The Challenge to Redesign the Patient Health Record

Blue Button has been a big success, with over a million patient users and many vendors committing to supporting similar functionality for providing patients access to medical records. Amazingly, all Blue Button gives users is a large (and ugly) text file dump of the medical record. This barely human-readable document contains a wealth of health information about patients — it’s just all hidden in its ugliness. 

Significant efforts are underway to take that valuable Blue Button data and using design to engage patients, caregivers, and providers.

Later this week is the deadline for the Health Design Challenge sponsored by the ONC. The challenge, which has gotten a decent amount of press, is looking for the best designs that take CCD data and make it visually pleasing and usable by both patients and providers. The overall design prize is $26,000 for the top three designs. There are also prizes for specific categories of designs. Submissions only need to be images, not coded apps, which should lower the barrier to submission considerably.

The setup of the challenge is quite cool. All submissions are required to use Creative Commons licensing. This means that the designs can be freely used and enhanced while giving attribution to the original author. The winning designs will be developed into working apps using HTML, CSS, and Javascript and be made available to all on Github, which is pretty awesome. The challenge doesn’t specifically address mobile, so I hope all apps developed will be responsive so they can be used on mobile screens.

The open source license gives vendors and organizations a great starting point, which hopefully they’ll use. I imagine it’s bit of a downer for some submitters, but considering you don’t have to code the actual app and if you win you have your design on Github with props from ONC, it seems worthwhile.

The goal of the design challenge is to add a very nice visual layer on top of CCD data. In looking at the criteria, the four specific goals of the design are that it:

  • Improves the visual layout and style of the information from the medical record;
  • Makes it easier for a patient to manage his or her health;
  • Enables a medical professional to digest information more efficiently;
  • Aids a caregiver, such as a family member or friend, in his or her duties and responsibilities with respect to the patient.

I love the idea of the challenge. ONC has done a good job of setting it up. My main gripe is that the ONC is looking for designs that are great for both providers and patients. I think designs for patients and providers are different enough that they should have been broken out into different categories. We’ll see what people come up with to see how well designs work across those two groups. I realize that’s a minor gripe.

My main questions are (a) how is Blue Button being used? and (b) why have 1 million people used it to download their medical records?

My suspicion is that people are downloading the data so they have it just in case they ever need it. I’m betting they don’t’ download it to help them review their recent lab values or medical problems, though some might use it for medical lists.

If I had access to Blue Button, that’s how I’d use it. I’d probably scan it into Evernote and be done with it. I searched Google and couldn’t find any information about how people that have used Blue Button are actually using the data. Let me know if you’ve seen any information.

My suspicion above makes me think the real power of Blue Button is in a workaround for interoperability, allowing patients to act as their own personal HIEs in transferring medical records to providers as needed. Since this challenge is all about design, this will be great for designs that make Blue Button data easily digestible by providers, and these are designs I’m excited to see.

The other area I’d love to see is a way to auto-generate premium health services such as medication adherence, glucose logging and tracking, or other evidence-based recommendations. I don’t think this is really captured in this challenge.

For medication reminders and maybe some other services, I think you can do this today, but it’s a bit of a daunting process. It requires you to download your health record, signup for Microsoft HealthVault, upload your CCD from Blue Button, then add a medication reminder app (or whatever other app) that partners with HealthVault.

I’d like an easy way to sign up for a health-related service, add data via CCD, and then kick that service off. I’m sure this is coming, or maybe already here, but didn’t see anything listed on the Blue Button partner website about it.

Can design save healthcare (the author is a judge of the design challenge), or at least push it forward? I vote that it’s a step in the right direction and that ONC is doing a good job in designing and rolling out these challenges. If you take the screenshot above (from Northrop Grumman’s mobile Blue Button app), there is room for improvement.

Step 1 is providing access to the data. We’re now moving on to trying to make that data more useful to all parties vested in the care of patients. Hopefully we can all learn something from the winners and how the open-sourced outputs get used. Will better design make Blue Button more than a workaround for disparate systems? What do you think?

Travis Good is an MD/MBA involved with health IT startups. More about me.

  • Chris Wasden

    I too have been amazed at the “success” of Blue Button given that it provides almost no useability and utility, is not interactive, interoperable, editable, or easy to use. Try and name another app that had all these shortcomings that got to a million downloads. I can’t think of one. I think you are right, it is an app that is downloaded once as an emergency management issue, and then never used. This doesn’t create much or any commercial value because it isn’t sticky or usable.

    Perhaps other clever entrepreneurs will figure out how to leverage this in ways that are more useful.

  • Alessandra Ferrerio RN

    Well at least it’s a start. By flooding healthcare with technology, we put the cart before the horse. Not many anticipated knew how this would affect practice or figured what the unintended consequences might be and little prospective research added insight to the plan but here we are to witness the evolution. What a great time to be an informaticist!

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