Both Congress and the administration are moving to relieve the backlog of veterans waiting for access to medical care by authorizing them to get private treatment at the VA's expense. But those veterans are still facing some formidable obstacles, not the least among them getting access to their own records and taking them with them to new providers. But technology that's already in place can help them jump some of the bureaucratic hurdles. Many veterans are covered by a variety of health plans, including the VA, Tricare (the military's medical insurance), and older vets may be covered by Medicare. In addition, their medical records may reside with the Department of Defense (DoD) and the Veterans Administration as well as private providers. Since many vets are facing (or are living with) long and complex medical problems, just gathering their records together to bring them to a private hospital or doctor is challenging. Critics point out that so-called legacy electronic medical record systems, like those housing DoD records, and VA systems are not even capable of talking to one another.
Aneesh Chopra, the former White House chief technology officer, says the government has spent billions of dollars and decades trying to resolve the problem. But he notes that fundamentally they may be going after the wrong solution.
The challenge is actually simpler. The question ultimately is, 'What problem are you trying to solve?' Are you solving a modernization problem, or are you solving an interoperability problem? Because if you want to solve the interoperability problem, the better thing to do, I believe is to have each IT node point the data directly to the patient because the thing that the patient can do that the systems can't do together is verify with 100 percent confidence that I am who I am to get my own records.
In simpler language, it's going to be a lot easier for the patient to get his own records from the DoD or the VA and then bring them with him than to get those institutions to see each other's records and talk to one another. In 2010 the government launched a technology initiative called Blue Button, which does exactly that. It enables patients to go to the VA or Medicare and download their medical records electronically to their own computers. More recently, companies like Humetrix have created applications like iBlueButton so those records can be collected in an easy-to-understand format and securely loaded onto a mobile device such as a tablet or smartphone. That means a veteran can now download all his VA or DoD medical records to his device and then take them to a private practitioner and have them with him if he needs emergency treatment.
One of the million or so vets who've taken advantage of the technology is Vietnam-era vet Randy Watson, who is totally disabled as a result of exposure to Agent Orange, the chemical defoliant widely used in the Vietnam War. Watson, who has had multiple surgeries and survived eight heart attacks, lives in Neosho, Missouri, about 15 miles south of Joplin. His closest VA medical center is in Fayetteville, Arkansas, more than an hour's drive away. He often makes use of a closer VA clinic about 45 minutes away in Mt. Vernon Missouri. But over the years Watson has often needed emergency attention which he's gotten in nearby Joplin, where his primary care physician is also based. Using all those VA and non VA facilities created a paperwork nightmare. Watson became one of the first vets to start using the new technology.
I've used it several times. I can assemble all my records, download all my health records from the VA website, My HealtheVet, whether it's self entered or entered by the VA. iBlueButton includes all my lab reports, different tests, blood work, lists of X-rays or CT scans -- I can download all that information, all my doctor visits, all my medication that I take and all the allergies that I have to different medications. If I have to go to an emergency room or see another doctor that's not from our area, I have all that information on my iPhone, and I can bring it up and show him without having to sit and fill a bunch of forms...
If I'm in an emergency situation, I can bring this information up. And if I'm not able to, my wife or my children know how to access this information on my iBlueButton app. That way they don't have to repeat tests, say if I had an MRI a week ago. It's easy and saves time and saves money too because I don't have to go to hospitals or doctors and ask for paper records -- and have to pay for them. I've saved my paper records over the years and scanned them into my computer and put them into a PDF format, and then I can upload those files to my iPhone to the iBlueButton. So it's helped me out a lot, and it's a safety factor.
But Watson cautions vets that it's still going to be their own responsibility to keep those records current. And he says that no matter what changes are made, or how helpful the technology, the vet himself has to take on the role as his own health care advocate.
They're the ones that really need to step up to the plate and get the app and go online and take the initiative to do that. In order for the iBlueButton to work in their favor, they have to make sure it's up to date and in downloading updated records after a new hospital stay or after they get new lab done. With the health care system the way it is, they have to take control, they have to do if for themselves, because no one else will.
The federal BlueButton initiative has not gotten very much attention or usage, neither from the millions of vets who can make use of it, nor the tens of millions of Medicare recipients who can get it. The original program allowed downloading only to a PC, and not to a mobile device. The government then turned to private industry to innovate around the program, which resulted in applications like iBlueButton from Humetrix, which made the Blue Button mobile, and other programs from developers like HealthVault and RelayHealth. But so far the numbers are almost embarrassing. According to the office of the national coordinator for healthcare IT at U.S. Dept of Health and Human Services, about 17 percent of eligible vets have used the BlueButton system on the VA site, while less than 2 percent of all Medicare recipients have made use of it.
According to Dr. Bettina Experton, CEO of Humetrix:
Unfortunately, most Veterans do not know that they can bring their health information from the VA or DoD to non-VA doctors. Bringing copies of paper medical records is not a practical option, especially when you are sick or when an emergency strikes. As a result, the coordination of care between DoD, VA and civilian doctors can be poor, causing unnecessary and additional delays in diagnosis and treatment. But apps like iBlueButton can change that by allowing Veterans to bring their medical records from the VA and DoD with them to non-VA doctors via their mobile device.
iBlueButton is free to download and provides one free Blue Button downloaded record. Then there is a one-time in-app purchase of $3.99 that covers all subsequent downloads of Blue Button records. But, Dr. Experton says, "At this time of crisis, we've made iBlueButton available at no charge to our veterans so they can easily take their medical records to any doctor and help expedite the process of getting needed care and in the safest way."
Author's Note: We did contact the Veterans Administration for help with this blog. They asked us to submit a list of questions, which we did. But two weeks and several inquiries later, we have yet to hear a word back from them.