True Blue: VA’s Gift To the Country

In August 2010, President Obama told veterans they soon would be able to go to the Veterans Affairs Department website, “click a simple blue button, download or print your personal health records so you have them when you need them and can share them with your doctors.” It was a radical notion: Doctors controlled, and sometimes only reluctantly shared, health records with patients.

Blue Button access on VA’s website My HealtheVet went live within weeks and a full national rollout two months later. Peter Levin, the department’s chief technology officer at the time, estimated 20,000 veterans would use the tool in the first year—a milestone Blue Button hit in its first month, Levin says. 

The Centers for Medicare and Medicaid Services launched Blue Button on its website in September 2010, and the Defense Department signed on that year as well.

The tool proved so useful that in December 2011 the Office of Personnel Management directed all federal employee health benefit plans to add the Blue Button function to their patient portals—that’s more than 200 carriers covering 8 million federal employees. 

Since its launch at VA, Blue Button has fueled a national movement to give patients access to their health care information. More than 500 carriers and health care providers have pledged to adopt it, says Levin, who is considered the father of Blue Button. He left VA in March to start his own data security company, Amida Technology Solutions.

Empowering Patients

The Office of the National Coordinator for Health Information Technology, which is in the Health and Human Services Department, has embraced Blue Button as a way to empower patients by giving them an easy way to access to their health information and share it with clinicians, says Ellen Makar, a nurse who serves as the consumer e-health advisor at ONC.

Informed patients involved in their care are healthier, Makar says. For a nation facing spiraling health costs, such engagement could lead to significant savings over time. Asked who would end up using Blue Button, Makar says “everyone.” 

Defense TRICARE beneficiaries—active-duty and retired military personnel and their families—have become heavy users of Blue Button. Since January 2010, they’ve used it to schedule more than 1.5 million appointments. In addition, more than 330,000 people have accessed it to refill prescriptions and download personal health data.

Aetna and UnitedHealth Group were early private sector adopters. Aetna added Blue Button to its patient portal in September 2011 and UnitedHealth Group followed in July 2012, predicting that 26 million beneficiaries would be able to download information using Blue Button by mid-2013.

Craig Newmark, founder of the classified ad site craigslist and a veterans advocate, told Government Executive: “Your medical history is vital for your health at any time, and that’s particularly true for vets. Having health records handy—online, in a memory stick, or [something] similar—means that any doctor will make smarter decisions on your behalf. It also means that the treating doctor could add records of the new treatment to the existing Blue Button record.”

This applies to the entire health care sector, which continues to grapple with paper records, Newmark says, noting that he has to tote piles of paper from one specialist to another, compared with “Blue Button style,” in which doctors just email them.

“Right now, getting records from one place to another is difficult enough that we don’t do it, or get it done painfully. Blue Button can get everyone reliable health records that can be shared between medical professionals. That means, for example, that doctors won’t prescribe conflicting drugs, and that saves lives,” he says.

Newmark and Makar characterize Blue Button as “VA’s gift” to the nation. 

Five Feds and Six weeks

Former VA deputy secretary Scott Gould says Blue Button stands out as a prime example of the public sector producing something valuable that helps the private sector. Gould, who resigned in March and now is executive vice president of medical affairs for CareFirst BlueCross BlueShield, a health insurer that serves the Baltimore-Washington area, estimates 1.8 million people use Blue Button to access their personal health records.

The program had its genesis at a January 2010 meeting of public and private health care providers at the New York-based nonprofit Markle Foundation focused on health IT, Levin says. The germ of the idea was that patients should share in medical decisions with clinicians and have access to their records. 

Levin returned from that meeting and in February 2010 pulled together a team of five VA employees to quickly develop a way for patients to both access and contribute to their health records. He tapped Rachel Lunsford to lead the effort as product manager. Lunsford was a 25-year-old self-described “pedigreed geek” with a Master of Science degree from Carnegie Mellon University, specializing in public policy management.

Lunsford, now health IT coordinator for the Iowa Medicaid Enterprise, says development focused on data simplicity. The Blue Button team relied on the most basic data format—ASCII text, which can be read by both people and machines—developing a prototype in just six weeks.  

Federal Chief Technology Officer Todd Park summarized the approach in remarks at a Microsoft health care conference in March 2012: “Look, there’s all this complicated stuff happening with health information. But why can’t we just do this: Why can’t we just let an American get a copy of their own information? And don’t worry about the format.” The signpost was a large blue button. 

That first VA prototype, Levin says, primarily included self-reported information, such as demographics and health history. The next release, in late 2010, allowed patients to access lab data. Today, veterans who have authenticated their identity can access their entire VA health record online, he says.

Veterans also can use Blue Button to make appointments and access information provided by Defense, including service and deployment dates.

Levin said Blue Button quickly evolved from its ASCII origins and now  handles data in machine-readable code based on the health care industry’s Health Level 7 Continuity of Care Document XML-based standard for patient information.

ONC has bootstrapped development of Blue Button apps through mashups and crowdsourcing challenges, spokesman Peter Ashkenaz says, including a prize-winning iPhone app for clinicians developed by Humetrix of San Diego. 

People have a legal right to their health information, Makar says, which is enabled by Blue Button. ONC has started to develop a Blue Button hub—a central website that will detail which insurers and providers use Blue Button, so patients can get access to their data.

The Blue Button movement could soon spread to the United Kingdom.
Beverley Bryant, director of Strategic Systems and Technology for the National Health Service there, says she would like to use the technology to help manage care for diabetics and elderly patients suffering from dementia—two key health issues the United States faces as well.

Bryant says she was impressed by the speed with which VA developed Blue Button—a credit to a project that succeeded by putting simple first. 

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