"Blue button" technology pushed to give patients instant access to medical records

Proponents say Web-based entry will save physicians time and hassle from gathering information for patients. But technical and privacy concerns must be addressed.

By — Posted Nov. 1, 2010

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As members of the public-private Connecting for Health collaborative met last winter, several people spoke offhandedly about how great it would be if there were some simple way for patients to download all of their health records from the Web.

That way, patients would have easy access to their own health information, and physicians wouldn't have to spend so much time putting together records requests. The people at the Jan. 27 meeting even came up with a term to describe what they imagined: the "blue button."

Only nine months later, that concept has gone from what-if to reality. Even though, technically, what's being used isn't a button, and it isn't blue.

Two federal organizations have implemented virtual blue-button icons on their patient portal websites that, when clicked, give patients the real-time ability to download their own health information. Meanwhile, the concept is gaining steam in the private sector.

The Dept. of Veterans Affairs and the Dept. of Health and Human Services' Centers for Medicare and Medicaid Services worked together to develop their own versions of the blue button on their respective patient portals, and Because both organizations serve different roles -- the VA provides health care while HHS manages payment for care -- the two blue-button programs offer different things. The VA has a complete medical record for each patient, and CMS provides claims information. But gauging from the response, both provide a service patients find useful.

Both departments did soft launches of the system over the summer. By the beginning of October, more than 60,000 veterans used the VA's systems to access their medical records, and more than 5,600 Medicare beneficiaries used CMS' blue button to access their claims records.

"CMS has long been interested in helping beneficiaries be more engaged in their health care," said Lorraine Doo, senior policy adviser of eHealth standards and services for HHS. The blue button was a way of letting the patients know what data CMS has on them, she said.

Experts say most physicians aren't yet ready to add their own version of the blue button to their websites. For one thing, the physicians' electronic medical record systems probably don't have the capability to provide a blue-button link between their EMRs and their sites.

Still, members of Connecting for Health and others are pushing for widespread adoption of the blue button as physicians face "meaningful use" requirements, passed under the 2009 economic stimulus package, that give patients the right to receive their medical records electronically upon request. The blue button would be a convenient way for physicians to satisfy this requirement, as they could direct all patients with Internet access to the Web to obtain the information.

"The time is fairly opportune to increase awareness for this potential," said Josh Lemieux, director of personal health technology for the New York-based Markle Foundation, which sponsors Connecting for Health. The American Medical Association is one of the collaborative's members.

Driving demand

According to results from an October survey conducted by Connecting for Health, 70% of the public and 65% of doctors agree with the blue-button concept.

Many EMR systems allow for patient portals that provide access to patient records in a read-only format. But they do not allow records to be downloaded or uploaded to another system, such as a personal health record.

Stage 1 meaningful use requirements for EMRs say only that systems must allow for patients to receive electronic versions of their records. (Meeting meaningful use allows physicians to collect incentive payments under Medicare and Medicaid.) But the rules do not specify how those data are delivered, said Sue Reber, spokeswoman for the Certification Commission for Health Information Technology, one of three organizations named by the HHS Office of the National Coordinator for Health Information Technology as an official EMR testing and certification site.

"In most cases, it is not a blue button, because in general the request is going through the physician, and they are going to create that kind of electronic copy for the patient," she said.

Because patients are being asked to share in making more of their health care decisions, having the ability not only to access the information but also to download it will become increasingly important. As demand for data access grows, the demand to make access easier also will grow, Lemieux predicted. Eventually, vendors will feel pressure from those demands and create blue-button applications, he said.

After the VA and HHS launched their blue-button systems, Markle and the Robert Wood Johnson Foundation held a contest for developers to submit ideas for applications that convert data downloaded from one of those sites into useful health tools. Taking the top prize in October was Adobe, which developed an application that converted health data into a pdf file that could be shared with physicians or caregivers.

"Downloading your information is only the first step to making use of it," said Carol Diamond, MD, MPH, managing director of Markle's health care program, in a prepared statement. "The real winner of this challenge is the consumer, because so many different approaches and ideas emerged to help patients put their information to good use."

Privacy concerns

Despite the growing interest from the public, however, there hasn't been much of a demand for widespread adoption of the blue button, in part because many people haven't thought to ask for electronic copies of their records.

The Connecting for Health survey found that 83% of the public have never asked for their records in electronic format. And the majority of physicians surveyed said patients rarely (27%) or never (67%) have asked for electronic records.

Lemieux thinks the lack of interest could be because the concept of downloading medical records as easily as one would download a song is too foreign for most people to grasp. Patients are used to a process of making a formal request for their records, paying a nominal fee per page to have them printed, then waiting several days to receive them. The idea of reducing that process to the act of pushing a button seems too simple -- and dangerous, he said.

More than 80% of both the public and physicians said privacy safeguards were an important part of any federally funded health information technology program. Concerns include making sure the person accessing the records is authorized to do so, and making sure the records aren't harvested by machines developed to "data scrape," or crawl websites to obtain aggregated data.

A policy paper -- whose member co-signers include the AMA -- published by Connecting for Health in August addresses many of those concerns, with recommendations for privacy controls that can be implemented into any blue-button system.

The controls include "challenge response tests" that ensure the person accessing the information is a human -- similar to when a user is asked to type in a string of letters to access a webpage; authentication systems to help ensure that a person logging in is authorized to do so and that he or she understands the possible security implications of downloading that information; and pop-up warnings the patient must read and acknowledge by clicking "OK" before the records can be downloaded. But, the policy paper warns, the pop-ups can't be too intrusive or even too scary looking, or people won't use it.

With its set of specific recommendations for how blue buttons could be implemented in a safe and secure way, Markle is calling on HHS to make it a priority in its health IT efforts. The organization also is calling on private organizations to include blue buttons in any new system procurement contracts.

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