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South Texas Veterans Health Care System (STVHCS)

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VA's Blue Button Innovation Takes Private Healthcare Sector By Storm

Blue Button
By Richard W. Walker
Friday, November 25, 2011

 One day early last year, Veterans Affairs Department chief technology officer Peter Levin happened to run into VA Secretary Eric Shinseki.

"He came up to me and said, 'I hear you're working on a special project.'" Levin's project was a tool that would give veterans easy and quick online access to their personal health records.

The idea for the project had come out of a January 2010 meeting at the Markle Foundation in New York of government, private sector and other healthcare experts about ways to give patients on-demand access to their medical records. Levin suggested that they start with a small, easy technology that would let veterans access and retrieve a copy of their records.

"I explained it to him," Levin said. "He said, 'It sounds pretty interesting. How many people are going to use it?'"

The question caught Levin off-guard. He thought to himself, "We're breaking new ground here. Nobody in government has ever done this before."

So in his "most confident and serious CTO voice," Levin looked Shinseki in the eye and said, "Sir, we're going to get 25,000 users in the first year." The figure was purely arbitrary. "I was thinking that 25,000 was big enough to get his attention and small enough that I could sign them up personally if I had to," Levin admitted in an interview with AOL Government.

As it turned out, the project--now known as Blue Button--drew 25,000 users in the first month.

Officially launched about a year ago, Blue Button's base has since expanded to more than 500,000 patients, including users at the Defense Department's Military Health System and the Health and Human Services Department's Centers for Medicare and Medicaid Services (CMS).

But Blue Button has mushroomed into something more.

Private Sector Takes Notice

The technology caught the attention of a growing number of America's leading private sector healthcare organizations, which have begun to incorporate Blue Button into their own websites. In the process, it has also demonstrated how the federal government has gained the capacity to take a leadership role in creating major innovations in health information technology.

"Perhaps the most important thing that has happened-and that we're most excited about--is that the private sector has adopted Blue Button," Levin said. "Everybody can agree that this is government at its best. We didn't spend a lot of money and it didn't need an act of Congress."

"Blue Button technology represents the vanguard of a cultural shift away from the doctor as isolated service provider to patient as partner in the management of their healthcare." - VA's Peter Levin

Aetna, for example, recently began offering a Blue Button option to its members through the healthcare insurance company's Web site.

"Blue Button expands the ability of patients and their healthcare providers to easily share personal health information, [which] will lead to more informed healthcare decisions," said Aetna chairman and chief executive officer Mark Bertolini. By 2012 Aetna officials expect to give members the means to send text files of their personal health records (PHR) directly to their Aetna network providers.

Other private sector companies that have adapted Blue Button technology for their members include the UnitedHealth Group and Walgreens Co. In addition, Microsoft and Northrop Grumman have created applications that use Blue Button.

Enabling the Patient

"One of the things that is important about [Blue Button] is that it is actually providing access for consumers to the information in electronic health records," said Lynne Dunbrack, director of research firm IDC Health Insights Connected Health IT Strategies program.

"Blue Button" is a registered services mark of the VA. But to encourage its use, VA officials made it a snap for private sector organizations to obtain a license.

"The license is Web-enabled, free and perpetual and we did it only to protect the market against nefarious use," Levin said. "By no means does the government want to make money on this, nor do we want it to be considered in any way onerous to people who want to participate."

VA just last month concluded a contest designed to promote Blue Button, announcing RelayHealth had won a $50,000 prize by making a Blue Button personal health record system available to all patients, including veterans, of more than 25,000 physicians across America. (RelayHealth subsequently donated the prize to the Wounded Warrior Project.)

A big factor in Blue Button's gathering momentum, both in the government and in the private sector, is its sheer simplicity. Users simply click on the Blue Button to securely download their personal health information into a basic text file that can easily be imported into other computer systems or personal health management tools for both patients and providers.

"All we are trying to do is the simplest possible thing--make that data available to veterans and we do this in a way that is not tagged, labeled or coded," Levin said.

Moreover, what is emerging from Blue Button is a new, patient-centered framework for accessing and exchanging healthcare information.

Since 2004, under the Department of Health and Human Service's Office of the National Coordinator for Health IT (ONC), the government's efforts have focused on supporting the development of a nationwide, interoperable health IT infrastructure that would let providers share electronic health data. Blue Button brings the patient into the process.

ONC's model is "institution to institution or provider to provider and Blue Button shows up frankly as an idea that nobody thought of," Levin said. "What about the voice of the patient? What about the patient's access to data? What we're discovering to our delight is that patients want to be involved."

Patients, he added, are "perfectly comfortable" to become the transport mechanism for their personal health records.

"When they show up at the doctor's office, they don't have to fill out the clipboard anymore," he said. "They hand over a USB stick or they send a secure e-mail [containing their personal health information] in advance of their appointment so the doctor has already pre-populated the electronic health record with the information he's getting from the personal health record. It's an altogether new model of healthcare."

Recasting the Healthcare Records Debate

Overall, Levin said, Blue Button technology represents "the vanguard of a cultural shift" away from "the doctor as isolated service provider to patient as partner in the management of their healthcare." At the VA, "we want our veterans to be full-throated, empowered participants in their healthcare."

Blue Button also is beginning to connect personal health records with electronic health record systems such as the Veterans Health Information Systems and Technology Architecture (VistA) is an enterprise-wide information system, Levin said.

"The part that is truly innovative and groundbreaking is that we started pulling information out of VistA," he said. "We are blurring the difference between a personal health record like Blue Button and an electronic health record like VistA and we are doing it in a way that puts the patient in control. This is a patient-centered record."

Moving forward, VA wants to continue to drive propel Blue Button innovation in the private sector.

"We want the private sector partners to do even more and better than we do," Levin said.

"For example, we are keenly looking for partners who can provide a data mash-up: taking all the different Blue Buttons-the CMS Blue Button, the Aetna Blue Button and the VA Blue Button-and have a single Blue Button so that a veteran or a Medicare beneficiary or a patient in the private sector...can have a Blue Button that's fed by all their different clinical providers. Wouldn't it be nice to have the choice to have one Blue Button?"

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