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98-471: The 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 addition, Blue Button has pledges of support from numerous health plans and some vendors of personal health record vendors across

196-480: A preferred provider organization -like option called Tricare (CHAMPUS) Extra that required use of network providers in exchange for lower cost sharing, and the standard CHAMPUS option that continued the freedom of choice in selecting providers but required higher cost sharing and insurance deductibles known as Tricare Standard. Although DOD's initial intent under the CHAMPUS Reform Initiative

294-410: 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

392-462: A Tricare benefit even though they may be paid by Medicare, such as chiropractic benefits. The policy limitations applying to Tricare also apply to Tricare for Life and must therefore be deemed medically necessary and skilled care. Custodial care therefore is not covered. In 2004 the Tricare for Life benefit was transferred from the individual regional Tricare contractors. Medical claims are processed by

490-616: A collaboration among more than 68 volunteer organizations. In September 2014 an updated Blue Button Toolkit was released to replace the Blue Button Implementation Guide. The current version—the Blue Button 2.0 Implementation Guide issued in 2018—includes the FHIR (Fast Health Interoperable Resources) standard for transmission of data. SMART Platforms, Harvard Medical School, and Boston Children’s Hospital built

588-532: 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 access. 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

686-490: A granular way with particular health care providers at the patient's discretion in support of the patient's work with health care providers. This project would enlist open source contributions and enhancements from developers, with particular emphasis on supporting patient expectations of privacy and responsible patient control of private health information (PHI). Since the National Academy of Medicine (previously

784-434: A hospital laboratory. The most basic form of a PC-based PHR would be a health history created in a word-processing program. The health history compiled in computer based software can be printed, copied, and shared with anyone with a compatible word processor . PHR software can provide more sophisticated features such as data encryption , data importation, and data sharing with health care providers. Some PHR products allow

882-730: A nationwide managed care program for the MHS that would be completely implemented by May 1997. Under this program, known as Tricare, the United States was divided into 12 health care regions. An administrative organization, the lead agent, was designated for each region and coordinated the health care needs of all military treatment facilities in the region. Under Tricare, seven managed care support contracts were awarded covering DOD's 12 health care regions. Since then, Tricare has undergone several restructuring initiatives, including re-alignment of contract regions, Base Realignment and Closure , and

980-412: A natural disaster. Paper records can also be printed from most electronic PHRs. However, Fawdry et al. have shown that paper records are extremely flexible and do have distinct advantages over rigid electronic systems. Personal health information is recorded and stored in personal computer -based software that may have the capability to print, backup, encrypt, and import data from other sources such as

1078-502: A partial premium cost sharing arrangement with DoD similar to civilian private or public sector employer plans, although typically at a lower cost than civilian plans. The program coverage is available worldwide to Selected Reserve (SELRES) members of both the Title 10 USC Federal Reserve Components ( Army Reserve , Navy Reserve , Air Force Reserve , Marine Corps Reserve ), Title 14 USC Federal Reserve Component ( Coast Guard Reserve ) and

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1176-427: A proof-of-concept Blue Button+ app called Growth-tastic. With Growth-tastic, parents could view charts of their child’s height, weight, and BMI trended over time. 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

1274-570: A series of demonstration projects. Under a program known as the CHAMPUS Reform Initiative, a contractor provided both health care and administrative-related services, including claims processing. The Tricare Reserve Retired project was one of the first to introduce managed care features to the CHAMPUS program. Beneficiaries were offered three choices – a health maintenance organization -like option called Tricare (CHAMPUS) Prime that required enrollment and offered enhanced benefits and low cost sharing ,

1372-581: 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 represented

1470-736: A systematic literature review of PHRs and were able to divide architecture types into two groups: model-based and coverage-based. Model architectures represent more traditional takes on PHRs, including health data that is still stored on paper. Coverage architectures represent more hybrid takes on the PHR, "with the PHR distributed inside and outside the health care organizations" based on the data's physical location. The associated architectural types have different costs and benefits. Likewise, stand-alone, provider-tethered, and payer-tethered PHRs have different advantages and disadvantages for patients related to their individual circumstances. Such differences are among

