President Barack Obama touted the technology in an Aug. 2 speech before the Disabled American Veterans national convention in Atlanta.
"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 when you need them and can share them with your doctors outside of the VA," Obama said.
When the technology officially rolls out in October, according to the VA, veterans will be able to access their own blue buttons via their Web-based MyHealtheVet personal health records. The technology will pull data from their medical records at VA hospitals and clinics as well as self-entered metrics such as blood pressure, weight and heart rate, according to the VA.
The blue-button technology outputs the data into an ASCII text file. The information can be printed or stored on a computer, thumb drive or other portable storage device.
A sample of how a veteran's record appears when downloaded using the blue-button function can been seen here.
In its 18-page report, Common Framework for Networked Personal Health Information, Policies and Practices, the Download Capability, Markle said that the VA and the CMS were "leading the way in making publicly available sample data sets for demonstrations" of their jointly developed download capabilities. "We call on other private-sector custodians of health information to join the effort by contributing additional sample data sets and joining in problem-solving."
Christine Bechtel is vice president of the not-for-profit National Partnership for Women & Families and serves on the federally chartered Health IT Policy Committee, which advises the Office of the National Coordinator for Health Information Technology at HHS. Bechtel also served on the Markle work group on consumer engagement that developed the policies and practices recommendations in the Download Capability report. Bechtel was effusive in her praise of the VA and the CMS in developing the blue-button technology.
"I can't tell you how delighted I am that the federal government has taken the leadership in this," Bechtel said. "The technology is never the barrier. It's always a matter of leadership."
One recommendation from the Markle work group report is that the federal government use its leverage in the health IT subsidy program under the American Recovery and Reinvestment Act of 2009 by including a requirement that electronic health records have download capabilities as a future meaningful-use criterion for subsidy eligibility.
"One of my concerns under meaningful use is that patients will end up in a system where they will have access to their information through a portal, but if you have information in six or seven places, you can access it but you can't move it," Bechtel explained. "I'm hoping in the next phase of meaningful-use criteria, software developers will use the technology to upload their information to centralized personal health records."
In addition to the subsidy program, the group recommended that government include download capability as "a core procurement requirement for federal- and state-sponsored health IT grants and projects as well as a priority in health information exchanges (HIEs) and private-sector purchasing initiatives for personal health information services."
Members of the Markle coalition also said in the report they would do their best to ensure that download technology is implemented in systems they support.
The Markle paper notes that fair-information practices, which are globally recognized privacy principles, call for patients to have a right to have copies made of information about them that has been created and stored by others, that the Health Insurance Portability and Accountability Act of 1996 gave patients the legal right to request and receive copies of their records from "covered entities" as defined under the law, including healthcare providers, and that the health IT provisions of the stimulus law give patients the right to request and receive electronic copies of their EHRs, if available.
The Markle document recognizes that an increased ability to download patient information also increases the risk of unwanted exposure of an individual's personal health information, and, in a worst-case scenario, possible collection via automated disclosures.
"Specifically, an individual may want to authorize a service to aggregate personal health information on the individual's behalf," the Markle report's authors wrote. "Clearly, the most efficient way to perform such aggregation is through automated downloads of the individual's personal health information. The challenge is, therefore, not to distinguish between a human and a machine, but to be able to detect an individual-authorized machine versus a nonauthorized machine."
Markle also suggested that government, through the National Institute of Standards and Technology and other agencies, "recommend a framework for acceptable methods and accuracy thresholds for the initial identity proofing and authentication for individuals accessing copies of their personal health information online."
Finally, the report advised that organizations holding patient records make available two distinct pathways for downloading information, one for use by humans and another by machines.
