Blue Button is a system for patients to view online and download
their own personal health records. Several Federal agencies, including
the Departments of Defense, Health and Human Services, and Veterans
Affairs, implemented this capability for their beneficiaries. In
Blue Button has pledges of support from numerous health
plans and some vendors of personal health record vendors across the
United States. Data from Blue Button-enabled sites can be used to
create portable medical histories that facilitate dialog among health
care providers, caregivers, and other trusted individuals or entities.
Blue Button usage supports downloading
human-readable data in ASCII. In January 2013, the Office of the
National Coordinator for Health IT announced an implementation
guide for data holders and developers to enable automated data
exchange among Blue Button+ compliant applications using structured
data formats. Blue Button+ is designed to enhance the ways consumers
get and share their health information in human-readable and
machine-readable formats; and to enable the use of this information in
1.3 Standardization & Interoperability
3 Growth of Blue Button
4 Blue Button+
5 Usage and Licensing
6 Green Button and Red Button
7 Related initiatives
10 External links
Blue Button initiative began during the
Markle Foundation Work
Group on Consumer Engagement meeting in New York City on January 27,
2010. At the time,
Meaningful Use was newly authorized and
dominated health care IT dialogue in the United States. Members of
the Markle Connecting for Health Community felt that while Meaningful
Use criteria embraced patient engagement, the rules should also
“[c]onsider individuals as information participants—not as mere
recipients, but as information contributors, knowledge creators, and
shared decision makers and care planners.” Markle convened the
Work Group on Consumer Engagement to focus on using health information
technology (IT) to achieve this kind of patient engagement.
The January 2010 meeting included representatives from private
industry, not-for-profit foundations, and the federal government.
Kim Nazi, performance and evaluation manager for VA's My HealtheVet
personal health record (PHR) and a VA representative to the Work
Group, said the attendees were from diverse backgrounds and that the
discussion was “passionate”.
The Department of Defense (DoD) first provided secure on-line access
to patient health information in December 2009 with its TriCare Online
(TOL) portal. In 2010, the DoD rebranded under the "Blue Button"
construct and enabled health record downloads as well as access. The
DoD has added additional health record information over time and
continues to enhance its
Blue Button features.
The Work Group discussed many challenges related to engaging patients:
numerous health IT data standards, data confidentiality and privacy
laws, and fortress-like health databases. VA Chief Technology
Officer (CTO) Peter Levin, also an attendee at the Markle Work Group
meeting, described trying to balance the benefits of data standards
with getting a solution to patients quickly. He assessed that it was
only when the group decided to break the problem down into the
simplest possible solutions that they were able to progress.
A central theme emerged from the dialogue: give patients their data.
HHS CTO and U.S. CTO
Todd Park summarized the decision as: "Look,
there's all this complicated stuff happening with health information.
But why can't we just do this: why can't we just let an American get a
copy of their own information? [A]nd don't worry about the format,
don't worry about the standards." The group agreed to create a
large, prominent button that would represent data liquidity and
In August 2010, President
Barack Obama announced that Veterans could
soon “go to the VA website, click a simple blue button, download or
print your personal health records, so you have them when you need
them and can share them with your doctors . . . .”
VA launched the
Blue Button later that month (see "Growth of Blue
Button", below). In October 2010, US
Chief Technology Officer Aneesh
Chopra, Health & Human Services
Chief Technology Officer Todd
Park, and VA
Chief Technology Officer Dr.
Peter L. Levin
Peter L. Levin announced
that VA and HHS’s Center for Medicare and Medicaid Services were
Blue Button downloads to Veterans and to Medicare
Blue Button was designed to empower patients with their own health
data and improve the quality of patient-clinician interactions with
the expectation that these would contribute to enhanced quality of
life, better treatment outcomes and potential reduction in
costs. The framework on which
Blue Button is based—including
patient empowerment, data security and privacy protection – draws
heavily on work by the Markle Foundation’s collaborative of industry
In September 2012, the
Blue Button trademark was transferred from the
Veterans Administration to the U.S. Department of Health and Human
Standardization & Interoperability
In 2012, efforts began by the Standards & Interoperability
Framework to standardize the content formats and transport
Blue Button data in order to make them more
interoperable between health data-holding organizations, patients, and
patient-authorized 3rd-parties such as physicians, caregivers, as well
as applications and services.
