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Once a beneficiary logs onto Tricare Online, accessing medical records is as simple as clicking on the Blue Button to view medication lists, allergies and lab results.
The last thing you need when you have a medical problem is to struggle with a bureaucracy just to get copies of your medical records. The Defense Department’s Tricare Online Blue Button project was designed to prevent just that.
Actually, DOD's Military Health System began offering patients secure online access to their records in June 2010. But the system wasn’t easy enough for many users to navigate, and many beneficiaries instead chose to suffer through the old system of repeated phone calls, waiting in lines for prescriptions and managing stacks of paper medical records.
So Jenna Noble, director of Clinical Support Systems of the Defense Health Services Systems office, began working with her team to find a a solution.
In looking for one, the team faced another problem: Regulations prevented health data from being provided in digital format.
“Since we can’t share electrons in the medical arena, we are paper-based, at least for now,” Noble said. “One of the ways to help our beneficiaries share data across providers was to have the data available to them in a downloadable form. Then they can print it off and take it with them to whatever provider they are going to. And they don’t have to re-create it by filling out forms at the beginning of every doctor’s visit.”
The solution Noble’s team came up with was the Blue Button, an online access point for personal health records that reside in the DOD’s Tricare Online system, which is the 24/7 gateway to military health care services for Tricare beneficiaries and their families.
Once a beneficiary logs onto Tricare Online, accessing medical records is as simple as clicking on the Blue Button. Users can then view a variety of information, including medications, allergies and lab results. By default, Blue Button first offers a summary of the beneficiary’s information. That information can be expanded or contracted by simply clicking on a “+” symbol. And downloading the data in PDF or text format is as simple as clicking on the “Blue Button Download My Data” button. You can also specify data types and date ranges.
Easier access isn’t the only benefit of Blue Button. “Beneficiaries now have one central place to collect all of the data that is available to them,” Noble said.
“Electronic health records are not pervasive across the industry,” said Dan Magee, program executive officer. The military direct care system has kept electronic records for the past several years. But many patients also seek treatment outside the military system. “Those systems are not all linked at this time, so this is basically to empower the beneficiary with their own data, so they can manage their own care as they go to those different venues."
Noble said the biggest challenge in rolling out Blue Button was standardizing the look and feel of the data. “We are standardizing across multiple federal agencies,” she said. “We want to have the same look and feel for the downloadable data."
That goal, of course, meant communicating across multiple agencies. “We use the same terminology in different ways,” Noble said. “Our developers came up with some very creative solutions for communicating across agencies.”
Not surprisingly, another major issue was data security. “DOD is quite sensitive about our personal health data,” Noble said. “The department had to make accessibility very, very strict. [Thanks to new technologies,] we now have the opportunity to enhance the usability of Tricare Online by making it easier for our beneficiaries to get there while still ensuring security.”
Another challenge was the fact that the team was under a tight three-month deadline. Magee said, the agencies “came together relatively quickly, with a lot of emphasis from the White House to make that happen. And our leadership set very aggressive schedules for making the data available. So the team had to work very quickly to resolve technology issues and deployment issues.”
Cost and impact
Because the Blue Button project was part of a larger effort, and many of the staff members working on it also worked on other projects, there are no cost estimates for the Blue Button enhancement to Tricare Online. Similarly, the impact of the tool can’t be measured accurately.
“The initial impact was the ease of the customer getting to their data,” Noble said. “We have about 300,000 users who use it
on a regular basis. We actually have about 1.4 million registered users.”
And one of the greatest impacts of Blue Button on those users is what they don’t have to do anymore. “One of the things that I am personally most proud of is that because of the technological improvements that we’ve made to the patient portal, they don’t have to download their data using the Blue Button every time,” Noble said. "On a weekly basis we have 15,000 to 16,000 hits on the Blue Button data, of which they only download the data approximately 2,000 times. What that says is they are getting a positive experience by simply viewing the data on Tricare Online. They don’t feel the necessity to download it, because they’re not going to the doctor every week. When they need it, it is there.”
Noble attributes the success of the Blue Button project in large part to “a lot of very senior-level support.”
“They were there for us when we needed it," she said. "We got decisions quickly, and I know the federal government doesn’t have a reputation for doing that.”
Beyond that, Noble advises that, especially when development time is limited, the smaller and better-defined the capability under development, the easier it will be to get it deployed in a timely manner. “If you’re trying to do the whole ball of wax at one time, you’re probably going to have some challenges in getting it out quickly,” she said. “If you divide up what it is that you’re doing into manageable pieces and integrate them into an already existing portal-like structure, you’ll get it out there and the benefits will be almost immediate and users will be looking forward to the next iteration.”
McGee agreed, adding that a willingness to use existing technologies is also a plus. “One of the right decisions the technical team made was that rather than create a new interface they took an existing interface that was used to exchange data between the agencies and used that interface to now pull data and make it available to the patient,” he said. “Rather than build something from scratch, they took an existing technical capability and adapted it.”