Thursday, January 31, 2013

It Would Be Nice If NEHTA Created A ‘Blue Button’ for The NEHRS And GP Vendors Also Adopted It.

There has been some renewed in the downloadable Blue Button in the last week.
See here:

ONC posts tech guide for Blue Button Plus

By Mary Mosquera
The Office of the National Coordinator for Health IT has made available technical descriptions and guidance for its more automated version of the Blue Button feature aimed at giving patients easier access and use of their health information.
ONC announced in a Jan. 16 webinar an initial draft implementation guide for Blue Button Plus (+), a rebranding of its Automated Blue Button Initiative, so vendors and others can begin to incorporate the feature in their health IT system updates.
Blue Button+ will help providers meet requirements for meaningful use stage 2 because it incorporates in their certified electronic health records (EHRs) the function for view, download and transmit information for patients, said Lygeia Ricciardi, acting director of ONC’s Office of Consumer Health.
“But it goes beyond that, most notably by automating the information update functions for them,” she said at the webinar sponsored by the National eHealth Collaborative.
Any provider, developer or others may access the technical guides to accelerate a growing ecosystem of tools to help patients participate in and manage their care, especially through easier, secure access to their health information, Ricciardi said. The health IT tools also enhance communications between patients and their physicians and improve care coordination.
Blue Button+ is being advanced through ONC’s Standards & Implementation Framework community. The full draft implementation guide will be launched by the end of this month, said Pierce Graham-Jones, Innovator in Residence at the Health and Human Services Department, and a member of the S&I community working on the project.
The draft implementation guidance includes how to transmit data to patients in structured format, how to transmit data to patients using Direct secure messaging protocol, and a privacy and security piece.
More here:
as well as here:

VA Blue Button adds patient summary document tool

By Mary Mosquera
The Veterans Affairs Department has added a new tool through its Blue Button feature so veterans may more easily download a summary of their essential health information. The enhancement is the VA Continuity of Care Document (VA CCD) in xml file format.
The VA CCD uses recognized standards that support the exchange of information between healthcare systems and providers for coordinated and continued care of the patient. VA started Blue Button as an unstructured ASCII text document, a simple download mechanism.
VA has expanded its Blue Button feature with other capabilities, including demographics, active problem list, discharge summaries, progress notes, expanded laboratory results, vitals and readings, pathology reports, radiology reports and electrocardiogram (EKG) list of studies.
“As of today, veterans can electronically download their entire medical record plus CCD summary,” said Peter Levin, VA chief technology officer, on his Twitter account Jan. 20.
Veterans must be authenticated in person at a local VA clinic or hospital or online to confirm their identity to obtain their health information through MyHealtheVet.
More here:
It is interesting to think what this all means. Perhaps the NEHRS is even just an idea which has passed its use by date before it even starts.
Think of it - press the Blue Button - collect your EHR record on your USB key and share it as needed. Ultimate privacy control, ultimate personal control and no centralised database to be cracked.
I also think it would be a good deal cheaper than what is presently planned and everyone who wants such a portable accessible EHR could have one for a few dollars.
Of course we would need Standards and so on and some vendor support to provide genuine interoperability at a record level. Hard to see any losers if such a plan was adopted.
What do you think?


Bernard Robertson-Dunn said...


I don't think that the downloaded version of the veteran's health record is the primary or only copy.

If it were, then I can think of a myriad questions that would need to be answered, not the least being "Do you have to carry your health record at all times in case of emergency?"

Dr David More MB PhD FACHI said...


It is a copy - provided by the VA of what they know abut you so you can share it with other health providers as I understand it.


Anonymous said...

I can see why you'd do that in a health system that had limited interoperability between the various providers, no central record, and in which you really wanted to share your records.

It could work OK for someone with chronic illness so long as:
- there are strong standards that all products support
- they're personally capable enough to make sure that those records get taken to every interaction they have, and they take updates where-ever they go
- they're personally capable enough to manage security on that device (imagine losing an unencrypted USB stick with all your records in XML!!!)
- they aren't worried about emergencies and they have no need for someone that they're not personally interacting with to see those records
- they don't mind all those records being downloaded into each clinician's system, and being up-to-date only as of the last visit

I'm not sure why you'd do this if you had alternatives though. Surely most patients expect their "clinical team" to share data and have access to the most up-to-date data - when I visit my specialist and get a test done, surely my GP should have access to it? A USB stick isn't going to do that.

And in general, I try never to recommend that people put personal data on removable media - a large proportion of security breaches are due to loss of removable or portable media.

In short I think, as eHealth professionals/interested observers, that our aspirations for eHealth should be more than "I can put a copy of my records on a USB stick." That's not the eHealth future I'm imagining.