Blue Button, HIPAA and Mobile Devices

Bettina Experton
Bettina Experton

Guest post by Bettina Experton, MD, MPH, CEO of Humetrix.

The HITECH Act and its $30 billion attached budget mainly focused on building a provider-based health IT (HIT) infrastructure for providers to exchange patient health information. Two years after its implementation and the adoption of Stages 1 and 2 of meaningful use (MU 1 and MU 2) requirements for the use of electronic health records (EHRs), the federal government, EHR industry and providers across the country can claim remarkable results: more than 55 percent of hospitals and close to 50 percent of primary care physicians were using basic EHRs in 2012 (versus 10 percent, and 14 pecent respectively in 2009).

Now that the building of an HIT infrastructure is well underway, the capacity of the newly deployed provider EHRs to allow for health information exchange (HIE) remains limited.  The persistent lack of interoperability of the more than 1,200 MU-certified EHRs and the scalability issues attached to provider-centric means of HIE leave policy makers, providers and especially patients wishing for a novel approach to achieving true anytime, anywhere HIE.

In almost all other economic and social activities, personal information exchange is driven by the consumer. In banking for instance, whether it is online, using mobile apps or ATM cards, consumers direct and mediate the necessary exchange of their personal information to enable and complete the desired transactions. The days of mainly bank-to-bank transactions by letters of credit are long gone. The convenience and control of today’s online and mobile banking services make them universally used around the globe.

 

Why should we think differently for healthcare? Why should HIE be primarily driven by the provider, with operational cost, provider adoption and patient consent issues impairing the process. Could a consumer-centric or consumer-mediated type of exchange become a critical means of HIE, in addition to and complementing provider to provider means of exchange?

The federal Blue Button initiative, initially launched by the Veterans Administration (VA), the Centers for Medicare and Medicaid Services (CMS) and the Department of Defense is now embraced by more than 500 private and public organizations.

Blue Button is about giving Americans easy access to their online health records and allowing them to share that data with their care providers. Today more than 100 million individuals can access their Blue Button records from provider or payor portals displaying the Blue Button icon. The Blue Button record is also standardized (the Blue Button+ content and transport standards) for machine and human readable records in C-CDA format for patients to receive and use with applications of their choice, whether on their mobile devices or desktops. The Blue Button+ standards are equivalent to the MU-2 requirements for providers to enable their patients to View, Download and Transmit (V/D/T) their health records from MU-2 certified EMR patient portals.

Starting in October for hospitals and January 2014 for office- based physicians, patients will be able to “V/D/T” their health or Blue Button records. This combination of the Blue Button initiative, MU-2 and expanded HIPAA regulations, which give patients a right to electronically access their health records, is providing a powerful policy and regulatory landscape to empower patients to not only better engage in their healthcare, but also to enable consumer-mediated exchange to address the large and persistent HIE gaps.

With consumer-mediated exchange enabled by these policies, patients become the direct connectors to their records and gain new control over whether, how and when to share critical, up-to-date health information with their physicians. As mobile devices are increasingly becoming the platform of choice for accessing information, patients who are accessing and storing their Blue Button records on their own devices gain the capacity to enable consumer-mediated exchange anytime and at any point of care.

In its September 2012 report, “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America,” the IOM stated that about one-third of healthcare expenditures are wasted and up to 100,000 preventable deaths per year result in part from a lack of information at the point of care.

The IOM further called for the use of interoperable EHRs and mobile technology to help solve this issue and enable more effective communication between patients and providers. In its response to an HHS and CMS request for information (RFI) to accelerate health information exchange, the Consumer Partnership for eHealth, a coalition of more than 150 patient advocacy groups and consumer organizations, called on HHS and CMS to promote the use of Blue Button and Blue Button enabled mobile applications, such as my company’s iBlueButton mobile (and Blue Button+ certified) apps especially for use by patients covered by Medicare or their family caregivers.

On average, a Medicare beneficiary sees seven different physicians in a given year. With only 30 percent of these physicians capable of exchanging their patient health records with other providers, the likelihood of any physician caring for Medicare patients having a complete list of medications or medical history for their patients at any given time is very low. The low likelihood that physicians have an up-to-date patient history when making diagnostic and therapeutic decisions is a critical patient safety issue.

Empowered with their own mobile devices and benefitting from an enhanced HIPAA policy, MU-2 requirements and the Blue Button initiative, patients can now better manage their own healthcare for safer and more cost-effective results. On June 6, in a Blue Button meeting at the White House, more than 20 private organizations (patient facing organizations, payors, EMR and other HIT and mobile technology companies) and government agencies (including VA, CMS, the New York eHealth Collaborative) all agreed that the time is now to widely communicate to consumers and healthcare providers the public health importance of Blue Button, and the right of individuals to obtain an electronic copy of their medical information as guaranteed by the revised HIPAA rule, which takes effect this month.

As a group, they decided to support a national campaign for Blue Button. Supporters of the campaign will be announced at the Patient Access Summit in Washington, DC on September 16. Let’s all embrace this initiative and support this important public communication campaign to empower us all and help truly reform healthcare to deliver lower costs and, most importantly, better health outcomes, for all.

2 comments on “Blue Button, HIPAA and Mobile Devices”

Today more than 100 million individuals can access their Blue Button records from provider or payor portals displaying the Blue Button icon.

What does “can access” mean? Just barely one year ago the statistic thrown around was “1 million VA patients have registered for Blue Button” and even that was ambiguous as to whether or not the patients actually registered for Blue Button or the VA simply created an account for them, and whether or not they actually downloaded their health record. I am skeptical of these numbers.

Blue Button initiative … is now embraced by more than 500 private and public organizations.

Who? Where’s the list? If a company were seeing this much traction they would have their biggest customers’ logos plastered all over their site. I’ve seen some providers first-hand who do indeed have Blue Button because I’ve consciously looked for them but otherwise no one I know has ever heard of it.

The Blue Button record is also standardized (the Blue Button+ content and transport standards) for machine and human readable records in C-CDA format for patients to receive and use with applications of their choice, whether on their mobile devices or desktops.

Where is Blue Button+? Literally no one is using it. And worse, except for Ryan’s TED talk, no one seems to be selling it to vendors. I have some more lengthy thoughts on that here: https://groups.google.com/forum/#!topic/bluebuttondev/pioSOFfr_mE

Like you, we’re building a mobile app that integrates Blue Button: https://useprime.com/. We’re focusing on the personal social networking side of health and Blue Button is one piece of that. Still, it would be a great piece to have.

I want Blue Button to exist. Specifically I want Blue Button+ (the Pull API, not Direct Push). It would be a great thing if providers adopted that. But I don’t see real progress in the real world.

Just discovered all my PHI displayed on my health insurance company site. I don’t want my data health data displayed on my account. Surely the point of the Blue Button is for me to use it if I need it, not for the insurance company to take the initiative and just list everything?

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