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Rebooting the Blue Button

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The Blue Button is a way for patients to download their medical information, spearheaded by the VA. As it expands, its original, text-based implementation is a bit long in the tooth. The White House ...

The Blue Button is a way for patients to download their medical information, spearheaded by the VA. As it expands, its original, text-based implementation is a bit long in the tooth. The White House has called on designers to re-imagine the downloadable, printable, consumer-facing health record.

It's intended to be a single-file download, like the healthcare equivalent of your bank statement, for print and screen.

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Rebooting the Blue Button Rebooting the Blue Button Presentation Transcript

  • RebootingtheBLUE BUTTONM. Jackson Wilkinson @mjacksonw
  • xperimentTODAy’SBLUE BUTTONHAS BEEN AN IMPORTANTE
  • TODAy’SBLUE BUTTONDOCTOR READABLEPATIENT READABLEMACHINE READABLE
  • TODAy’SBLUE BUTTONDOCTOR READABLEPATIENT READABLEMACHINE READABLEmostlykindasorta
  • MUCH BETTERwe can do
  • any newBLUE BUTTONshould be...
  • &TO THE POINTwith a quick historyTHOROUGHas an accurate andcomplete record
  • &HUMAN-FRIENDLY SYSTEM-FRIENDLYwith relevant codes& technical detailswell-designed onscreen & in print
  • &CATERED TO DOCTORSwith the details they needHELPFUL TO PATIENTSto remember & understandtheir medical history
  • &MODERN ACCESSIBLEwith a formateveryone can useleveraging today’sformats & standards
  • ELECTRONIC HEALTH RECORDSUNIVERSALINTEROPERABILITYreaching the potential ofrequires
  • CCD? CCR? HL7?FAT CHANCEThere are plenty of options:
  • CONSUMERSEMPOWEREDThings will start moving whenareto handle their own records.
  • GREAT FORMAT,COOL THINGS CAN HAPPENwith aDOCTOR HOSPITALMERGEDINTEGRATION WITHTHIRD-PARTY SERVICESPATIENT EMPOWERMENTINFORMED PHYSICIANS
  • WEBSTANDARDSMANY TECHNOLOGIESHTML markup & filewrapper formatJSON dataformatJavascript & jQuerybasicinteractionsd3.js chartcreation SVG chartimagesCSS3screenstyles CSS3printstylesIN A SINGLE FILE
  • BLUE BUTTON RECORDintroducing the new
  • ## ##A COMPOSITION INTHREEMOVEMENTS
  • ## ##TheBIOGRAPHYIncludes the patient information,demographics, and emergencycontact information.
  • ## ##AT AGLANCEAggregates all availableinformation to give the readera brief but broad overview ofthe patient’s medical history.
  • ## ##ENCOUNTERHISTORYCollapses all information, groupedby encounter (date), starting withthe most recent.Icons represent the type ofinformation contained within eachencounter.
  • ## ##ENCOUNTERHISTORY–EXPANDEDWhen expanded, each encountercontains everything recorded onthat date: Vitals, labs & results,procedures, problem list additions,and updates to the plan of care.
  • ## ##ENCOUNTERHISTORY–PrintWhen printed, each encounterwould be expanded and brokenoff onto its own page for easierrecord location.
  • ##TheBIOGRAPHYIncludes the patient information, photo ifavailable, demographics, & emergency contactinfo. The header timestamps the record andgives easy access to a primary care provider.
  • ##AT AGLANCEAggregates all available information to give thereader a brief but comprehensive overview ofthe patient’s medical history. Clicking onanything will take you to its Encounter entry.
  • Advance Directives, such as Do Not Resuscitate orders, if available,are prominently displayed to ensure they are not missed.
  • The Problem List shows a lifetime of medical issues succinctly. Thespace behind the problem list acts as a timeline to show when andhow often each listed problem occurred. If end dates aren’t known,minimum-sized bars can be used to show occurrence.
  • Vitals are shown when available, and simple sparkline-style chartsare drawn for BMI and BP to show how the patient has beentrending recently. Ideally, the last BP reading measured by thepatient’s primary care physician is used to establish a baseline.
  • Like the problem list, Medications & Procedures are charted outhistorically and succinctly, giving a temporal perspective of thepatient’s medical history. Again, if end dates are not available, eachprescribed instance can be represented by a single bar.
