Blue Button Initiative (s) 2014, 2015

Personal health records have had a lackluster adoption by patients and their families.  

The Veterans' Administration initiated the Blue Button as a method for veterans to download their VA medical history. 

The "My Health Vet" provides  the access page for downloading Vet's health records. 

My HealtheVet is VA’s online personal health record. It was designed for Veterans, active duty Servicemembers, their dependents and caregivers. My HealtheVet helps you partner with your health care team. It provides you opportunities and tools to make informed decisions and manage your health care


Sample Data available from the Blue Button 

Among the newest features available to Veterans with a Premium Account include VA Notes.  These are clinical notes that your health care team records during your appointments or hospital stays.  Also available are your VA Immunization records, more detailed lab reports and a list of your current medical issues. These features are in addition to prescription refills, VA Appointments and Secure Messaging – all very popular with Veterans!

Study: Low Awareness, Usability Limit Veterans' Blue Button Adoption

Paradoxically the awareness and use of the Blue Button has lagged. The use of personal health records by non- VA patients is also poor.

A recent study in March 2015 re-evaluated the Use of the Blue Burron Initiative.  The results were disappointing.

WEDI Survey Finds Decreased Awareness of Blue Button Tool

Details of Survey

The survey was conducted between Oct. 31, 2014, and Dec. 8, 2014. It included 274 responses from a variety of stakeholders (Clinical Innovation & Technology, 3/16).

WEDI, a designated adviser to HHS under HIPAA, sent the survey findings to HHS on Friday (WEDI release, 3/15).  

Findings

The survey found that 49% of respondents in 2014 said they were unaware of the Blue Button tool, up from 32% in 2013. Researchers attributed the change to the fact that the 2014 survey added providers that are not eligible for incentives under the meaningful use program (WEDI letter, 3/13).

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

Insurer and provider respondents increased their use of Direct -- a federally sponsored messaging protocol -- to transmit data compared with 2013, while technology developer and government respondents decreased their use of Direct for such purposes.

Among all respondents, use of Direct with Secure Blue Button Trust decreased from 15% in 2013 to 8% in 2014 (Conn, Modern Healthcare, 3/16).

Meanwhile, the survey found that health care organizations are increasingly using integrated EHRs and medical device data to populate PHRs accessible through Blue Button. The survey also found that use of integrated EHR data to populate PHRs through Blue Button increased to 100% in 2014 among government respondents, up from 60% in 2013. Meanwhile, use of integrated EHRs remained consistent among providers in the same time period.

In addition, researchers found that both providers and government respondents increased their use of medical device data to populate PHRs that are accessible through Blue Button.

The survey also found that about 80% of respondents either offered or planned to offer all patients access to PHRs.

Meanwhile, health plan respondents cited the importance of privacy controls over PHRs. For example, 89% of insurers provided out-in functionality in 2014, an increase from 69% in 2013.

The survey also found that while direct mail, email and text messages remain top priorities for communication with patients, some respondents also cited the importance of providing mobile services, sharing data with other providers, and sending information to third party services and applications 

Unknown to many patients is their 'Right to Access " their medical records protected by the Federal Government

You should know you have the right to: • Ask to see and get a copy of your health records from most doctors, hospitals, and other health care providers such as pharmacies and nursing homes, as well as from your health plan; • Get either a paper or, if records are kept electronically, an electronic copy of your records; and • Have your provider or health plan send a copy of your records to someone else. 

Attestation: Meaningful or Meaningless ? That depends

The HITECH Act passed in         fueled the adaptation of EHR with a carrot and a stick. HITECH required providers to implement EHRs with several mandatory features that would allow analytics to evaluate 'BIG DATA" streaming from their EHRs/  The  carrot was accepted and now the stick is playing a bigger role for providers who have been unable to attest to the new MU regulations.

Last month, 81,500 eligible professionals attested to 2014 meaningful use requirements, up from 67,254 in January, according to CMS data. Overall, fewer than half of the 515,158 providers who registered to participate in the meaningful use program have attested to meeting the 2014 requirements. CMS expects an uptick in attestations as the  deadline approaches. Bloomberg BNA's "Health Care Blog."

Last month, CMS extended the deadline for eligible professionals to attest to the Medicare meaningful use 2014 reporting period from Feb. 28 until March 20 (iHealthBeat, 2/25).

Government deadlines seem to never be met, despite implications of incompetence, fraud, and deceit.  Nevertheless imposing inherently unobtainable deadlines undermines the credibility of health programs and others.

