Blue Button (and Blue Button Initiative)
The Blue Button refers to both a web-based tool for the download of medical record information and an initiative to make accessibility and sharing of health records easier for patients through the adoption of this tool   . The button is a single, highly visible, clickable web button that allows the individual to download his or her medical record in a digital format from a secure website with a minimal number of clicks . The goal of the Blue Button tool is to make it easier for users to access, examine and share their health information with doctors and other providers as they see fit .
According to the VA: “VA’s Blue Button allows you to access and download your information from your My HealtheVet personal health record into a very simple text file or PDF that can be read, printed, or saved on any computer. It gives you complete control of this information – without any special software – and enables you to share this data with your health care providers, caregivers, or people you trust.” .
Since it’s creation the Blue Button function has been adopted by several governmental organizations and many private businesses . A full list of committed and implemented organizations can be seen at the Blue Button website (http://bluebuttondata.org/) .
Leadership and Adoption
On August 2, 2010 President Obama announced the creation of the “Blue Button®” – a web-based capability that allows patients to download their personal health information from the United States Department of Veterans Affairs (VA) (http://www.va.gov/), Centers for Medicare and Medicaid Services (CMS) (http://www.cms.gov/) and the Department of Health and Human Services (HHS) (http://www.hhs.gov/)  .
President Barak Obama and his administration have played an active role in the promotion of the Blue Button initiative. In a speech to the national convention of Disabled American Veterans in Atlanta, Georgia on August 2nd, 2010 the president stated that: “For the first time ever, veterans will be able to go to the VA website, click a simple Blue Button and download or print your personal health records so you have them and can share with your doctor outside of the VA.” .
The VA developed the Blue Button in collaboration with CMS, and the Department of Defense (http://www.defense.gov/), along with the Markle Foundation’s (http://www.markle.org/) Consumer Engagement Workgroup. VA’s Blue Button became operational at the end of August 2010 and the initiative was made nationally available in October 2010 .
VA’s My HealtheVet
My HealtheVet (https://www.myhealth.va.gov/index.html)  is a web-based Personal Health Record (PHR) system for veterans  and was the first system to incorporate Blue Button medical record download functionality . My HealtheVet allows Veterans to self-enter their personal health indicators (blood pressure, weight, heart rate), emergency contact information, test results, family health history, military health history, and other health related information. My HealtheVet users who receive VA health care services can also refill prescriptions and view appointments, allergies, and laboratory results online .
My HealtheVet is intended to improve the delivery of health care services to Veterans, promote health and wellness, and engage Veterans as more active participants in their health care . The My HealtheVet portal enables Veterans to create and maintain a web-based PHR that provides access to patient health education information and resources, a comprehensive personal health journal, and electronic services such as online VA prescription refill requests and secure messaging. Copies of key portions of the VA Electronic Health Record (EHR) are being added to the PHR incrementally. Veterans can visit the My HealtheVet website and self-register to create an account .
Once registered, Veterans can create a customized PHR that is accessible from any computer with Internet access. For Veterans who are VA patients, a one-time identity verification process of In Person Authentication (IPA) at a local VA facility provides access to additional features, such as the ability to import extracted VA EHR data to create a complete summary of VA medications and the patient’s self-entered prescriptions, over the counter medications, herbals, and supplements . The site also includes a customizable health calendar, online learning modules, and self-assessment tools .
The Blue Button feature of My HealtheVet allows Veterans to access and download their information into a text file or PDF that can be read, printed, or saved on any computer. Blue Button allows the user to specify information downloaded to include all health data, or be broken out by data class, or by date range .
Of the 1.1 million users of My HealtheVet, more than 233,000 Veterans have upgraded (identity-verified) access to data from their VA medical record via Blue Button . During the first two months following Blue Button’s launch on August 28, 2010 about 100,000 Veterans asked to view their personal health data using the Blue Button and more than 150,000 PHRs were downloaded .
After the VA’s successful launch of Blue Button functionality Medicare incorporated a feature known as Download My Data/Blue Button . Rather than the ASCII text file or PDF download available from the VA, Medicare’s Blue Button allows the download of personal health information as Microsoft Excel file that can be uploaded to a compatible PHR application . The download is available from any computer to patients who log into the secure Medicare access portal (https://www.mymedicare.gov/) . Like the VA system, myMedicare.gov users can add personal health information and create and print a report called the "On-the-Go report" to share with their caregivers and providers .
Medicaid – need more information about Blue Button integration with Medicaid.
TRICARE – need more information about Blue Button integration with TRICARE.  .
Compatible Personal Health Record (PHR) Systems
MyPHR (http://myphr.com/) is a service provided by AHIMA  that can help consumers identify existing PHR systems and evaluate the capability of an individual system to incorporate data downloading using Blue Button  
In October 2007, Microsoft launched HealthVault (http://www.healthvault.com), a free web-based platform for the storage and maintenance of health and fitness information . Microsoft has a page dedicated to helping veterans upload their VA health information into HealthVault .
Additional information needed about other compatible PHR systems .
Blue Button Initiative
In May 2010 the Centers for Medicare & Medicaid Services (CMS) and the Department of Veterans Affairs (VA) provided the public with access to synthetic sample data sets. The intent of this access is to foster innovation, enable industry stakeholders to provide feedback for future development, and to further support e-personal health care using open government principles .
On May 10, 2010, CMS and VA co-hosted a web-based meeting on increasing consumer access to data through the use of Personal Health Record (PHR) applications. This meeting was intended as a dialogue and exchange of ideas to foster innovation, and as an opportunity for representatives from the PHR industry to gain experience in using data from the VA and CMS PHR systems .
Presentations were made by Todd Park, HHS Chief Technology Officer and Peter Levin, PhD. VA Chief Technology Officer about the Mymedicare.gov website and the VA's My HealtheVet PHR. These representatives from CMS and VA also presented sample data sets of the information that patients would be able to download using the Blue Button function. These data sets were made available to the public to facilitate the development of compatible PHR systems and services. The released data sets can be used to test PHR functionality and related health information technology applications and services .
The presentation and release of sample data sets are part of the federal government's ongoing efforts to support ehealth initiatives and open government principles. CMS provided test files for both CMS and VA, which PHR application vendors can download to determine their compatibility, usefulness and usability with various tools .
Presidential Innovation Fellows
In May 2012, the White House launched an initiative to “pair top innovators from the private sector, non-profits, or academia with top innovators in government to collaborate on game-changing solutions that aim to deliver significant results in six months. “
One of the five Presidential Innovation Fellow positions is titled “Blue Button for America”. The goal of this position is to “Develop tools that will help individuals utilize their own health records -- current medications and drug allergies, claims and treatment data, and lab reports -- to improve their health and healthcare.” . By doing this, the president and white house staff are seeking to “empower all Americans, working to spread implementation voluntarily by the private sector and helping to stimulate the development of tools that can help individuals utilize their own data to improve their health and healthcare.” .
Submitted by (Arthur Knepper)