1568-477: A web solution. Web-based PHR solutions are essentially the same as electronic device PHR solutions, however, web-based solutions have the advantage of being easily integrated with other services. For example, some solutions allow for import of medical data from external sources. Solutions including HealthVault , and PatientsLikeMe allow data to be shared with other applications or specific people. Mobile solutions often integrate themselves with web solutions and use

1666-441: A wide range of health information sources, best medical practices, and health knowledge. All of an individual's medical records are stored in one place instead of paper-based files in various doctors’ offices. Upon encountering a medical condition, a patient can better access test results, communicate with their doctors, and share information with others suffering similarly. Moreover, PHRs can benefit clinicians. PHRs offer patients

1764-705: Is Tricare eligible. Tricare for Life was first incorporated as part of the then-seven regional Managed Care Support Contracts of Tricare in May 2001. The benefit was enacted by Congress in response to growing complaints from beneficiaries that as Medicare out of pocket costs increased a benefit was needed to pay these costs in lieu of Tricare retirees being required to purchase Medicare Supplemental Coverage to pay for prescriptions, physician and hospital dispensed drugs, cost shares and deductibles. Before Tricare for Life, Tricare beneficiaries immediately lost Tricare coverage upon attaining Medicare eligibility at age 65, placing them at

1862-635: Is a health maintenance organization (HMO) style plan available to active duty personnel, retirees from the Active Component, retirees from the Reserve Component age 60 or older, and their eligible family members. Under Tricare Prime, beneficiaries must choose a primary care physician and obtain referrals and authorizations for specialty care . In return for these restrictions, beneficiaries are responsible only for small copayments for each visit (retirees and their families only). There

1960-425: Is a private, secure web-based tool maintained by an insurer that contains claims and administrative information. PHRs may also include information that is entered by consumers themselves, as well as data from other sources such as pharmacies, labs, and care providers. PHRs enable individual patients and their designated caregivers to view and manage health information and play a greater role in their own health care. It

2058-727: 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 Defense's TRICARE Online can use

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2156-503: Is a tablet-based application that parses health information downloaded through 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 through Blue Button to automatically populate personal health records in Microsoft HealthVault. Blue Button+ extended the Blue Button concept to include

2254-578: Is also available to reservists and their family under the Tricare Reserve Select Component. Under Tricare Select, beneficiaries can use any civilian health care provider that is payable under Tricare regulations. The beneficiary is responsible for payment of an annual deductible and coinsurance , and may be responsible for certain other out-of-pocket expenses . There were no enrollment fees for Tricare Select prior to 2021. As of January 1, 2021 The fees are: Tricare Prime

2352-491: Is an Internet-based set of tools that allows people to access and coordinate their lifelong health information and make appropriate parts of it available to those who need it. PHRs offer an integrated and comprehensive view of health information, including information people generate themselves such as symptoms and medication use, information from doctors such as diagnoses and test results, and information from their pharmacies and insurance companies. The personal health record (PHR)

2450-472: Is an annual enrollment fee for Tricare Prime for military retirees and their family members. There is no enrollment fee for active duty military and their family members. The majority of Tricare PRIME enrollees must exclusively use the MTF (Military Treatment Facility) to receive their care, as long as the MTF has capacity. If the MTF does not have capacity, the commander of the MTF notifies the region's contractor and

2548-479: Is an electronic, universally available, lifelong resource of health information needed by individuals to make health decisions. Individuals own and manage the information in the PHR, which comes from healthcare providers and the individual. The PHR is maintained in a secure and private environment, with the individual determining rights of access. The PHR is separate from and does not replace the legal record of any provider. The industry model personal health record (PHR)

2646-449: Is controlled entirely by the patient. While PHRs can help patients keep track of their personal health information, the value of PHRs to healthcare organizations is still unclear. Electronic health records and electronic medical records contain clinical data created by and for health professionals in the course of providing care. The data is about the patient but the data resides in a health care provider's system. Most EHRs, however, are

2744-584: 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 third-party applications. The 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

2842-530: Is important to note that PHRs are not the same as electronic health records (EHRs) or electronic medical records (EMRs), which are software systems designed for use by health care providers. Like the data recorded in paper-based medical records, the data in EHRs are legally mandated notes on the care provided by clinicians to patients. However, generally there is no mandate requiring patients to track their own health data. Like EHRs and EMRs, PHRs may still fall under

