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Hit the Blue Button!

By Dr. Raag Airan

In my internship a common complaint was that our patients seem disengaged from their own care. They never seemed to remember their medication lists, their own medical history, or other basic items of the medical history. Part of the issue was previous paternalism on the part of doctors that convinced our patients that their care was not their responsibility, but instead, the responsibility of doctors and myriad medical institutions. That's why I got very excited to hear about the Blue Button project.

The Blue Button is an effort by the US Chief Technology Officer and the VA to enable transparency of medical data for patients. Essentially, the VA has a website where after clicking an aptly constructed blue button, a VA patient can download their complete electronic medical record. So far over 300,000 VA patients have downloaded their records.

I see this as incredibly empowering for the patient. Now the patients can be their own keepers – at least as far as the medical data we are so eager to get our hands on when a new patient arrives in our clinic. At the very least, a patient will be able to say "hit my blue button" to a doctor asking questions of their medical history that they may not easily remember. At the most, this has the potential to directly engage the more curious patient in their own care. What do these pulmonary function tests mean? What does it mean that the radiology report says "hazy infiltrate in the right lower lung"? Moreover, giving patients access to their own records easily will allow patients to act as a check on us. Savvy patients can use that information to question whether our recommendations are truly evidence-based or cost-effective.

A lot of this information exists in electronic formats already, but not in formats easily communicated to the patient or to a consulting physician. The Blue Button is designed to address that barrier to communication. And it's not just a feature of the VA system. Per Aneesh Chopra, the US CTO, after seeing the success of the Blue Button project at the VA, Aetna has decided to ensure all their patients – roughly 10 million strong – will have a Blue Button. Moreover, Walgreens has also jumped onto the Blue Button bandwagon for all of its pharmacy records.

So, what do we, as physicians, do now? We tell our patients to hit their Blue Button. If they don't have one we give feedback to the systems that keep their electronic records that they need to provide Blue Button access. If our records aren't electronic, we take advantage of the incentives for HealthIT out there to make them electronic. The VA, Aetna, and Walgreens are already on the Blue Button train - we need to get on board before it leaves the station.

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