Wednesday, September 1, 2010

The Little Blue Button

The Markle Foundation is promoting easier access to health information for patients. They propose that systems that contain personal health information have "a little blue button" that allows the patient to download all their own data.  What are the upsides?  This Markle Policy Brief suggests that it would::
• Change consumer expectations and help them become more efficient in managing
their health information.
• Increase market pressure for technical standards to exchange electronic health data.
• Enable innovation through a host of applications and services that could add
significant value to individuals by using their information with their permission, such
as tools to help people with diabetes track their blood sugar, medication use, and
preventive care.
We're all for that!  How about downsides? Well, privacy certainly seems an issue. Can we be sure that others aren't downloading our embarrassing details? The technology is available for encryption, passwording, and the like. The biggest threats will be the usual "social hacks" like phishing, password guessing, and just conning folks out of their passwords.

What about erroneous information? We certainly don't want to be telling patients stuff about their health status that isn't true. Thinking that you have a nasty health problem because of an erroneous billing entry can cause some pretty sleepless nights. So, we need real clarity on what is valid personal health information (such as a confirmed diagnosis) and what is merely a weak proxy (a single test result, a billing code, a possibility mentioned in a differential diagnosis list, etc.).  However, the best strategy for errors in the data stream is to have someone who cares check it out. Giving patients an easy way to review their medical record and give corrective feedback ("I had heartburn, not a heart attack.") would be a great leap forward.

It looks like the VA may be among the first systems to offer a blue button. They have announced that it is available to users of their MyHealthVet portal. However, the sample report they show seems awfully long on patient-entered data and awfully short on the diagnoses, lab results, procedures, problems lists, and progress notes that make up the VA's medical records.

So, there is a lot of good in the idea of the "Little Blue Button" (beyond the wonderful pirating of a ubiquitous pharmaceutical marketing campaign), but, as always, the devil will be in the details.