Blue Button protocol for easy EHR transfers fails to gain traction

The federal push to adopt and use the Blue Button format for exchanging healthcare information between clinicians equipped with electronic health-record systems and patients armed with home computers and mobile computing devices is, at best, stalled, according to a recent survey by the not-for-profit Workgroup for Electronic Data Interchange.

WEDI queried 274 representatives of providers, health plans, health information technology vendors and claims clearinghouses last fall in the second annual survey of industry awareness of Blue Button. Only 8% of respondents said their organizations actually used what are known as Secure Blue Button Trust bundles delivered using the DIRECT messaging protocol. That was down from 15% of survey respondents in 2013. The survey was conducted online.

Asked whether they were familiar with the feds' Blue Button initiative, just 33% of respondents in the newest survey indicated they were, down from 37% in the 2013 survey. Another 34% indicated they'd heard of Blue Button, but weren't familiar with it, compared with 36% a year earlier.

Blue Button was conceived by the Veterans Affairs Department as a quick method to achieve interoperability between providers and veterans by enabling them to obtain copies of their medical records from their Web-based personal health record, a module of the VA's VistA EHR. The name comes from the Blue Button on the VA's PHR that initiates the download.

The first Blue Button-reproduced records were in the plain text ASCII format, readable by people and by most computers.

Blue Button has since been touted by President Barack Obama, dozens of healthcare organizations and vendors, and by federal health IT policy leaders. It's also been the subject of federally sponsored developer contests. It's later, beefed-up versions give it more capabilities for data-sorting and categorization.

But Blue Button remains just one of several channels by which providers might achieve interoperability between their systems and with patients.

“We're starting to see there are other technologies out there to do this,” Jopp said. The standards framework FHIR (which stands for Fast Healthcare Interoperability Resources) is aimed at improving interoperability, as is Apple Healthkit.

For providers and developers, “It's a little unclear which horse you bet on,” Jopp said. For now, there is no “clear leader you can rally around.”

In comparison, the use of the federally sponsored messaging protocol DIRECT rose to 39% of respondents from 30% in 2013.

Jopp cautioned that the survey didn't reach the same respondents in 2014 as it did in 2013, and that may have affected results. Still, he said, if there had been a significant uptick in Blue Button adoption and use, this year's survey results likely would have reflected that.

The use of personal health-record systems, which also have been highly touted, but slow to be embraced by both providers and patients, is increasing, albeit slowly. In the WEDI survey, 39% said their organizations are offering a PHR now, 15% are in the process of doing so and 4% planned to offer one by the end of 2014.

But that's more than a dozen years after the VA, one of the pioneers in this area, launched its MyHealtheVet PHR.

“We've all been working on personal health records for more than a decade and the traction hasn't been there,” Jopp said. “We're (still) trying to figure out how to get people to move. The demand out there for consumers hasn't been as high as people thought when they originally conceived of PHRs.”

Results of the survey were sent to HHS Secretary Sylvia Mathews Burwell (PDF).

Follow Joseph Conn on Twitter: @MHJConn



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