  • Allergies are shown and badged according to severity.Throughout, I’m avoiding using color as a primary indicator. 15% offolks are color-blind, and more than that use black & white printers.note!
  • The Plan of Care, listing upcoming medical appointments, is listedchronologically, and clicking on any item will take the viewer to theencounter during which it was scheduled.
  • Finally, the patient’s Immunizations are shown here in brief, listedreverse-chronologically to show the most relevant first. Instead ofshowing all dates, just the most recent is shown, along with thenumber of doses this patient has received.
  • ##ENCOUNTERHISTORYDisplays all known medical encounters inreverse-chronological order, with basicinformation as well as icons representinginformation collected for each encounter.
  • On the web, Encounters are collapsed by default, to better see anoverview of the patient’s history. In print, each is expanded andconsumes its own page. Icons represent immunizations, labs/results, medication prescriptions, and procedures contained within.
  • Each encounter displays the patient’s Vitals, including height,weight, BMI, and BP. Again, BMI and BP are charted in the context ofthe surrounding five-year period, and metric conversions arepresent for the convenience of physicians.
  • For Results of Tests with quantitative values, we show the resultas well as chart it in the context of its expected range. It alsocharts results of the same lab from before & after this encounter.
  • When a user Expands Normal Results in a web browser, she willsee each of the components of the lab or test just like theabnormal results. In print, normal results are always expanded.
  • For Results of Tests which don’t have quantitative results, butinstead use text to describe an abnormal result, it shows that textalong with the normal/abnormal status of the last five results.
  • If there were any medications prescribed during an encounter,they are listed here, denoting the drug, its brand name ifapplicable, its form, and the instructions for use.
  • Information about new Problems, Procedures, Immunizations,changes to the Plan of Care, and the Provider are contained inone-third-width containers below the vitals, results, & medications.
  • so aboutthePRINT VERSION
  • ## ##THREE MAINCHANGESINCREASE CONTRASTEXPAND ALL CONTENTPAGE-BREAK ENCOUNTERSTo fend against printer inconsistencies.and remove unnecessary web-oriented UI.Each on its own page for clearer navigation.
  • At a GLANCEin print
  • ENCOUNTERSin print
  • if only there were time...ADDITIONAL IDEAS
  • For the print version, use thefinal page to create a wallet-sizefolding emergency reference card.Bio & allergies on the front, problemlist on the back, medications inside.CUT & FOLDREFERENCE CARDMichelle BlumfeldAllergiesSex: FemaleAge: 32 yearsWeight: 175 lbContact
  • In the print version, display eachencounter and its page number,and label each printed pageaccordingly.TABLE ofCONTENTS ## ################
  • Allow patients to privately,securely, and locally mergemultiple files by simply droppingone into the other in the browser.Do the merge using JS and offer tosave the new, combined file.DRAG & DROPFILE MERGING ## ##
  • Allow the patient to set anencryption key affecting only theJSON data contained. Perhaps medprofessionals would have a“master” universal key, like postalworkers do for mailboxes.ENCRYPTEDHEALTH DATA ## ##
  • Available DataFINAL NOTESAll of this assumes, of course, that theincluded data is available. In looking throughCCD & HL7 documents, it appeared to be.Technical IssuesTo the best of my knowledge, everythinghere can be implemented in modernbrowsers, and could degrade in ancientbrowsers with reasonable levels of grace.Medical NotesIdeally, the actual physician’s notes wouldbe available, in which case they would beincluded/collapsed for each encounter.You are AmazingIf you’re actually reading this, you obviouslycare a lot about improving the way we dothese kinds of things. If so, thanks. You’repretty swell in my book.
  • FINhealthrecord.mjacksonw.com@mjacksonw