2940-452: Is not new. The term was used as early as June 1978, and in 1956, there was a reference was made to a "personal health log." The term "PHR" may be applied to both paper-based and computerized systems; usage in the late 2010s usually implies an electronic application used to collect and store health data. In the early 2000s, healthcare organizations began to propose formal definitions of the term. For example: The Personal Health Record (PHR)

3038-445: Is similar to Tricare Reserve Select, but differs in that there is no premium cost-sharing with DoD as there is with Tricare Reserve Select. As such, retired Reserve Component members who elect to purchase Tricare Reserve Retired must pay the full cost (100%) of the calculated premium plus an additional administrative fee. Payments could range as high as $ 900.00 a month. Although open to all eligible retired Reserve Component personnel under

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3136-663: Is they return to a SELRES status. Reserve Component personnel who are also Federal civil servants (to include Army Reserve Technicians and Air Reserve Technicians in the Army Reserve, Army National Guard, Air Force Reserve and Air National Guard) and eligible for the Federal Employee Health Benefit Program (FEHBP) are also excluded from Tricare Reserve Select. Retired Reserve Component personnel and eligible dependent family members become eligible Tricare Standard, Tricare Extra or Tricare Prime on

3234-512: Is typically defined as a view into the electronic medical records. In addition, ancillary functions that support a health care provider's interaction with a patient are also found in those systems e.g. prescription refill requests, appointment requests, electronic case management, etc. A new concept being discussed is the UHR or "universal health record", which would be a patient-centered and patient-controlled body of information that could be shared in

3332-472: Is when the PHR is tethered to an electronic health record, which automatically updates the PHR. Not all PHRs have the same capabilities, and individual PHRs may support one or all of these methods. In addition to storing an individual's personal health information, some PHRs provide added-value services such as drug-drug interaction checking, electronic messaging between patients and providers, managing appointments, and reminders. PHRs grant patients access to

3430-531: 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. The Blue Button

3528-839: The Obama administration announced the White House Presidential Innovation Fellows which will focus on five program areas including expanding 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 Automate Blue Button Standards and Interoperability Framework Initiative, which culminated in 2013 with

3626-797: The Reserve Component . Tricare is the civilian care component of the Military Health System , although historically it also included health care delivered in military medical treatment facilities. The Tricare program is managed by the Defense Health Agency . Before 1 October 2013, it was managed by the Tricare Management Activity under the authority of the Assistant Secretary of Defense (Health Affairs) . On that date, it

3724-519: The Title 32 National Guard ( Army National Guard and Air National Guard ) in a drill pay (also known as "paid") status. As of February 2008, retired Reserve Component personnel under the age of 60, actively drilling Individual Ready Reserve personnel in a non-paid status, or actively drilling Volunteer Training Unit personnel in a non-paid status do not qualify for Tricare Reserve Select. Individual Ready Reserve and Volunteer Training Unit members are eligible for reinstatement under Tricare Reserve Select

3822-406: The ownership of the data. Once data is in a PHR it usually owned and controlled by the patient. Patient can edit, save or share this record with any one. Finally, PHRs are data that resides with the patient, in a system of the patient's choosing. This data may have been exported directly from an EMR, but the point is it now resides in a location of the patient's choosing. Access to that information

3920-409: 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 Peter L. Levin announced that VA and HHS’s Center for Medicare and Medicaid Services were offering Blue Button downloads to Veterans and to Medicare beneficiaries. Blue Button

4018-568: 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

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4116-647: The Blue Button trademark was transferred from the Veterans Administration to the U.S. Department of Health and Human Services. In 2012, efforts began by the Standards & Interoperability Framework to standardize the content formats and transport mechanisms for 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

4214-558: The Department of Veterans Affairs announced that the Blue Button has one million registered patients. The Center for Medicare and Medicaid Services (CMS) launched its version of 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,

4312-530: 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 L. Levin, also an attendee at

4410-630: The European Union, which provides some of the most significant protections to PHR data through the General Data Protection Regulation (GDPR), the reviewers found "significant room for interpretation and a degree of ambiguity in key areas." With further questions arising about the security and privacy of PHI that makes its ways to expanding platforms such as smartphones and associated applications, clearer regulations and policies will likely be required. PHRs have

