Kim Nazi and the Blue Button Initiative Team

Veterans, Medicare recipients and military health care beneficiaries today can download digital files of their available personal health data on a computer, smartphone or flash drive, providing them with instant access to critical information and promoting personal management of their own health care. 

This groundbreaking development is possible because of additions to three government websites, all now containing a “Blue Button” icon that allows individual users to login, view, print and save copies of their available personal health information, some of which is extracted from organizational health records. More than 250,000 people had downloaded their health information through the fledgling Blue Button initiative by the spring of 2011, but there is a potential for millions of people to use the system.

“The idea is to engage consumers in their own health and health care,” said Dr. Stephen Ondra of the White House National Science and Technology Council. “This moves the medical information to the consumers where they can access it and use it in ways they feel appropriate.”

Unlike electronic medical records that are owned and controlled by doctors, personal health records available through Blue Button systems are owned and controlled by the individual. This allows the patients to take their health records from appointment to appointment, and from doctor to doctor.

This is important because a doctor’s quick access to a patient’s medications, allergies and medical history can save a life or make a big difference in a medical emergency. Blue Button information makes it easier for veterans who see a doctor outside the medical system of the Department of Veterans Affairs (VA). It also helps healthcare providers avoid duplicate procedures and tests, which protects the patient and saves time and unnecessary health care costs.

This achievement, placing the government ahead of the private sector, is made all the more impressive because it spans three agencies, requiring unparalleled collaboration and adaptations to different computer systems.

Among those who quickly embraced the idea and led the initiative was Kim Nazi, an analyst with the VA. Nazi worked tirelessly with colleagues at her department, including Rachel Lunsford and Howard Green, to make personal health information more accessible last year to veterans on the My HealtheVet website. 

The VA group collaborated with Lorraine Doo, the acting deputy director of the Office of eHealth Standards and Services at the Centers for Medicare and Medicaid Services (CMS), who helped create the Blue Button consumer record system on the MyMedicare.gov website. 

In addition, Jenna Noble of the Department of Defense (DOD) Health Services Systems Program was part of a team responsible for making patient personal health information accessible through the TRICARE Online website, and working with the two other agencies. TRICARE provides health coverage for active duty service members, National Guard and Reserve members, retirees, families and survivors worldwide.

The accessible information on these government sites can include a combination of self-entered information such as medications, allergies, immunizations, medical events, health care providers and treatment facilities and data extracted from the organizational medical record such as the patient’s complete medication history, allergies and laboratory results.  It also can include emergency contact information, family health history, military health history and other health related information.

“There was a chorus of voices saying the same thing. ‘What we can do to advance consumer engagement is to take a simple step of providing consumers access to their data,”’ said Nazi.

In bringing these systems online, the VA, DOD and CMS shared information, and strategically developed the technology and format.

“We were able to design and implement it in a short time, worked together, and now our constituents can generate and download a copy of their available health data in a simple format,” said Nazi.

Noble said there has been “robust coordination between DOD and VA.”

“We meet at least weekly, and we shared our successes and failures,” Noble said. “We’re constantly trying to make it better.”

Doo said there were technology challenges along the way, in part because CMS uses a claims system and the VA uses an electronic medical record model. “It just took technical people dealing with each other,” she said. “Getting consensus was not difficult.”

Nazi said all three agencies have been making improvements and “releasing information in stages rather than waiting until everything could come online at once.” Additional types of information from the VA health record are in the process of being added to My HealtheVet and the VA Blue Button.

The availability of the online data is an outgrowth of a 2010 Markle Foundation initiative that focused on ways of getting health information into the hands of consumers. While Blue Button is still in its infancy in terms of usage, its potential is enormous. Medicare covers 44 million people, while there are more than six million patients in the VA system and 9.6 million who are covered under TRICARE.

“When you look at one of the greatest challenges facing the country, it’s how to deliver health care with greater quality and more efficiency,” said Ondra. “Blue Button is one of the ways we can manage information and involve consumers in their own health care. It’s a significant way to transform the system.”