The roadmap to meaningful use is long, tortuous and expensive. It require(s)(d) significant investment of time and money into new healthcare software with either totally new functions or expensive patches and upgrades.  Interested parties were also given a deadline for implementation  of ICD-10 to replace the ICD-9 classification of diseases. The U.S.A has been mired in ICD-9 for decades, even after the world health organization has been using ICD-10 for some time.

Implementing MU is a task unto itself, however adding attestation adds another challenge to providers.  The charge is even more difficult for small or solo medical practices who do not have the human resources to accomplish the task. Consultants must be hired. For larger groups or institutional providers an IT department may be already at hand. Nevertheless one can only wonder how this promises to save tax payer dollars.

Meanwhile,

CMS Has Doled Out $28B in Meaningful Use Incentives

Meaningful Use Payments Reached $25.7B as of Dec. 1, CMS Says

CMS Extends Meaningful Use, Quality Reporting Deadlines

Electronic Health Records and Meaningful Use Criteria

Giving Patients Access to EHRs Does Not Increase Provider Workloads

"Doctors are overworked"  Ask any of them.

If you ask a physician if they use social media or want to begin participating at least one-half would respond with, "I don't have time " The same applies to giving patients access to their  electronic health records. In  fact the opposite may be true.

Allowing patients to view their electronic health records during hospital stays does not drastically increase nurses' and physicians' workloads, according to a University of Colorado study published Monday in JAMA Internal Medicine, Reuters reports.

To assess what patients might learn while viewing their EHRs during hospitals stays, University of Colorado assistant professor Jonathan Pell and his team provided tablet computers to 50 individuals who knew how to use the Internet. Most of the individuals had home computers, and more than half had laptops or smartphones with them.

The average age of participating patients was 42 years old, and about 75% had annual incomes of $45,000 or less.

Researchers also questioned 42 health care providers about how they thought patients would respond to viewing their EHRs.

Findings

Overall, the study found that allowing patients to view their EHRs did not create additional work for doctors or nurses.

• 68% of surveyed doctors expected it would lead to additional work; and
• All 14 nurses who were surveyed thought it would result in more work.

However, after patients viewed their records:

• 36% of doctors reported larger workloads; and
• Half of the nurses reported additional workloads.

Researchers found that 92% of patients before the study thought that seeing their EHRs would enable them to better understand their medical conditions, while 80% said they expected the practice to help them understand their providers' instructions. (this key feature alone decreases provider time by re-inforcing what the physician says, including informed consent, education, and treatments)

However, after viewing their records, 82% percent said seeing their EHR helped them understand their medical conditions, and 60% said it helped them understand their providers' instructions.

Meanwhile, patients' fears that reviewing their medical records would increase their feelings of worry or confusion proved false. Specifically, after viewing their EHRs:

• The percentage of patients who felt worried fell from 42% to 18%; and
• The percentage of patients who felt confused fell from 52% to 32% (Rapaport, Reuters, 3/9).

What Health IT Tools Do Young Adults Support?

How Do Physicians' Digital Tools Help Patients ? 

The Future of Medicine lies in Human Capital

Innovation Is Sweeping Through U.S. Medical Schools

Preparing doctors—and in greater numbers—for new technologies and methods has only recently been  put in the forefront of health reform. Without an increase in efficiency and primary care physicians offering insurance is meaningless without having access to the care. The Wall Street Journal  features an article on the changes coming to Medical Schools.

Century-Old Model

Medical educators say such innovations are long overdue. The U.S. health-care system is rapidly becoming ever more data-driven, evidence-based, patient-centered and value-oriented. But for reasons having to do with tradition, accreditation concerns and preparing students for national board exams, the designers of medical-school curricula have been slow to shift their focus.

“The reality is that most medical schools are teaching the same way they did one hundred years ago,” says Wyatt Decker, chief executive of the Mayo Clinic’s operations in Arizona, which include a medical school in Scottsdale, Ariz., that is scheduled to enroll its first class in 2017. “It’s time to blow up that model and ask, ‘How do we want to train tomorrow’s doctors?’ ”

Doctors today are well schooled in the science of medicine, says Susan Skochelak, the American Medical Association’s vice president for medical education. “What’s been missing is the science of health-care delivery. How do you manage chronic disease? How do you focus on prevention and wellness? How do you work in a team?”

To encourage med schools to move their curricula in that direction, an AMA initiative called Accelerating Change in Medical Education is giving $1 million to each of 11 schools to help fund novel programs. Of the nation’s 141 medical schools, 118 competed for the 11 grants.

“We should have done this 10 years ago,” Dr. Decker says of the many med school changes. Then he quotes a Chinese proverb: “The best time to plant a tree is 20 years ago. The next best time is tomorrow.”

