Blue Button Interoperability – A Step Backward?

Last month when it was announced that all health insurance carriers in the Federal Employees Health Benefit Program (FEHBP) were to add Blue Button functionality, I was excited. Anything that promotes access to health information for patients and makes it easier for them to update new providers is a good thing. The amount of positive press the Blue Button initiative received only highlights the desire of both patients and those who work in the healthcare industry to embrace this idea.

The one thing that surprised me about the Blue Button initiative was the output, which is either plain text or PDF. These are great output formats for the patient to read their health information, but they are not interoperable – they cannot be uploaded into another provider’s system.

With Meaningful Use criteria, which was part of the American Recovery and Reinvestment Act (ARRA) of 2009, all certified Electronic Health Record (EHR) systems should be able to view and exchange a Continuity of Care Document (CCD). With this ruling, the CCD document has since become an accepted way to transfer health information among providers and with patients.

The CCD is unique in that it is has structured data that is also human readable using a standard style sheet. This means any patient can view the CCD document using a standard web browser, and an EHR may upload and update the patient health information stored locally. By satisfying human-readability and machine-readability, it is the best of both worlds.

Since the CCD standard, which was endorsed by the ONC for Meaningful Use, is to be the industry standard for sharing health information for the future, I was surprised that the CCD standard was not embraced by Blue Button. Having a unique format for Blue Button causes me the following concerns:

Patient Confusion. Because of Meaningful Use, EHR vendors have already added CCD capability to their patient portals. Patient Health Record (PHR) solutions, such as Microsoft Healthvault, have already embraced CCD as well. Now we are asking these applications to add an additional Blue Button to download their data in yet another format. If I were a patient unfamiliar with healthcare IT, I would ask: Why are there two? What’s the difference? When do I need one versus the other?

Interoperability. Blue Button output is not machine-readable. If a patient takes Blue Button output to a provider, the health information will have to be manually entered into the EHR by the staff. And, how does the new medical information get transferred to the next point of care? If it’s Blue Button once again, it is manual.

Duplication of Vendor Efforts. Given that many applications already support the export of a CCD due to Meaningful Use, additional work will be needed to make their product “Blue Button compatible.” HL7 is working on a transformation to convert CCD to Blue Button, which will lighten the workload for the vendor, but it is still a redundant effort to produce information that already exists in the CCD.

As I said in the beginning, I am pleased that there are new ideas and positive press coverage about the availability of personal health information. However, I can’t help but wonder whether Blue Button is taking a step backwards with regards to interoperability.

I am not aware of how the Blue Button format decision was made, but I can guess that maybe a simpler alternative to CCD was preferred. But, from my point of view, many applications already support CCD, and it has the big advantage of being truly interoperable.

One suggestion I have for the developers of the Blue Button: Allow a Blue Button to export a CCD format as well. At least that would allow the patient portals and PHRs that already support CCD to not take a step backwards in their efforts to create a connected healthcare system.

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Rob Brull

Rob Brull is the product manager for Corepoint Health. He has worked with software products for over 15 years as both a product manager and sales engineer. Past companies and organizations include Tyco Electronics, Deloitte Consulting, and various distributors of software monitoring and control products. His main focus is to ensure his solutions enable customers to simplify healthcare integration complexities with user-friendly yet powerful software capabilities. This includes meeting applicable Meaningful Use requirements as well as fully supporting related healthcare standards such as CCD, CCR, and greenCDA. Rob is also a Certified HL7 CDA Specialist.