In January 2013, ONC unveiled the Blue Button+ Implementation Guide to
provide guidance to both data holders and third-party application
developers to enable automated data exchange and data parsing
features. The Blue Button+ implementation guide specifies appropriate
structured data formats, transmission protocols, and APIs for
developers to use when creating applications that rely on automated
exchange of Blue Button-accessible health record data.
Blue Button is a symbol on a website —for example, an online
patient portal provided by a health care provider or insurer — that
patients may use to download their health information. Depending on
the implementation, users can download a variety of information in
multiple formats, including text and PDF. At the Department of
Veterans Affairs, Veterans can download their self-entered
information, such as additional insurance, and information from their
medical record, including medications, allergies, and lab results.
They can also download their military personnel information like
occupation specialty and pay details. Users of Department of
TRICARE Online can use the
Blue Button to download their
medications, allergies, and lab results as a PDF or text file.
Organizations like Medicare or
Aetna offer health claims information
as a downloadable text file.
Using Blue Button, patients have an easy way to retrieve and keep
track of their health.
Blue Button offers physicians an easy way to
provide that data to patients. The simplicity of the Blue Button
format allows users to carry their health information which ever way
suits them—print, thumb drive, or on their smart phone.
Developers can create applications to enhance the use of this data,
such as the application offered by Northrop Grumman.
Growth of Blue Button
VA launched the
Blue Button function on its patient portal, My
HealtheVet, in August, 2010. By May 2012, more than 500,000
individual (unique) Veterans had used the
Blue Button to download
their data. They opt-in to be able to download their health data,
first by registering for a My HealtheVet account, and second, by
validating their identity for privacy and security reasons, 
which includes appointment information, prescriptions and medications,
laboratory results, vital signs and readings, military health history,
and military occupations. In August 2012, the Department of
Veterans Affairs announced that the
Blue Button has one million
The Center for Medicare and Medicaid Services (CMS) launched its
Blue Button in September, 2010 on the My Medicare patient
portal, giving 40 million beneficiaries online access to their
Medicare claims. The Department of Defense also added a Blue
Button function to its Tricare Online patient portal in 2010.
In July, 2011, the VA Innovation Initiative (VAi2) sponsored the
Blue Button for All Americans Contest to encourage widespread use and
assure that all Veterans had access to their
Blue Button health data
regardless of whether they sought care from VA or from a private
non-VA health care provider.  In October, 2011, McKesson
Corporation’s Relay Health Division won VA’s
Blue Button contest
Blue Button functions to the patient portals which it offers
through its 200,000 physician and 2,000 hospital clients.
These represent slightly less than one third of physicians and
slightly more than one third of hospitals in the United States.
In September, 2011, the Robert Wood Johnson Foundation launched a
website to advocate cross-industry use of the Blue Button; its website
collects the pledges of industry adopters of the technology, including
United Health Care, Humana, Patients Like Me, Walgreens, and
One of those pledging support, Aetna, announced in September 2011 that
it had added the
Blue Button function to its patient portal, and in
addition offered its beneficiaries the ability to share their Blue
Button downloads with
Aetna providers. At the time,
Aetna said it
served more than 36 million people. United Health Group began
Blue Button downloads to its commercial health plan
beneficiaries in July, 2012, rolling out the capability to its
customers. The company expects 26 million plan beneficiaries will have
Blue Button downloads by mid-2013.
Other private sector organizations contributed to the growth of Blue
Button. For example:
Iatric Systems, Inc., a hospital-focused EHR vendor, includes the Blue
Button on the patient portals of its products.
Humetrix, Inc., offers a mobile
Blue Button application through which
patients can send their
Blue Button data directly to their
Microsoft HealthVault and Dossia, which are patient-controlled
repositories of personal health information, each accept Blue Button
Napersoft, Inc., a consumer communications management software
Blue Button in its Talk2Health product to transmit data
between patients, payers and providers.
In December 2011, the U.S. Office of Personnel Management announced
that it had requested all federal employee health benefit plans to add
Blue Button function to their patient portals. FEHB’s
health benefit plans are offered by more than 200 insurance carriers
and serve approximately eight million federal employees (including
Members of Congress), their families, and retirees.
In May 2012, the Obama administration announced the White House
Presidential Innovation Fellows
Presidential Innovation Fellows which will focus on five program areas
Blue Button capabilities nationwide. The
Office of the National Coordinator for Health IT wants to expand Blue
Button to any patient in America. In 2012, the ONC launched the
Blue Button Standards and Interoperability Framework
Initiative, which culminated in 2013 with the release of the Blue
Button+ Implementation Guide.
