Rebootin the BLUE BUTTON M. Jackson Wilkinson @mjacksonw 

x erimen TODAy’S BLUE BUTTON HAS BEEN AN IMPORTANT E 

TODAy’S BLUE BUTTON DOCTOR READABLE PATIENT READABLE MACHINE READABLE 

TODAy’S BLUE BUTTON DOCTOR READABLE PATIENT READABLE MACHINE READABLE mostly kinda orta 

MUCH BETTER can do 

an new BLUE BUTTON hould be... 

& TO THE POINT with a quick history THOROUGH as an accurate and complete record 

& HUMAN-FRIENDLY SYSTEM-FRIENDLY with relevant codes & technical details well-designed on screen & in print 

& CATERED TO DOCTORS with the details they need HELPFUL TO PATIENTS to remember & understand their medical history 

& MODERN ACCESSIBLE with a format everyone can use leveraging today’s formats & standards 

ELECTRONIC HEALTH RECORDS UNIVERSAL INTEROPERABILITY eaching the potential of equires 

CCD? CCR? HL7? FAT CHANCE There are plenty of options: 

CONSUMERS EMPOWERED Things will start moving when are to handle their own records. 

GREAT FORMAT, COOL THINGS CAN HAPPEN with a DOCTOR HOSPITAL MERGED INTEGRATION WITH THIRD-PARTY SERVICES PATIENT EMPOWERMENT INFORMED PHYSICIANS 

WEB STANDARDS MANY TECHNOLOGIES HTML markup & file wrapper format JSON data format Javascript & jQuerybasic interactions d3.js chart creation SVG chart images CSS3screen styles CSS3print styles IN A SINGLE FILE 

BLUE BUTTON RECORD introducing the new 

## ## A COMPOSITION IN THREE MOVEMENTS 

## ## The BIOGRAPHY Includes the patient information, demographics, and emergency contact information. 

## ## AT A GLANCE Aggregates all available information to give the reader a brief but broad overview of the patient’s medical history. 

## ## ENCOUNTER HISTORY Collapses all information, grouped by encounter (date), starting with the most recent. Icons represent the type of information contained within each encounter. 

## ## ENCOUNTER HISTORY–EXPANDED When expanded, each encounter contains everything recorded on that date: Vitals, labs & results, procedures, problem list additions, and updates to the plan of care. 

## ## ENCOUNTER HISTORY–Print When printed, each encounter would be expanded and broken off onto its own page for easier record location. 

## The BIOGRAPHY Includes the patient information, photo if available, demographics, & emergency contact info. The header timestamps the record and gives easy access to a primary care provider. 

## AT A GLANCE Aggregates all available information to give the reader a brief but comprehensive overview of the patient’s medical history. Clicking on anything 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. The space behind the problem list acts as a timeline to show when and how 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 charts are drawn for BMI and BP to show how the patient has been trending recently. Ideally, the last BP reading measured by the patient’s primary care physician is used to establish a baseline. 

Like the problem list, Medications & Procedures are charted out historically and succinctly, giving a temporal perspective of the patient’s medical history. Again, if end dates are not available, each prescribed 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% of folks are color-blind, and more than that use black & white printers. note! 

The Plan of Care, listing upcoming medical appointments, is listed chronologically, and clicking on any item will take the viewer to the encounter during which it was scheduled. 

Finally, the patient’s Immunizations are shown here in brief, listed reverse-chronologically to show the most relevant first. Instead of showing all dates, just the most recent is shown, along with the number of doses this patient has received. 

## ENCOUNTER HISTORY Displays all known medical encounters in reverse-chronological order, with basic information as well as icons representing information collected for each encounter. 

On the web, Encounters are collapsed by default, to better see an overview of the patient’s history. In print, each is expanded and consumes 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 of the surrounding five-year period, and metric conversions are present for the convenience of physicians. 

For Results of Tests with quantitative values, we show the result as well as chart it in the context of its expected range. It also charts results of the same lab from before & after this encounter. 

When a user Expands Normal Results in a web browser, she will see each of the components of the lab or test just like the abnormal results. In print, normal results are always expanded. 

For Results of Tests which don’t have quantitative results, but instead use text to describe an abnormal result, it shows that text along 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 if applicable, its form, and the instructions for use. 

Information about new Problems, Procedures, Immunizations, changes to the Plan of Care, and the Provider are contained in one-third-width containers below the vitals, results, & medications. 

o about e PRINT VERSION 

## ## THREE MAIN CHANGES INCREASE CONTRAST EXPAND ALL CONTENT PAGE-BREAK ENCOUNTERS To fend against printer inconsistencies. and remove unnecessary web-oriented UI. Each on its own page for clearer navigation. 

At a GLANCE in print 

ENCOUNTERS in print 

if onl there were time... ADDITIONAL IDEAS 

For the print version, use the final page to create a wallet-size folding emergency reference card. Bio & allergies on the front, problem list on the back, medications inside. CUT & FOLD REFERENCE CARD Michelle Blumfeld Allergies Sex: Female Age: 32 years Weight: 175 lb Contact 

In the print version, display each encounter and its page number, and label each printed page accordingly. TABLE of CONTENTS ## ## ## ## ## ## ## ## ## 

Allow patients to privately, securely, and locally merge multiple files by simply dropping one into the other in the browser. Do the merge using JS and offer to save the new, combined file. DRAG & DROP FILE MERGING ## ## 

Allow the patient to set an encryption key affecting only the JSON data contained. Perhaps med professionals would have a “master” universal key, like postal workers do for mailboxes. ENCRYPTED HEALTH DATA ## ## 

Available Data FINAL NOTES All of this assumes, of course, that the included data is available. In looking through CCD & HL7 documents, it appeared to be. Technical Issues To the best of my knowledge, everything here can be implemented in modern browsers, and could degrade in ancient browsers with reasonable levels of grace. Medical Notes Ideally, the actual physician’s notes would be available, in which case they would be included/collapsed for each encounter. You are Amazing If you’re actually reading this, you obviously care a lot about improving the way we do these kinds of things. If so, thanks. You’re pretty swell in my book. 

FIN healthrecord.mjacksonw.com @mjacksonw