The Obama administration announced significant adoption for the Blue Button in the private sector on Friday.
In a post at the White House Office of Science and Technology blog, Nick Sinai, U.S. deputy chief technology officer and Adam Dole, a Presidential Innovation Fellow at the U.S. Department of Health and Human Services, listed major pharmacies and retailers joining the Blue Button initiative, which enables people to download a personal health record in an open, machine-readable electronic format:
“These commitments from some of the Nation’s largest retail pharmacy chains and associations promise to provide a growing number of patients with easy and secure access to their own personal pharmacy prescription history and allow them to check their medication history for accuracy, access prescription lists from multiple doctors, and securely share this information with their healthcare providers,” they wrote.
“As companies move towards standard formats and the ability to securely transmit this information electronically, Americans will be able to use their pharmacy records with new innovative software applications and services that can improve medication adherence, reduce dosing errors, prevent adverse drug interactions, and save lives.”
While I referred to the Blue Button obliquely at ReadWrite almost two years ago and in many other stories, I can’t help but wish that I’d finished my feature for Radar a year ago and written up a full analytical report.
Extending access to a downloadable personal health record to millions of Americans has been an important, steady shift that has largely gone unappreciated, despite reporting like Ina Fried’s regarding veterans getting downloadable health information.
According to the Office of the National Coordinator for Health IT, “more than 5.4 million veterans have now downloaded their Blue Button data and more than 500 companies and organizations in the private-sector have pledged to support it.”
As I’ve said before, data standards are the railway gauges of the 21st century. When they’re agreed upon and built out, remarkable things can happen. This is one of those public-private initiatives that has taken years to take fruit that stands to substantially improve the lives of so many people.
This one started with something simple, when the administration gave military veterans the ability to download their own health records using from on MyMedicare.gov and MyHealthyVet and scaled progressively to Medicare recipients and then Aetna and other players from there.
There have been bumps and bruises along with the way, from issues with the standard to concerns about lost devices, but this news of adoption by places like CVS suggests the Blue Button is about to go mainstream in a big way.
According to the White House, ”more than 150 million Americans today are able to use Blue Button-enabled tools to access their own health information from a variety of sources including healthcare providers, health insurance companies, medical labs, and state health information networks.”
Notably, HHS has ruled that doctors and clinics that implement the new “BlueButton+” specification will be meeting the requirements of “View, Download, and Transmit (V/D/T)” in Meaningful Use Stage 2 for electronic health records under the HITECH Act, meaning they can apply for reimbursement.
According to ONC, that MU program currently includes half of eligible physicians and more than 80 percent of hospitals in the United States. With that carrot, many more Americans should expect to see a Blue Button in the doctor’s office soon.
In the video below, U.S. chief technology officer Todd Park speaks with me about the Blue Button and the work of Dole and other presidential innovation fellows on the project.
Alexander B. Howard (@digiphile) is a writer and editor based in Washington, DC. He currently holds fellowships at the Tow Center for Digital Journalism at Columbia Journalism School and the Networked Transparency Policy Project in the Ash Center at the Kennedy School of Government at Harvard University.
Howard blogs at E Pluribus Unum, where this post originally appeared.
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While Blue Button and Blue Button + have intrinsic appeal, and are worth promoting, it is hard for me to be optimistic that they will have a significant impact on the health care system.
In my office (2 physician endocrine practice) we use an electronic medical record (ComChart EMR) in which we have given patient access to their medical records via a web portal for more than 5 years and is consistent with Meaningful Use Stage I since 2011. During this time, patients have been able to see the problem list, medicine list, allergy list and lab results.
We have allowed all patients to have full access to their entire medical record since October 2012 and have encouraged patients to use this feature of our web portal. So, in addition to the Problem List, Medicine List, Allergy List and Lab results, patients have been able to read and print a copy of all of their progress notes and radiology reports since October 2012.
I just review our patient web portal log. Since October 2012, only 380 patients have utilized our patient web portal for any reason, which could have been to email their physician, pay a bill, request a prescription refills, look at test results, review their problem list, medicine list or allergy list. In my recollection, there were no more than 2-3 patients who have ever requested corrections/alterations to their medical record. Since October 2012, only 118 patients have looked at their Progress Notes.
Clearly, this data is not overwhelmingly supportive of the proposition that allowing patients access to their medical record is going to have a significant impact on their health care. In fact, it would suggest that only a small minority of patients are interested in being involved in their own health care decisions beyond what transpires during the office visit. Of course, my office data my not be representative of most practices.
However, my office’s experience is consistent with that reported in Electronic Patient Portals: Evidence on Health Outcomes, Satisfaction, Efficiency, and Attitudes. Goldzweig et al, Ann Intern Med. 2013;159:677-687 which concluded “Evidence that patient portals improve health out- comes, cost, or utilization is insufficient.”
So, while there is theoretical appeal that the use of Blue Button and Blue Button +, at this time I remain pessimistic that these features are going to significantly impact either the quality or the cost of our healthcare system.
Hayward, there’s a big difference between Blue Button and Blue Button +. What ComChart is doing is admirable but it asks too much of the patient. What’s missing is the automation in BB+ and that was the main point of my comment.
