Traditionally, health IT interoperability specifications have been structured, consensus-driven, focused on system-to-system communication first, and haven’t really focused on going that extra mile, said Shahid Shah, software analyst and author of the blog, The Healthcare IT Guy.
But, the Blue Button Initiative, created by the Department of Veterans Affairs in 2010, is changing all that, he said. Shah spotlights seven lessons learned from the Blue Button.
1. Don’t underestimate the importance of good leadership. The Blue Button Initiative was the first health IT interoperability standard promoted by the President, which made a difference, said Shah. “It was taken seriously, even though it didn’t come from an established standards body and wasn’t designed by consensus,” Shah said. “In fact, senior leadership at [the] VA made sure it didn’t die in a committee somewhere and ensured that paralysis by analysis didn’t hold it up either.” He added the initiative was a “textbook” lesson on how to ensure something big happens quickly – “through good leadership and steady stewardship.”
2. Patients should be at the center of the technology. The Blue Button was created quickly and released rapidly so veterans could benefit immediately, said Shah. “Unlike other health IT specs, which mostly target technicians, programmers, and IT people, Blue Button was defined and designed for one of the most important user populations in the armed forces – the veteran.” Shah added that when working with Blue Button folks, he was impressed with how “every meeting focused on how to perform the simplest and most useful tasks, so veterans could benefit quickly.” Not to mention, he said, the technology was available immediately to users without special permissions or forms.
3. Focus on human-readable exchange formats first. Blue Button was designed to be “human readable in simple text formats or universally acceptable PDF formats,” so if one system produces a record, but another system can’t read it immediately, physicians and professionals still could. “Later, as systems were upgraded to read the format, then it grew in importance,” Shah said.
4. Put the power in the hands of the patient. “The patient is the “last mile” and the most important participant in the healthcare system, said Shah, and the Blue Button approach puts the power into their hands. Anyone who wants his electronic record presses the “blue button” and has it immediately. “They can put it to any use they see fit and, as consumers, can demand that other health IT systems begin to omit or accept such records,” he said.
5. Flexibility is key. The initiative’s exchange format is simple enough to be handled by legacy as well as modern systems. “[It] was designed to generate records from a system that’s decades old,” Shah said. “Unlike modern specs, like HL7’s CCD or ASTM’s CCR, that are based on XML, the Blue Button format is plain text.” Although XML is a “great structured format,” he added, it requires more code and more computing resources to generate than the Blue Button format.
6. Give patients the responsibility. One of the reasons modern systems don’t share data easily between legal entities, said Shah, is because owners of the systems are worried about security. “In the Blue Button model, the patients ask for their own records, are empowered to download and manage it themselves, and, like their banking or financial data, are required to secure it and protect it themselves, too,” he said.
7. Find the balance between physicians and systems. The initiative is useful as a structured data format as well as an unstructured format, said Shah. “Although Blue Button is a terrific human-readable and empowering format for veterans, it’s almost as useful as a structured format [like] CCR and CCD,” he said. “With proper handling and parsing, Blue Button data formats can be useful to both humans and systems in the long run.”
Follow Michelle McNickle on Twitter, @Michelle_writes
