Blue Button at 5: Celebrating the Thought Leaders Who are Fulfilling the Vision
October 1, 2015
By Bettina Experton, MD, MPH, CEO of Humetrix

Today, October 1, Blue Button, the federal initiative created to give Americans easy access to their electronic health records, turns five. Looking back and understanding where we are and what we still need to achieve to truly deliver on this revolutionary initiative, a striking but unfortunately common medical mishap story put into perspective for me. Yesterday while attending the HUG/NATE/SHIEC annual meeting in Utah, a colleague clinician and informaticist told me of her mother' s horrific patient story when the health care system and IT system dramatically failed her. Hospitalized for emergency surgery, my colleague's mother was discharged to a rehab facility, within the same health care system, where she suffered a dramatic adverse drug reaction. This happened simply because no one knew of her hospital discharge medications or the medications she had been taking for the various chronic conditions.

For this Medicare-covered patient, the ability to access and share the list of her current medications, pulled from her Medicare Blue Button record, and displayed in clear text by the iBlueButton app with all the necessary prescription details (the name of the prescriber, the date and place where these were filled), on her or her daughter's phone would have prevented the serious medical error she experienced. My friend wished that she would have known of such a lifesaving tool, turning a plain Medicare EOB file into a longitudinal health record with so much of what you need to know right in your hand. Whether in an emergency situation, or simply as part of navigating our complex healthcare system, having this critical information can literally be a lifesaver.

Along with Medicare beneficiaries, millions of Americans enrolled in Medicaid could also benefit tremendously from having their health history with them at all times, to ensure their safety and avoid unnecessary or redundant tests and procedures. Leading the nation in offering such a patient-empowering tool to Medicaid beneficiairies, the State of New York in Redesigning its Medicaid Program has also required its new MMIS vendor to include a Blue Button feature, which Humetrix will provide as a subcontractor to Xerox.

By the end of 2016, over one million fee-for-service Medicaid enrollees in New York will have access to their Blue Button health record. This Blue Button record will not be a plain list of claims, but an actionable, searchable (in English or Spanish) longitudinal health record available for download to their computer, or more practically available on their own smartphone, which for many among the underserved populations enrolled in the Medicaid program, is the primary method for Internet/data connectivity. For these users, the record is securely stored on the device within the iBlueButton app and available even when no Internet connection is present, making it accessible and usable in a clinical setting.

As patient engagement meaningful use requirements have been seriously diminished and postponed, and when interoperabilty across provider systems will remain difficult for years to come, giving patients their medical histories, generated from these valuable Blue Button enabled Federal and State medical claim data sets, is a public health imperative. While new standards like FHIR will ease access by developers to these Blue Button data sets, we should not wait for these standards to be finalized with their unavoidable trust and governance issues. We must let the public make use of the life saving and cost saving tools available now.

Nowhere is the imperative that we aggressively expand Blue Button awareness and use more apparent than in the area of medical errors, as pointed out by the latest Institute of Medicine (IOM) report, Improving Diagnosis in Health Care, in which one can read that medical errors cause 10% of all deaths in the U.S., and that the majority of Americans will be victim to at least one “meaningful” diagnostic error in their lifetimes. One of the key recommendations included in the IOM report is that patients must be an integral and informed part of their own caregiving team, and have access to their electronic health records to facilitate patient engagement in the diagnostic process and patient review of their health records for accuracy.

By providing access to medical records – and making the information actionable – Blue Button tools can literally save lives. Especially among Medicaid beneficiaries, who often have to seek care from disparate healthcare providers, tools that can ensure continuity of care are key to ensure patient safety and cost effective healthcare.

As we celebrate Blue Button’s fifth birthday let’s foremost celebrate the thought-leaders starting with the leaders at the ONC who pioneered the program and today those from the State of New York who are turning a national initiative into a transformative health care program, giving even the most underserved the tools we need to be informed and involved health care consumers. This will truly transform healthcare.

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