Blue Button Initiative Takes Off, Contest Winner Announced

Blue Button, an easy to use open source tool to access the “MyHealtheVet” Personal Health Record (PHR) that was publicly released in August of last year by the U.S. Department of Veterans Affairs (VA), has surpassed all expectations and is now being used by more than 425,000 veterans across the country. In addition to veterans, the Blue Button app is being rapidly adopted in the private sector. The adoption will increase exponentially as a result of the  “Blue Button for All Americans Contest.” The contest, which was won by RelayHealth, a subdivision of the McKesson Corporation, was part of a two-pronged initiative to improve health care for veterans outside the VA and extend Blue Button technology to health care systems within the private sector.

Blue Button allows patients to view and/or update personal health data (family history, test results, emergency contact information, VA prescriptions, appointments, etc) on line. The patient can choose to store their data online or downloaded it as a text file to a personal computer or mobile device, or share it with a third-party medical provider. Users can share their data not only with physicians who use the Blue Button but also with physicians who employ other types of electronic health record (EHR) systems. The Blue Button solution stores all of the patients' information in one secure, easily accessible location. No more hunting around the house for those scribbled-on scraps of paper.

Blue Button information can make a big difference in a medical emergency.  Having quick access to a patient’s medications, allergies (especially to drugs), key medical history and emergency contact information can save a life. 

The “Blue Button for All Americans” Contest

Jonah Czerwinski, Director VA's Innovation Initiative (VAi2), which sponsored the Blue Button program, explains that “from our own experience [we know] that the six million Veterans who receive their care through VA want to have access to their health data using the Blue Button.”  Czerwinski adds that 'we thought it important that the more than 17 million Veterans across the country who get their care from non-VA providers have access to Blue Button downloads through their private physicians as well.”

Thus the idea behind the contest was to find a team that would create (or adapt) a PHR using the Blue Button format and have it installed on the websites of 25,000 physicians across America. This project would show how Blue Button can be extended to all veterans across the country. RelayHealth managed to modify its own pre-existing PHR within a three week time period and incorporate the innovative open source Blue Button code into its system. RelayHealth provides information exchange services to more than 200,000 physicians and their staffs and more than 2,000 hospitals and health systems.  More than 17 million patients and patient health records are available using RelayHealth applications.

To win the prize, RelayHealth had to show that it had upgraded its PHR to use Blue Button technology, and at least 25,000 of its physicians then offered the new Blue Button functions to their patients. “We stopped counting after we got past 25,000,” said Czerwinski. After winning the contest and the $50,000 cash award McKesson announced it was donating the prize to the Wounded Warrior Project, a nonprofit organization that strives to meet the needs of injured service members and veterans as well as their families.

So what makes the outcome of this contest significant?

“We held this contest to help veterans across America to be able to download their health data regardless of where they get their care,” according to VA Secretary Erik K. Shinseki.  Furthermore, he added, extending Blue Button beyond the VA to the private sector represents “a flagship open government initiative” enabling millions of Americans to access a more efficient, more convenient, and more interactive PHR.

“This contest proves that patient-controlled PHRs using the Blue Button can be simple, secure and inexpensive,” said Peter L. Levin, VA’s chief technology officer.  “It also proves that through collaborations like this, the government and private-sector organizations like RelayHealth can make health care information exchanges part of the mainstream of American medicine.”

Steve Downs of the Robert Wood Johnson Foundation applauds Blue Button as a developing technology that can help people make informed medical decisions. With Blue Button, he says, “people can review their health records or claims information, educate themselves about conditions, procedures, medications, or test results found in their records, and share their information...They can also point out errors they find and make sure they are corrected.”

CMS Administrator Donald Berwick said, "It is an iconic wonderful idea. The Blue Button isn't just valuable, it's magic. It's the open sesame button that will open the door to a whole new level of care."

So how did Blue Button get started?

It began as a collaborative effort between the VA, the Department of Defense (DoD), the Markle Foundation, and the Centers for Medicare and Medicaid Services (CMS) about a year-and-a-half ago. The VA launched the first Blue Button PHR in August 2010, enabling veterans within the VA health care system to track their medical data contained in the highly successful MyHealtheVet PHR system. MyHealtheVet is a portal into the VA’s world-leading EHR, VistA. 

Expecting to gain maybe 25,000 users by the end of a twelve month period, the VA actually acquired over 425,000 users over the first year. Since then, the Blue Button initiative has only gained ground in terms of both demand and actual practice. This bodes well for the expansion of the Blue Button system, which is making significant inroads into the private sector. In fact, the technology has already been implemented, or soon will be, by Kaiser Permanente ,Walgreens, Aetna, United Health Group, Iatric Systems, PatientsLikeMe, Microsoft Healthvault and Northrop Grumman.

Next Steps for Blue Button

Blue Button continues to take the initiative to expand itself in innovative ways. For example, one of the major requests from veterans was to be able to download laboratory reports. The VA has been responsive to those requests and added lab data to the app.

The VA, however, is not restricting itself to medical data. According to a customer service plan released on Oct. 24, the VA will soon provide veterans with information on the jobs they performed in the military. Details of their personal Military Occupation Specialty (MOS) data will help the veterans locate job opportunities in the private sector. This data includes codes denoting jobs performed during their military service. The data includes hundreds of job specialties related to aviation, communication, artillery, language, engineering and infantry. Many of the military jobs utilize skills that can be applied to civilian jobs.

According to the service plan, “This will be the first non-medical application of the Blue Button and will be featured on the National Resource Directory employment page and the VA’s VA for Vets website.” The document states that “Many websites will have a military skills translator, which will provide a list of civilian jobs matching the Veterans MOS data.”

Healthcare IT, Where Proprietary Fails and Open Wins

It is interesting to compare Blue Button's early success to the drawn-out demise of Google Health, which officially draws its last breath on January 1, 2012. Both PHR systems allow patients to view and update their records online, share medical data with third parties, and consolidate that data into one central location from multiple providers. Theories for Google Health's downfall abound, but health industry tech innovators say that the system failed to connect with developers and provided no incentive for hospitals to share their data with the PHR. In addition, all the data resided in Google's servers.

In contrast to Google Health, the Blue Button app is all about openness. It can be adapted and enhanced for use with any open source or proprietary PHRs or EHRs. It is meant to be shared and incorporated into any of these other systems In this respect the Blue Button app is very similar to popHealth, another open project that has become a great success in the past year.

This is a key point made by the VA's Levin who said he'd like to see the new adapters expand the technology's capabilities. "We're cheering from the sidelines when folks like RelayHealth adopt it and even change it to make it more useful to customers," he said. "We think that's a great thing, including if they do more with it than we do ourselves. That's the whole idea behind the concept."

Perhaps the Blue Button app will finally demonstrate to the industry as a whole what has been completely obvious to the open health community for decades--that an open health approach is the key to success in health IT.