But let’s look at your practice numbers: During the period you mentioned when 380 patients accessed the portal, how many clinical records did you send out of your practice to anyone in digital form (fax, and US mail is analog)?
How many records (analog or digital) did you send to registries and aggregators of any kind (immunizations, health information exchanges, quality measures, procedure registries, etc…) during the time of the 380 patient-driven accesses? Were these transmissions handled manually one-by-one the way we expect patients to access a 2010 Blue Button portal?
My point is that Blue Button Plus changes everything because it’s automation that both the patient and the physician can use.
I agree “automation” has appeal, but I remain uncertain that it will impact on the quality/cost issues. I am also concerned that physicians who receive frequent patient updates automatically into their EMR will be overwhelmed by the need to acknowledge the receipt of these messages. I know physicians who have turned off receipt of hospital progress notes as there is just too much incoming data to manage and they do not have the time to see patients and also review/acknowledge all the incoming information.
With regard to the number of outgoing documents, every office visit generates an out-going fax to another MD. However, this data goes directly to another provider. I suspect most of the patient downloaded data goes no further than the patient’s hard drive – as I have only had one patient bring in office records which they personally downloaded from their previous physician. If my suspicion is correct, the concept of “patient engagement” may turn out to be another good idea that does not work in “the real world”.
Just read Ina Fried’s piece and notice that it was written in 10/2010. As a surgeon and a physician who works in the VA system, I am very curious to know more about the numbers quoted. Anecdotally, I can count on one hand the number of people in the past 3years who have ever requested their digital health record or requested to communicate with me by secure email.
I think the other commenter are exactly on target –
(1) There is a difference between downloading and using data – at this point, I have seen limited use of either.
(2) The larger institutions have closed networks and if they aren’t sharing data, then the original use of the project is moot. This is certainly the case at the VA, Kaiser, and most Academic institutions.
(3) The issue of getting doctors on board is significant – I enjoy having an educated patient because I feel like the conversation is much more engaged, but I know many physicians who are not in favor of it – my mother’s physician angrily commented ‘this is why patients shouldn’t have access to their record’ when she challenged something he was doing – and he is reputationally one of the best primary care physicians in a very academic and competitive healthcare region. Most physicians are not compensated for the significant additional time it takes to answer a patient’s questions after they come armed with their records and google downloads; they are not compensated for the additional time that emails take (I think that Kaiser may allow some time for this, but it’s fairly minimal); and absolutely no one wants to deal with the potential liability issue that comes from putting down half thoughts and quick comments in a digital form.
I agree, as a patient and as a physician, with the idea that we should all be stewards of our own care and make informed and educated decisions. But, as with most things in healthcare, this is only a first step and without the additional structural changes (legal, operational, financial, etc), it will not provide nearly the level of benefit that is being promoted.
Speaking as a patient who has requested his medical records twice in the past two years and received 1) paper copies 2) a DVD my computer couldn’t read and 3) a secure email, I find the latter preferable. Speaking as someone who has acted as a caregiver or supported someone doing so, having easy, immediate access to an updated PHR in a clinic or ER is extremely useful. It’s true that this is all still new. How should we choose? Take the side of patients who want access to their records and lab data, or the doctors who would deny either because they then must deal with patients and caregivers who are advocating for their own care with equal information?
Blue Button is the future but numbers don’t tell the story. Even as payers and pharmacies move to support it, private-sector hospital adoption of Blue Button is still nil. To my knowledge, not one of our leading not-for-profit academic institutions has announced support for Blue Button or Blue Button Plus. Where are Kaiser, MGH, Cleveland Clinic to set an example?
The hospitals and their mega EHR vendors are busy building private data sharing exchanges like Epic Everywhere and CommonWell that are out of reach of the patient and independent physicians. These private HIEs compete not just with Blue Button Plus but with state health information exchanges as well. A Lucy might say, our research institutions have some ‘esplaining to do.
The Blue Button numbers are misleading in another respect: automation. Blue Button is a 2010 technology and it requires manual intervention by the patient for every transaction. We now have Blue Button Plus which moves the data automatically under patient control the way your phone company moves money automatically from your bank.
Blue Button Plus is the future because it gives average patients with high deductible health plans a chance to get independent advice without jumping through hoops and allows family caregivers to collect data from multiple portals int one.
We need Blue Button Plus because the alternative is a separate Blue Button portal for each of your pharmacies, your insurance company, your hospital, your specialists and your PHR.
Kaiser Permanente, McKesson, Aetna and United Health Group were early adopters. I hope you’ll note that I referenced and linked to Blue Button Plus in the post.
I have questions about how solid the VA number is. Saying 5 million veterans have downloaded data is not the same as saying that 5 million have used it ..
Well, the VA has been steadily adding the total number of downloads over time. It’s definitely not the same as usage, much like newspapers thrown onto people’s lawns don’t equate to actual readership. That said, some percentage of those downloads are resulting in use. We don’t know how much.
Here’s the problem in a nutshell. At the moment most people don’t know they need their personal health records. Although an enlightened few do. Agree the key is getting the docs on board. Will meaningful use be enough?