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Blue Button

By Meryt McGindley

Blue Button. If you’ve been in HIM for a while, you’ve doubtless heard the term. And despite it being part of the industry vernacular, its meaning remains unclear. Like many terms in a fast-changing industry, Blue Button has had numerous connotations. However, it has begun to settle into a label for any software tool that allows consumers to securely move their health information. Patients with an interest in the contents of their medical records should take advantage of this easy-to-use technology to download their health data into a consumer-facing application (CFA)—typically a PHR app—that they control and keep up to date.

The most ubiquitous method available for consumers to get their health information is by obtaining what is known as a Direct secure messaging address. (“Direct” is shorthand for technology standards that require information to be encrypted from end to end.) A Blue Button-enabled CFA provides a Direct address to users, enabling the secure exchange of health records between HIPAA-covered data holders and their patients.

A Blue Button-enabled patient portal uses consumers’ Direct addresses to send records from a provider’s EHR to the CFA of their choice. If a provider is using meaningful use stage 2-certified technology, Direct secure messaging should already be built into the EHR. Further, the HIPAA Privacy Rule requires that providers send patient records to users’ Direct addresses whenever requested.

The National Association for Trusted Exchange (NATE) is the only national nonprofit focused on helping HIPAA-covered entities compliantly share protected health information with consumers. NATE has prevetted numerous CFAs for trustworthiness in the NATE Blue Button for Consumers (NBB4C) Trust Bundle at https://bundles.nate-trust.org. Provider organizations that wish to send messages to their patients should ask their technology vendors to load this bundle into their trust stores. Subscribing to the NBB4C is free to both providers and consumers.

Through the NBB4C, consumers can choose from a variety of trustworthy CFAs to fit their needs. For example, Humetrix’s iBlueButton is a mobile PHR winner of Health and Human Services’ innovation competition. With iBlueButton, millions of Americans and their caregivers can receive, annotate, store, and share their Medicare, VA, and Tricare Blue Button records securely on their mobile devices. The app also uses Direct messaging to allow users to receive their records from hospital and clinic EMR systems directly on their mobile devices.

Microsoft HealthVault and Medyear, both Blue Button enabled, are excellent all-around PHR apps. Available online and as mobile apps, patients can use HealthVault or Medyear to consolidate records from multiple providers and laboratories. For example, through Medyear Bronze, patients can save and merge health records from various providers into a single master record on their smartphones. Medyear Silver enables consumers to securely send questions related to their PHR to physicians and other caretakers.

Other CFAs available through the NBB4C, such as Carebox and Get Real Health, are offered to consumers as untethered patient portals. The Carebox Direct Box add-on application—part of the Carebox for Box application suite—enables anyone with a Box account to send and receive Direct messages from within Box. Get Real Health’s InstantPHR is touted for its flexibility and ability to grow and change as industry trends dictate. Whether managing chronic disease, setting and maintaining wellness goals, or meeting federal mandates, InstantPHR is equipped to serve the needs of all patient populations and health organizations.

Get Real Health and other vendors are also using Blue Button and the NBB4C to enable data donation for research. For example, Get Real Health is working with the Interactive Autism Network to enable individuals on the autism spectrum and their families to better manage health information and, should they so choose, donate their health data to researchers. This effort illustrates how data donation supports President Obama’s Precision Medicine Initiative as well as hundreds of other initiatives pursuing the power of consumer-mediated exchange.

The VA—recognized as the birthplace of the Blue Button movement—continues to make it easier for consumers to share health information. For example, it uses Blue Button to allow veterans to access MyHealtheVet, a patient portal where users can send data to their non-VA physicians as well as the CFA of their choice.

The Centers for Medicare & Medicaid Services (CMS) is setting Blue Button “on FHIR”—a turn of the phrase to represent the agency’s effort to build an API interface that will allow beneficiaries to use their choice of CFA to download their personal claims information. NATE is currently collaborating with the CMS Blue Button API Team to pilot FHIR-based resources and standard application program interfaces to allow beneficiaries easy access to their electronic health information from Medicare.

Blue Button can be used in a wide variety of ways by a wide variety of apps. The tool will continue to evolve as new technologies grow and spread and as consumers find new reasons to securely move their health information.

— Meryt McGindley is vice president of communications and public affairs for the National Association for Trusted Exchange.