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More on Blue Button Plus and MU2

My last post, based on comments from Frost & Sullivan health IT analyst Nancy Fabozzi at last week’s Healthcare Unbound conference, has generated a bit of controversy. Fabozzi said that “Blue Button Plus is totally disruptive,” possibly eliminating the need for some providers to get full-fledged patient portals in order to meet Meaningful Use Stage 2 standards.

In the comments under that post, David Smith of, a health improvement consortium in three Western states, correctly pointed out that MU2 requires not just that providers give 50 percent of patients electronic access to their records, but also that 5 percent of patients actually view, download and/or transmit information back to their doctors or hospitals. I also got an e-mail from a GE Healthcare executive reminding me that of the view/download requirement as well as the fact that EHR technology had to be certified by an ONC-approved certification and testing body.

The viewing and downloading certainly can be accomplished with Blue Button Plus apps or widgets. In fact, ONC’s Lygeia Ricciardi has said Blue Button Plus could be part of the Stage 3 rules.

Transmitting would seem to necessitate a portal since HIPAA demands — and patients should expect — security when sending protected health information over the Internet. Standard e-mail doesn’t cut it, but e-mail following Direct Project protocols does. MU2 already sanctions Direct Project for health information exchange between healthcare entities. There is no reason why it can’t work for individuals as well, as Dr. Deborah Peel’s Patient Privacy Rights Foundation is trying to facilitate.

This might be a bit unwieldy, asking each patient to set up a Direct e-mail address, but remember, providers only need 5 percent to do so in Stage 2. I see it as perfectly feasible that some small physician practices could bypass the portal and just make do with freely available resources like Blue Button Plus — though Blue Button Plus app developers likely will charge fees — and open-source Direct standards.

UPDATE, July 18, 12:40 a.m. CDT:

HHS itself says Blue Button Plus meets MU2 standards.


Blue Button Plus is a blueprint for the structured and secure transmission of personal health data. It meets and builds on the view, download, and transmit requirements in Meaningful Use Stage 2 for certified EHR technology in the following ways —

Structure: The recommended standard for clinical health data is the HL7 Consolidated Clinical Document Architecture or Consolidated CDA. The C-CDA is a XML-based standard that specifies the encoding, structure, and semantics of a clinical document. Blue Button Plus adopts the requirements for sections and fields from Meaningful Use Stage 2.

Transmit: In alignment with Meaningful Use Stage 2 standards, Blue Button Plus uses Direct protocols to securely transport health information from providers to third party applications. Direct uses SMTP, S/MIME, and X.509 certificates to achieve security, privacy, data integrity, and authentication of sender and receiver.

It sounds to me like compliance is just a matter of making sure that a Blue Button Plus app is certified as an EHR module.

July 17, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

‘Blue Button Plus is totally disruptive’

AURORA, Colo.—”Blue Button Plus is totally disruptive,” Frost & Sullivan health IT analyst Nancy Fabozzi just told me at the Healthcare Unbound conference. Why? Because the enhanced Blue Button Plus format can eliminate the need for healthcare providers to invest in patient portals in order to meet Meaningful Use Stage 2.

I tend to agree. The Stage 2 rules don’t require a portal, just the ability to transmit records securely from provider to patient. Providers, whether they be hospitals, clinics or even small physician practices, can just put a Blue Button widget on their Web site and give patients easy access to their medical records, transferred securely by the Direct protocol, itself a disruptive force for health information exchange.

Longtime readers might recall that I had dissed Blue Button in the past. More than once, in fact. That’s because the original Blue Button format was plain, unstructured text when it was an experiment at the VA. My opinion changed this week, when I realized that Blue Button Plus adds structure such as the Continuity of Care Document, and third-party vendors like Humetrix, make of the iBlueButton mobile app, provide additional context.

I don’t think this will kill the portal business because portals provide additional services such as secure messaging, appointment scheduling, refill requests and online bill payment. But it will make a lot of providers think twice about springing for an advanced portal when Blue Button Plus will fill the Meaningful Use need so easily.

July 12, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

See you at Healthcare Unbound

Happy 5th of July! I hope you had a happy 4th, and that you don’t have to work today as I have to.

I just wanted to let everyone know that I will be on a panel next Thursday at the 10th annual Healthcare Unbound conference at the University of Colorado Anschutz Medical Campus in Denver:


The market for mobile health (mHealth) products and services is an important area which can be a catalyst for healthcare’s evolution, dramatically altering healthcare delivery and the patient experience. In the health system of the future, patient care will be greatly enhanced by a connected and seamless information flow between patients and other stakeholders, with mobility being a core need for all users of health information. With a growing ocean of mHealth applications, scalability, sustainability, security, interoperability are some of many points which will continue to be vital for developers.

mHealth can provide new ways for patients to be engaged in their health, beyond those interested in the “quantified self”, to shift the focus in healthcare from treatment to wellness. The healthcare industry therefore has the unique chance to harness this opportunity to create positive change.

There is the argument that regulation and restrictions could impede innovation, as the freedom of the market has fostered the rapidity of modernization in mHealth technology. However, other hurdles exist for developers, such as achieving adoption and sustained use of mobile applications, where users from physicians, to patients need to better understand what apps can make a real difference and which are just noise.

The panel will explore some of the ways mHealth is transforming healthcare and also tackle some of the serious questions, offering insight and solutions for those facing mHealth’s distinct challenges.
Daniel Ruppar, Research Director, Connected Health, Frost & Sullivan

Proteus Duxbury, , Director of Technology Strategy – Virtual Health Services, Catholic Health Initiatives
Wayne Guerra, MD, MBA, Co-Founder & Chief Medical Officer, iTriage
Keith Toussaint, Executive Director, Business Development, Global Business Solutions, Mayo Clinic
Neil Versel, Contributing Editor, MobiHealthNews
Malinda Peeples, RN, VP Clinical Advocacy, WellDoc

This breakout session starts at 4:15 p.m. MDT. As the last thing standing between conference attendees and happy hour that day, we sure had better be engaging. Hopefully there will be video available after the fact. If there is, you can be sure I will post it here.

To register for the conference, click here.

July 5, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Why healthcare is so troubled, and what consumers are doing about it

Consumerism hasn’t completely caught on in healthcare, but it has gained a bit of a toehold. Consider these two slides shown Monday at the Healthcare Unbound conference in San Diego:

Look at the bottom of each slide, starting with the second one. According to GreatCall, maker of the Jitterbug phone for seniors, 35 percent of consumers plan to buy “wellness electronics” in the next year. That’s great news and a great opportunity for people in health IT to make sure such devices connect to larger networks to data collected will be usable.

In the upper slide, Kaiser Permanente cites numbers showing one reason why healthcare is in such a crisis. Again, look at the bottom. Just 2 percent of current residents in internal medicine will end up in primary care. That’s not exactly reassuring in the face of a projected shortage of 40,000 family practice physicians by 2020. Thus, connected devices will gain in importance as an adjunct to primary care for the purpose of disease management.

Really, it could be our only hope.

July 12, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.