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Searching for the Possible Blue Button Market

October 18, 2012
by Gabriel Perna
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ONC’s Blue Button Hits the Private Sector in a Recent Initiative

The people at the Advisory Board Company, a Washington, D.C.-based research, technology, and consulting firm, are listening loud and clear to the message of Farzad Mostashari, M.D., the National Coordinator for Health IT. Dr. Mostashari has been actively promoting the Blue Button initiative, which is a concept that allows patients to easily view, transmit, and download their health information on the web. It was originally adopted by the Veterans Administration (VA), which recently surpassed the 1 million patient mark for accessing Blue Button.

The Advisory Board Company got on board with this initiative by opening up a Patient Engagement Blue Button Challenge. The initiative had the company look at five patient engagement vendors and their products, which were paired with five host sites. The vendors were judged on functionality, ease of use, updating and sharing patient information, and ease of integration.

The winner of the challenge was Kinergy Health, Vienna, Va., for its MyKinergy cloud-hosted tool. The Advisory Board Company awarded them $25,000. The judges included David Chao, Ph.D., chief technology officer of The Advisory Board Company; Aneesh Chopra, senior advisor at The Advisory Board Company, and the first chief technology officer of the U.S.; John Halamka, M.D., CIO at Beth Israel Deaconess Medical Center; Jeffrey DiLisi, M.D., vice president, and chief medical officer at Virginia Hospital Center; and Halle Tecco, CEO of startup accelerator, Rock Health.

In an exclusive interview with Healthcare Informatics Associate Editor Gabriel Perna, Dr. Chao explained the appeal of Blue Button and why The Advisory Board decided to take on this initiative. Below are excerpts from that interview.

David Chao, Ph.D.

Why did you start this challenge?  What’s the appeal of the Blue Button  initiative?

We ran the challenge because it seemed like a great way to get the competitive juices flowing in the market in general. Doing our part to foster the growth of something like Blue Button seemed like a great idea. Much more acutely, a great reason to run a challenge like this is to hopefully shine the light in areas where your company does not have a focus. We’ve been focusing for years on the provider side, on the hospitals, physicians, doing what we can to prove quality care, efficiency of care, through those parties. Blue Button, all of a sudden, is promising to do what we’ve possibly talked about for years. That’s getting patients, families, and patient advocates in the center of driving healthcare.

Blue Button puts the patient in the position of having something that the providers want, which is exactly this data. They’d love to have this data because it improves care for patients, and secondly it helps hospitals connect the dots to prevent readmissions. We can only prevent readmissions when we start gathering data to see where we can make improvements. With the data that the patient walks through the door with with Blue Button, the hospitals and clinics are going to be more sophisticated in their care.

For those reasons, we wanted to promote it. It’s not a business we’re in, but we have deep roots and strong connections to the hospitals, to the patients. We thought we were in a good position to host this challenge, and connect up these nascent companies with our customer base.

Did providers find the Blue Button-type solution helpful? How did connecting them with these vendors turn out?

It raised their awareness. Prior to this challenge, doctors didn’t know enough about Blue Button to form an opinion. In terms of awareness, I don’t think they got how contemporary the data was. The most interesting thing to me about what this challenge did for us is it gave us an incredibly strong indication that if these vendors build it, the providers will come and sign up. There is most likely a formula that will end up with a large number of patients signing up for and using Blue Button. The key to that is the physicians’ take on this.

The physicians were surprised. We tried this out in a variety of settings. We tried this out at the Virginia Hospital Center, which is right across the river from D.C. It gets lots of tourists in the emergency room, and they see lots of folks traveling through for the day. As a result, they’ll have no prior visit for that patient, and as a result, won’t know what kind of care they are getting, what kind of medication they are taking, what their chronic illnesses may be. Of course, the usual next step is the physician asking you these questions. It would be great if the patients had this all written down, and kept it up to date, but that’s not there, and your memory isn’t likely to be sharpest in this kind of situation either. So the experiment at Virginia Hospital was to take some set of patients, and use the physician auxiliary administrative assistants to get these patients set up as they walk in. These folks had iPads set up so they could explain to the patients the Blue Button process and what it could get the doctors there in terms of getting them signed up, getting the data shared out with the emergency department right then and there.

I think the biggest impact in this, besides how it will be used in the real world and how it could be scaled up, is answering this question – is it likely that Blue Button will be used? Are we going to see up to 80 percent of Medicare patients enrolled in Blue Button? Are we going to see a significant percentage of United Healthcare patients enrolled in Blue Button? I have no doubt the government will continue to increase the breadth and depth of their coverage on Blue Button. It makes sense for insurance to broaden and deepen their programs. The question is: are patients going to use it and then share it? That’s what we were trying to get to with this challenge.  Even though this challenge didn’t go on for a long time, we looked for strong hints whether this would happen. The great news is we got incredibly strong hints that this is possible and this will happen.

Why Kinergy? What did they offer that others didn’t?

The reason why we awarded the challenge to Kinergy is that they provided a great story on how this is going to work. They treated for what this was, which was their first introduction into the acute care side of things. Most of these companies’ heritage is working with caregivers, patient advocates, and care transition people, and also marketing directly to patient.

What Kinergy Health did is they flew out staff to their host site Lynchburg, Va., to train physicians and get everything installed. They actually would approach patients in the waiting room, and talk to them about Blue Button and about their product. But that wasn’t the most effective way of enrolling patients. The most effective way was after they walked into the treatment room, and after their physician ran through their vitals, ran through their complaints and symptoms; they would end their visit by asking the patient if they had heard about Blue Button. The physician was in the position of doing so because of training from Kinergy Health. What Kinergy Health did in particular, is they showed physicians what data was available. They also provided success stories, in terms of what this could give patients. They didn’t try to get people to sign up right there. Instead, they got the patients to go home and sign up.

Patient education and broad marketing is a big part of this. However, in the early days, to get that 10 percent, I think physicians will be important. What we saw from Kinergy Health is that it’s pretty easy to make physicians understand how valuable this is and it’s pretty easy to give them the tools to show patients how to use this. That is, I think, how I see the system working.

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