4508-665: The Institute of Medicine) called for greater adoption of PHRs in 1999, the software has faced many barriers to adoption, including economic, technological, regulatory, behavioral, and organizational issues at both the environmental and individual levels. A study from 2002 was carried out in an effort to assess the functionality and utility of the budding online PHR. It found that most people did not keep record of minute details of their healthcare experiences and therefore made it difficult to get full value from web-based PHRs. The PHRs selected for evaluation offered limited functionality to

4606-631: 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

4704-464: The Puget Sound region of Washington state. Tricare Reserve Select is a premium-based health plan that active status qualified National Guard and Reserve members may purchase. The classification is sometimes referred to as Tricare Reserve Component (RC). It requires a monthly premium and offers coverage similar to Tricare Standard and Extra for the military member and eligible family members. It has

4802-484: The Tricare Prime option and pay no out-of-pocket costs for Tricare coverage), Military Health System beneficiaries may have a choice of Tricare plan options depending upon their status (e.g., active duty family member, retiree, reservist , child under age 26 ineligible for family coverage, Medicare -eligible, etc.) and geographic location. Historically, health care for military personnel and their dependents

4900-497: The Tricare program. Currently, there are three regional Managed Care Support Contractors, a Medicare/Tricare Dual Eligible Fiscal Intermediary Contractor, and a Tricare Pharmacy contractor, who administers both Mail Order Pharmacy and Retail Pharmacy programs. In addition several administrative contractors provide quality management, auditing, and statistical services. Tricare Management Activity contracts and administers dental programs. In 2004, Tricare Management Activity re-aligned

4998-546: The U.S. Department of Health and Human Services. 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

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5096-791: 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

5194-668: 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. As of 2013, widespread Blue Button usage supported 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+

5292-485: 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 by adding Blue Button functions to

5390-401: The addition of "Tricare for Life" benefits in 2001 for those who are Medicare -eligible, and "Tricare Reserve Select" in 2005. Tricare Select provides a similar benefit to the original CHAMPUS program and is available to Active Duty personnel, dependents, retirees from the Active Component, retirees from the Reserve Component age 60 or older, and their eligible family members. Tricare Select

5488-594: The age of 60, the program's principal focus is often perceived as being focused on recent Reserve Component retirees who are self-employed or otherwise ineligible for civilian employer provided/subsidized health insurance, especially those who were mobilized for full-time active duty service subsequent to 11 September 2001 in support of Operations Enduring Freedom , Iraqi Freedom , New Dawn and/or Noble Eagle . Retired Reserve Component personnel who elect to participate in Tricare Reserve Retired exit when

5586-631: The capability to its customers. The company expects 26 million plan beneficiaries will have access to Blue Button downloads by mid-2013. Other private sector organizations contributed to the growth of Blue Button. For example: In December 2011, the U.S. Office of Personnel Management announced that it had requested all federal employee health benefit plans to add the 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,

5684-479: The contractor's provider network is used to supplement the MTF's capacity. If the MTF regains capacity, the MTF reserves the right to move the beneficiaries back to receiving their care at the MTF in a process known as "recapture." US Family Health Plan , a Tricare Prime-sponsored health plan option, is made available by nonprofit health care providers in the Northeast U.S., Southeast Texas/Southwest Louisiana, and

5782-404: The copying of health records to a mass-storage device such as a CD-ROM , DVD , smart card , or USB flash drive . PC-based PHRs are subject to physical loss and damage of the personal computer and the data that it contains. Some other methods of device solution may entail cards with embedded chips containing health information that may or may not be linked to a personal computer application or

5880-506: The development and implementation process, from developers talking with providers about a proposed system, clinics forming patient focus groups, and providers posting physical and digital news of the PHR to patients. The features and usability of the system also drive adoption, with groups such as Kaiser Permanente and Cleveland Clinic seeing substantial increases in PHR use when adding the features users want. Provider use and communication has also proved important; "[s]ecure communication with

5978-623: 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. The Federal 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. Personal health record The term "personal health record"

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6076-479: 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,

6174-495: The general public, with limitations in data entry, validation, and information display methods. A 2005 survey found that limited access to computers and the internet access, as well as low computer literacy levels, known as the digital divide , was a barrier for low-income and aged populations. A 2010–11 set of interviews of clinicians and patients found "that both usability concerns and socio-cultural influences are barriers to PHR adoption and use." More recent studies and reviews in