In 2012, ONC held the
Blue Button Mashup Challenge to encourage the
development of third-party applications that increase the usefulness
of data downloaded via Blue Button. The first-prize winner,
iBlueButton, is a smart phone app that takes data from Medicare’s
online portal and organizes it into an easier to read, easier to
navigate format. The second-prize winner, ID BlueButton, is a
tablet-based application that parses health information downloaded
Blue Button and presents it in a form that more clearly shows
changes in health indicators and medication use over time. The
third-prize winner, InstantPHR, is a web app that uses data downloaded
Blue Button to automatically populate personal health records
in Microsoft HealthVault.
Blue Button+ extends the
Blue Button concept to include a standardized
data format and additional functionality for trusted, automated
exchange of health data, and advanced parsing of health data to
improve human readability. In January 2013, ONC
released the Blue Button+ Implementation Guide, offering guidance and
a toolkit for both data holders (such as health care providers and
insurers) and third-party application developers seeking to add this
functionality to their products and services. The Blue Button+
Implementation Guide is the result of a collaboration among more than
68 volunteer organizations.
SMART Platforms, Harvard Medical School, and Boston Children’s
Hospital built a proof-of-concept Blue Button+ app called
Growth-tastic. With Growth-tastic, parents can view charts of their
child’s height, weight, and BMI trended over time.
Usage and Licensing
Originally, in 2010, organizations needed a license to use the Blue
Button marks. As of September 2012, application and licensing is no
longer required. Usage of the
Blue Button logo and brand is free, but
must conform to the established usage guidelines set by the U.S.
Department of Health and Human Services.
Green Button and Red Button
Blue Button is part of a larger “My Data Initiative” that aims to
empower consumers with the tools and information they need to make
optimal choices. Other, similar "button" projects include the Green
Button (for personal energy usage data) and the Red Button (for
personal educational data).
In September 2011, US CTO
Aneesh Chopra challenged the energy industry
to model a Green Button, off the successful Blue Button, where energy
providers would give energy users their consumption data in an easy to
read and use format at the click of the button. In January 2012,
two major California utilities—Pacific Gas & Electric and San
Diego Gas & Electric—announced their implementation of Green
Button. Energy customers can manage their consumption via their
smart phones using the standard Green Button data format.
The National Institute of Standards and Technology awarded a contract
to HyperTek Inc. to work with developers and users to expand the Green
In healthcare, there is a related proposal for a Green Button, as a
way for doctors to use summarized patient data for real time decision
making at the point of care. A related, patient-driven, green
button initiative to promote the donation of medical data analogous to
donation of organs.
Department of Defense's implementation of the
Blue Button was awarded
one of the 10 GCN 2011 awards.
Blue Button team was selected as a finalist by the
Partnership for Public Service for the Citizen Services Medal for
their contributions to implementing
Blue Button at Departments of
Defense, Health and Human Services, and Veterans Affairs.
Blue Button The White House". Whitehouse.gov. Archived from the
original on 2012-02-03. Retrieved 2012-04-19.
^ See: "Growth of Blue Button," infra.
^ Fridsma, Doug. "Health IT Standards Committee Update November 13,
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^ "'Meaningful Use' Tops List of Concerns in New Health IT Survey".
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^ Aneesh Chopra, Todd Park, and
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Information". Department of Health & Human Services / Office of
the National Coordinator. Retrieved 2012-11-09.
^ Department of Veterans Affairs
Blue Button Website
^ Stegon, David (2011-12-08). "VA's
Blue Button Now Includes Service
Records". FedScoop. Retrieved 2012-04-19.
^ Marshall, Patrick (2011-10-21). "DOD's
TRICARE Blue Button
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^ "Center for Patient and Family-Centered Care" (PDF).
^ September 5, 2011 at 2:23 am Greg Frisilone says: (2011-08-27).
Blue Button ® gives access to health information". craigconnects.
^ "VA Mobile
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^ a b
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^ Office of Public and Intergovernmental Affairs. "News Releases -
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^ "RelayHealth's PHR wins
Blue Button contest". Healthcare IT
^ Office of Public and Intergovernmental Affairs. "News Releases -
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^ Jim Greene. "RelayHealth Donating '
Blue Button For All Americans'
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Blue Button Plus
Electronic health record
Health Insurance Portability and Accountability Act
Personal health record
Patient Activation Measure
Health information on the Internet
Health information on
Online patient education
Roles to play
Open-source healthcare software
Patient opinion leader