At the new Hofstra North Shore-LIJ School of Medicine in Hempstead, N.Y, students spend their first eight weeks not in lecture classes but becoming certified emergency medical technicians, learning split-second lifesaving skills on 911 calls.

At Penn State College of Medicine in Hershey, Pa., first-year students work as “patient navigators,” helping the ill, injured and their families traverse the often-confusing medical system and experiencing it from their perspective.

At New York University School of Medicine, one required course delves into a database that tracks every hospital admission and charge in the state. Discussions center on why, say, the average tab for delivering a baby is $3,000 in a rural area and $22,000 in New York City.

Century-Old Model

Medical educators say such innovations are long overdue. The U.S. health-care system is rapidly becoming ever more data-driven, evidence-based, patient-centered and value-oriented. But for reasons having to do with tradition, accreditation concerns and preparing students for national board exams, the designers of medical-school curricula have been slow to shift their focus.

“The reality is that most medical schools are teaching the same way they did one hundred years ago,” says Wyatt Decker, chief executive of the Mayo Clinic’s operations in Arizona, which include a medical school in Scottsdale, Ariz., that is scheduled to enroll its first class in 2017. “It’s time to blow up that model and ask, ‘How do we want to train tomorrow’s doctors?’ ”

Doctors today are well schooled in the science of medicine, says Susan Skochelak, the American Medical Association’s vice president for medical education. “What’s been missing is the science of health-care delivery. How do you manage chronic disease? How do you focus on prevention and wellness? How do you work in a team?”

New MCAT

To that end, in April, a new MCAT—the Medical College Admission Test—will be administered, the test’s first major revision since 1991. The new version is 2 hours longer (6 hours and 30 minutes) and tests knowledge of behavioral and social sciences as well as biology, physics and chemistry. One sample question has applicants read a passage, then asks which of four statements “is most consistent with the sociological paradigm of symbolic interactionism?”

Styles of teaching and learning are also changing.

“We’ve replaced ‘the sage on the stage’ with ‘the guide on the side,’ ” says Richard Zimmerman, a neurosurgeon and medical director for education for the new Mayo med school in Scottsdale.

At both the new school and Mayo’s existing medical school in Rochester, Minn., much of the material traditionally taught in lecture classes will be converted to electronic formats that students can absorb on their own, leaving class time for discussions and case studies.

Mayo also is creating a new course of study, called the Science of Health Care Delivery, which will run through all four years and include health-care economics, biomedical informatics and systems engineering. With a few additional credits, students can graduate with both an M.D. and a master’s in health-care delivery from Arizona State University.

In a course called Checkbook, Mayo students will track all of the services provided to their assigned patients during clinical rotations and look for redundancies or routine tests that add little value.

Focus on Teams

Learning to work in teams is a main focus at Mayo—and a sharp departure from traditional training for doctors.

“The old model was, you’d go on rounds; the attending would ask a question, and the young resident had to get the right answer,” says Dr. Decker in Scottsdale. “In the new model, you’re part of a team, and somebody else might have the right answer.”

To understand the roles of team members who aren’t doctors, first-year Mayo students spend half-days shadowing clinic schedulers, registered nurses, nurse practitioners and physician assistants. They also assist in managing a panel of patients, as care coordinators do. For example, they review records to see which diabetes patients aren’t managing their health well; they call the patients on the phone to discuss why they are struggling; then the students consult with the patients’ primary-care doctors to determine the next steps.

Managing Stress: Med Student Well Being Index,

In another departure from med schools past, Mayo is making an organized effort to help students avoid burnout. Classes in the first two years are pass/fail, not graded, and students can evaluate their level of stress, fatigue and risk of suicide in a confidential Med Student Well Being Index,

Less Memorization

What’s being left out of medical education to make room for the new material?

Some schools are placing far less emphasis on memorizing facts, such as which drugs do what and how they interact with other drugs. Such information is now readily available electronically.

“The fund of medical knowledge is now growing and changing too fast for humans to keep up with, and the facts you memorize today might not be relevant five years from now,” says NYU’s Dr. Triola. Instead, what’s important is teaching “information-seeking behavior,” he says, such as what sources to trust and how to avoid information overload.

Technology

Is also changing how med students learn. Simulators that look like patients and can be programmed to go into cardiac arrest, have strokes, spike fevers, cry, vomit and eliminate are particularly useful for teaching.

Some schools are condensing the typical four-year curriculum into three years, to let students start their residencies sooner and graduate with less debt. 

“We should have done this 10 years ago,” Dr. Decker says of the many med school changes. Then he quotes a Chinese proverb: 

“The best time to plant a tree is 20 years ago. The next best time is tomorrow.”

The Future of Medicine lies in Human Capital