6272-468: The growth in the standing forces of the U.S. military due to the Cold War , access to care in military facilities became increasingly unavailable for military retirees and the dependents of both active duty and retired military personnel due to resource constraints and growing demands on the system. It was at this time that the concept of "space-available basis" for military retirees and military dependents

6370-589: The integration and presentation of data across residential blocks to entire zip codes. However, like PHR, significant social approval would have to occur, and data use agreements would have to be established. TRICARE Tricare (styled TRICARE ) is a health care program of the United States Department of Defense Military Health System . Tricare provides civilian health benefits for U.S Armed Forces military personnel , military retirees, and their dependents , including some members of

6468-488: The mid- to late 2010s have revealed other issues such as privacy and confidentiality concerns, lack of motivation, low health literacy, health- and disease-related disabilities, and even administrative burdens. Additionally, how the PHR is promoted by healthcare organizations, how useful their features are, and how well the care provider uses it, particularly in the realm of patient communication, can influence adoption and usage rates. Promotion may occur at several steps of

6566-851: The national Tricare Dual Eligible Fiscal Intermediary Contractor. Pharmacy claims are processed by the Tricare Pharmacy Contractor (Express Scripts) and Overseas Tricare for Life claims are processed by the Tricare Overseas Program Contractor (as of September 2010 this will be International SOS using Wisconsin Physicians Service as their Fiscal Intermediary partner). The signing of the National Defense Authorization Act in January 2011 aligned Tricare with

6664-565: The need for PHRs and the availability of various online PHR providers, there has not been wide adoption of PHR services. E.g. Google discontinued its PHR service called Google Health on January 12, 2012. The reason cited for shutting down Google Health was that the service did not translate from its limited usage into widespread usage in the daily health routines of millions of people. Surveys of web-based services have found wide variations in functions between services and only limited data on efficacy and safety concerns. One analyst, describing

6762-710: The need for a computer or any other hardware. Probably the most successful paper PHR is the hand-held pregnancy record, developed in Milton Keynes in the mid-1980s and now in use throughout the United Kingdom. These include the Scottish Woman-Held Maternity Record, All Wales Maternity Record, and Perinatal Institute notes. Paper-based PHRs may be difficult to locate, update, and share with others. Paper-based PHRs are subject to physical loss and damage, such as can occur during

6860-573: The opportunity to submit their data to their clinicians' EHRs. This may help clinicians make better treatment decisions by providing more continuous data, resulting in improved efficiency in care. However, some physicians may have concerns about patient-entered information and its accuracy, as well as whether the added patient engagement creates more reimbursable work. Like other health information technology , PHR architecture can be roughly organized into three main components: Architecture types remain various. However, in 2017, Roehrs et al. performed

6958-489: 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

7056-454: The physician is important because the patients will eventually leave (the PHR) if there is no conversation going on with the physician." Additional studies have also shown that when put to use, PHR's ability to enhance communication and collaboration can change patient patterns from sporadic visits to steady visits, and more significant PHR use. One of the most controversial issues for PHRs is how

7154-438: The potential to benefit the public health sector in areas such as health monitoring, outbreak monitoring, empowerment through information and resources, linking to services, and research. However, tapping into this potential has been a slow process due to both the public health sector not fully engaging with adopters and the adopters themselves exhibiting "reticence to share sensitive information." Several surveys of Americans in

7252-481: The previous twelve regions into three large regions, known as Tricare North , Tricare South , and Tricare West . Services in these regions are provided by: All medical claims are processed ("adjudicated") by the following claims processing sub-contractors: In 2009, the Tricare Overseas Program contract consolidated the following: In October 2009 International SOS Assistance, Inc. was awarded

7350-418: The principal distinguishing features of a PHR is the platform by which it is delivered. The types of platforms include: paper, electronic device, and web. Personal health information is recorded and stored in paper format. Printed laboratory reports, copies of clinic notes, and health histories created by the individual may be parts of a paper-based PHR. This method is low cost, reliable, and accessible without

7448-480: The priority areas in PHR research. As PHRs may play a key role in advancing health information exchange, interoperability with other health IT systems is an important consideration for PHR architecture. Additionally, PHR systems requires users to put forth an "'ongoing' effort to keep their account up to date" (maintain an active role in managing their own health), which in turn requires further examination of PHR architecture and adoption models by developers. One of

