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Customer Experience and Design

Pushing the Blue Button for Meaningful Use

It has been shown that active patient engagement results in fewer hospital readmissions, decreased medical errors, and less consequences resulting from poor communications. Engaging patients improves healthcare, saves money, and reduces errors. Meaningful Use has a program goal to deploy technology to raise patient engagement. The timing is ideal, since more patients are connected every day using smartphones, tablets, and other mobile computing devices.

Improving healthcare is a training problem, which I discussed in an earlier blog. Along with changes to our general education about healthcare, we can adopt new technology to enable this education. Many organizations are providing online content, encouraging patients to manage their own health, and more technology solutions are appearing every day. For example, the HealthIT.Gov group has released details of their Blue Button + campaign.

mj blogThe Blue Button + program is intended to engage consumers (patients) in three distinct ways:

  • First, by easily providing access to patient’s health information.
  • Second, by allowing patients to take action on this information.
  • Finally, to shift the patients attitudes about their role in their own healthcare.

The technology behind Blue Button + is designed to ensure everyone can access their health information easily and quickly. The success of this has been proven. In 2010, the Department of Veteran Affairs started the Blue Button initiative. Since then, over 88 million Americans have been given access to download their health record from portals offered by CMS, Department of Defense, Aetna, and United Healthcare. Over one million Americans have downloaded their health records.

This is a challenging issue because healthcare data most often lacks structure, is inconsistent, has no secure transport, and is not seamless. The Blue Button + program has been released to address these issues. It does so by offering a structure and transport mechanism for the data, pre-defined anchor bundles, and triggers to automate the transmission.

Structure is accomplished using a Consolidated CDA (C-CDA) template. This same XML template is described in the Meaningful Use Stage 2 requirements. It uses a standard message format to move data between systems. Most modern Health IT solutions support CDA and will support C-CDA soon.

Transport leverages the DIRECT protocol using SMIME/SMTP transport to move data between systems. This uses the same infrastructure used by email to transmit health information between systems. DIRECT adds security to this process by pre-defining trust relationships between the sending and receiving systems.

All of the requirements listed so far are Meaningful Use Stage 2 regulations. Blue Button + adds some extra considerations to provide a better experience. This includes the Blue Button Anchor Bundles to pre-define collections of trust relationships, transmit context to help label messages based on their source and time of transmission, and finally enable the ability to automate the message push function via triggers. Triggers enable automatic updates to receiving systems when patient data changes on the source system. These let patients, when they register, determine how often data is refreshed between these systems. Once this trigger has been defined, the patient has nothing else to do, yet still receives updated data each time the data is updated at the source.

Have you had experience with Blue Button + or downloading your health information by other means?

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Mike Jenkins

Mike Jenkins has over 25 years of experience architecting, developing, and implementing solutions for organizations in the US, Canada, Europe, and Asia. Mike is experienced in healthcare, finance, defense, manufacturing, training, and retail industries. Some of Mike’s healthcare projects include: developing a core measures proactive monitoring system; developing an eHealth strategy for a growing community hospital; implementing transparent pricing and outcomes measurement solutions; automating clinical and administrative tasks through forms automation; connecting multiple healthcare systems through a common patient portal; and developing an electronic medical record application. He designed the Physician’s Portal and Secure Messaging Product for one of the top-five vendors in clinical information systems. His application development experience includes Amalga, CPOE, Clinical Portals, Patient Portals, Secure Messaging, HIM, Interoperability, and NEDSS for State level health departments. He is a Project Management Professional (PMP), a Certified Rational Consultant (RMUC), a LEAN Black Belt, and a Microsoft Certified Technology Specialist (MCTS). He is fluent in most methodologies and teaches the PMP Certification course in Atlanta.

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