The patients need and want their health data. Not a new theme, not a new demand. And, really, no one is arguing that patients should “own” and have complete access to their medical records. In fact, it’s a law. While not often considered a hot topic at the C-suite level, the government has taken some very interesting steps to encourage patients to become willing participants in their care, be it through ACO preventative care measures or healthcare standards.
Two government-designated standards, Consolidated CDA (data) and Direct Project (communication), are creating some very interesting options for data access. Combine the widespread usage of mobile devices and BlueButton+, and I believe the possibilities are fascinating for applications that truly involve patients in their care.
Humetrix‘ mobile application iBlueButton has been making quite a splash recently. The company just today announced that iBlueButton was named “Best Overall Consumer App” in the 2013 Mobile Merit Awards. And last year, Humetrix won the ONC Blue Button Mash-Up Challenge. To discuss the potential of patient-driven health information exchange, I asked Stephen Mickelsen, Mobile Application Architect at Humetrix, to answer the following five questions.
Kudos to Greg Meyer for bringing iBlueButton to my attention during a recent #HITsm chat.
I’ve often found that answers to obvious questions often have unexpected answers, so let’s start with an easy one: What motivated you to launch and develop iBlueButton?
Stephen Mickelsen: It has been clear to me from the start that the Blue Button initiative to provide easy and secure online access to health information to patients and their families is transformative and a major step forward. The impetus to create iBlueButton apps was to deliver the mobile embodiment of the Blue Button initiative in providing “one click” mobile access anywhere and anytime to Blue Button records.
As most of us do not receive healthcare from just one location and one provider — and that is especially true for our aging parents and relatives; what drove us to develop iBlueButton is to enable patients to have their medical records in their own hands at all times through using their mobile devices. Enabling users to access their Blue Button records anytime/anywhere so that these records can be shared with providers at the point of care takes the Blue Button initiative a critical extra step forward.
What type of technology currently has to be in place on the healthcare provider’s side for iBlueButton to be an option for patients?
Mickelsen: For healthcare providers, what is required in the best-case scenario is a Meaningful Use stage 2-certified EMR patient portal which uses the Direct Protocol and Blue Button+ standard to enable patients to transmit their record to a Direct address of their own choosing (the View, Download, Transmit –VDT – requirement). The iBlueButton app to be released this fall provides the user with a Direct Address, which once entered on the patient portal allows C-CDAs sent from the portal to be received directly within the iBlueButton app.
Until MU-2 VDT requirements are met, iBlueButton today provides a consumer-mediated health information exchange solution with no or minimum technology requirement on the provider side. With iBlueButton, over 80 million Americans can easily and securely download their VA, Medicare, TRICARE, Aetna and Relay Health Blue Button records to their mobile device.
Available now for 37 million Americans covered by Medicare and their family caregivers, the iBlueButton app parses the Medicare Blue Button ASCII claim file, translates its multiple billing codes and creates an intuitive longitudinal health record built from a 3-year claim history. At the point of care, the patient can, in the simplest use case, share his or her up-to-date medical history, full list of medications or detailed names and contact information of all healthcare providers.
For providers using iPads and the iBlueButton Professional app, our device-to-device push technology allows for health information exchange directly at the point care under the direct control of our app users.
What lessons did you learn from watching PHI predecessors Microsoft HealthVault and Google Health?
Mickelsen: There are several lessons we all learned about these PHRs – the first of which is that patients are unwilling or don’t have the time to enter their health data manually and, as a result, neither Google Health nor Microsoft HealthVault achieved much success in the market.
Secondly, physicians will not trust health information which has been solely created and edited by patients without also having access to authenticated health care records of their patients.
Thirdly, mobile technology has gotten everyone used to simple “one tap” user interfaces which are much preferred over the more complex traditional web-based PHR user interfaces.
Lastly, native mobile apps are the best method for giving patients anytime/anywhere access to their data, even when no Internet connection is available (e.g., in a natural disaster situation or in an ER with no wireless access), when web-based records will not be useful.
We talk quite a lot about the simplicity of Direct protocol and the benefits of human-readable consolidated CDA documents. What were some of your biggest challenges developing your programs using these standards? And, are they as “easy” as everyone hopes?
Mickelsen: Direct was not conceived with native mobile apps in mind and in consequence, Humetrix has had to innovate here and build a set of server functions to make use of the Direct protocol (and the Blue Button+ standards which use the Direct transport protocol) in a mobile environment, such as developing the means to securely relay incoming Direct messages to our users’ mobile devices as well as a means to manage Direct addresses. For the latter, many use cases must be considered: from a single user wanting to employ the same Direct address for multiple devices, to being able to have multiple user accounts on a single device each with an individual Direct address.
Finally, we went beyond the Direct and Blue Button+ standards to provide push notifications to notify iBlueButton app users when their online health information is updated so that they could review the new information immediately.
The biggest unsolved problem with Direct is the lack of knowledge of patients and of providers about “Direct” and how a “Direct Address” will be used. Our mobile application of Direct providing automated generation of Direct addresses for our users somewhat eases this lack of familiarity with the technology on the patient side. However, healthcare providers and payors adopting Blue Button+/Direct should clearly communicate and educate the public about Direct and Direct-based technologies: what Direct is all about, and how to use it. Patients are now left to independently (or with the help of hospital or clinic personnel) navigate on their own to the patient portal and then manually enter their Direct address in the appropriate place.
There needs to be a means to make it convenient for app users to insert their Direct address into the data holder’s EMR system. Until a solution to this is found and incorporated into the Blue Button+ implementation guide and broadly adopted, the use of Direct as a means of enabling patients to download their health information will be much slower than might otherwise be the case.
Look five years into the future and give me your best prediction for BlueButton’s place within the health information exchange discussion.
Mickelsen: Consumer-mediated exchange of health information through accessing and sharing of Blue Button records will become as important – or even more important – than query-based exchange through HIEs by providers, or use of Direct for Provider-to-Provider “push” type of data exchange.
The reason is simple: consumer-mediated exchange based on ubiquitous mobile devices to access and share medical information can scale in a way that HIEs and provider-provider exchange will not be able to match at the national health care system-wide level, and patients and their caregivers are getting more and more involved in managing their own healthcare in large part because of the ever growing cost of healthcare.
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