manila folders.
But giving a patient access to his own health data has the potential to empower the patient, Rasmussen said, and allows him or her to steer health records from an old provider to a new one, for the purposes of getting a second opinion, for example.
The Blue Button symbol grew out of the federal government and a U.S. Department of Veterans Affairs initiative allowing vets to access their health data via computer. Eventually the project expanded to include other federal employees and, now, anyone who gets health insurance through the Medicare program for seniors.
Today, Medicare patients with a computer or smartphone can download up to three years of health data and a year of prescription information. The tool can be especially valuable for seniors because they often see eight or nine specialists.
Someday, all of those specialists might be able to swap data with each other via a robust “health information exchange,” which will allow fully portable medical records to be shared among patients, physicians, insurers, pharmacists and hospital networks. States are racing to build these exchanges but are not there yet.
Now, for instance, for a patient who sees a University of Pittsburgh Medical Center cardiologist, a West Penn Allegheny Health System urologist and an independent primary care physician and gets medicine from two different pharmacies, there is no way for those various systems and specialists to instantly communicate with each other.
But if Medicare is the insurer, the program has all of the data on hand.
And now patients can, too.
The challenges in deploying that data were plentiful. Step one — translate dozens, if not hundreds, of pages of VA or Medicare medical records into an easy-to-read format that can be passed back and forth between patient and doctors.
Another challenge was developing a content management system that works on its own, in the background of a computer or smartphone, to download new data and update various physicians when necessary. Old Blue Button technology made it difficult to do that — because of privacy concerns, every time data were altered or swapped, the system needed a patient’s explicit permission.
Newer deployment technology — known as Blue Button Plus, in the industry — allows for a one-time patient authorization, meaning the patient doesn’t have to be involved every step of the way.
Yet another issue — who keeps the data? Does it reside on a phone? Online in a “cloud”? What happens if a patient downloads an app and then decides to delete it — do the data disappear?
“There are certainly concerns,” said Adrian Gropper, chief technology officer of Patient Privacy Rights, a Texas non-profit that seeks to give patients control over their own sensitive health record. “But in general, from (a privacy) perspective, we are more concerned about (the) kind of data flows between hospitals, amongst themselves without the knowledge of the patients.”
The next step is to get the Blue Button concept into the private sector, adopted by hospitals, doctors and insurers. And that rush is on, now that the Centers for Medicare and Medicaid Services are requiring medical providers that receive Medicare funding to show more evidence of “meaningful use” of electronic medical record technology.
Starting in fiscal year 2014, in order to prove “meaningful use,” many providers will have to adopt technologies that allow patients themselves to “view, download and transmit” their own medical data.
