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Implementing Blue Button in VA Primary Care Settings: Survey and Interview Findings

Richardson LM, Luger T, Hill J, Nazi K, Gordon H, Whittle JC, Weaver FM, McInnes DK, Simon SR, Smith BM, Hogan TP. Implementing Blue Button in VA Primary Care Settings: Survey and Interview Findings. Paper presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2015 Apr 25; San Antonio, TX.


Implementation of VA's medical home model is intended to enhance the patient-centeredness of care delivery, particularly within its primary care settings. Technology can facilitate coordination, communication, and patient education, and is a critical component of VA's medical home model. My HealtheVet (MHV),VA's personal health record portal, has a variety of features that can support patient-centered care. Its Blue Button (BB) feature allows users to view, print, or download an electronic file comprised of self-entered information and extracts from their VA medical record-including clinical progress notes. Despite the potential of BB to support effective information sharing, use of the feature is low, and few resources exist to support its uptake in primary care. The objective of this study is to examine current perceptions and use of BB among VA primary care team members and to use these insights to design a toolkit to promote the adoption and integration of BB in VA's medical home model. As part of a two phase design, we began by conducting an online survey (N = 245) and semi-structured interviews (N = 12) with VA primary care team members. Survey findings revealed that less than half of our sample (45.99%) had heard of BB. Over 75% of respondents reported that they never discussed the BB or its content with patients, although nearly 40% agreed that giving Veterans access to their clinical progress notes through BB was a good idea. Interviewees reported general awareness of the MHV portal, but expressed concerns about corresponding technical issues, the time necessary to promote its use, and that there was little incentive for them to integrate features of the portal into their practice. Interviewees were generally unaware of the BB and there were mixed concerns about the consequences of patients viewing their clinical notes through it. We are developing the components of our toolkit based on these findings. Prototypes are being developed for tip sheets that explain how to use BB, BB data class summaries, clinical vignettes, and a decision support tool for identifying situations that would benefit from BB use. The toolkit will subsequently be tested at three VA facilities. We expect that toolkit components will demonstrate the value of the BB feature to primary care teams-an important first step towards broader implementation.

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