7546-438: The privacy, security, and patient concerns surrounding PHI. On the technological side, failures occur at numerous points: The state of PHR regulations are also worth mentioning. A 2018 review and comparison of five legislative jurisdictions around the world found "considerable variances with regards to legal terminology and the degree of compliance required from entities offering PHR services across various jurisdictions." Even in

7644-695: The property of the provider, although the content can be co-created by both the provider and patient. A patient has a legal right in most states to request their healthcare data and under recent USA legislation those providers using a certified EHR will be required to provide an electronic copy as well. In the UK, according to the governments' information strategy for the NHS every primary care practice in England will have to offer patients online access to their care records by 2015. In 2012, only 1% did so. The patient portal

7742-491: The provisions of the 2010 Patient Protection and Affordable Care Act, and led to the creation of TYA. Enrollment began on 1 May 2011. The ultimate responsible organization for administration of Tricare is the U.S. Department of Defense Military Health System , which organized the Tricare Management Activity. The Tricare Management Activity contracts with several large health insurance corporations to provide claims processing, customer service and other administrative functions to

7840-558: The public's reluctance to adopt the services, called PHRs "a technology in search of a market." An emerging standard from HL7 , Fast Healthcare Interoperability Resources (FHIR), is designed to make it easier for developers of personal health record applications to access relevant medical records. The terms electronic health records , personal health records, and patient portals are often used interchangeably. By definition and working they are different from each other. The generally agreed upon definition of these terms relates mainly to

7938-518: The questionable state of regulatory efforts to protect PHR data from these and other concerns, the standard use of health data from PHRs in public health may still be far away. The U.S. Centers for Disease Control and Prevention has taken the idea of PHR integration with public health efforts a step further, in 2016 suggesting a framework for a community health record "for integrating and transforming multisector data into actionable information." Integration of EHR, PHR, and county health data would allow

8036-425: The regulatory scope of governments, depending on their origin, but rigorous regulatory protection of their data is still lacking in parts of the world. PHRs can contain a diverse range of data, including but not limited to: There are two methods by which data can arrive in a PHR. A patient may enter it directly, either by typing into fields or uploading/transmitting data from a file or another website. The second

8134-523: 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,

8232-526: The requirement for Part B coverage exists when the beneficiary that is Medicare eligible is the spouse of an Active Duty Service Member. In some instances Tricare for Life is primary payer when the services are normally a Tricare benefit but not covered by Medicare. This includes drug charges, when Medicare benefit limits are attained and services performed outside the United States or in a Veterans Affairs facility where Medicare does not pay. Tricare for Life does not pay patient liability for services that are not

8330-442: The same level of coverage as U.S. citizens who had never served full 20 to 30-plus year careers in the armed forces. This included becoming Medicare eligible due to disability. Tricare for Life is designed to pay patient liability after Medicare payments. There is no enrollment necessary for Tricare for Life and to be eligible, members must be Tricare and Medicare Eligible and have purchased Medicare Part B coverage. An exception to

8428-693: The service member reaches age 60 and he/she and their eligible dependent family members become eligible for the same Tricare Standard, Tricare Extra or Tricare Prime options as Active Component retirees and, in the case of Tricare Prime, at the same cost as Active Component retirees. Qualification questions should be referred to Tricare. Tricare Young Adult (TYA) is a premium-based health care plan available for purchase by qualified dependents who have aged out of Tricare at age 21, or age 23 for full-time college students. Dependents are eligible if they are unmarried, not eligible for either Tricare coverage or their own employer-sponsored health care coverage, and their sponsor

8526-550: The service member's 60th birthday in the same manner as Active Component retirees and their eligible dependents are eligible immediately upon retirement from active service. Qualification questions should be referred to Tricare. Tricare Reserve Retired is a premium-based health plan that qualified retired members of the National Guard and Reserve under the age of 60 may purchase for themselves and eligible family members. Established in 2008 and opened for enrollment in 2010, it

8624-431: 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 Button initiative. 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

8722-725: The technology could threaten the privacy of patient's protected health information (PHI). Network computer break-ins are becoming more common, thus storing medical information online can cause fear of the exposure of health information to unauthorized individuals. In addition to height, weight, blood pressure and other quantitative information about a patient's physical body, medical records can reveal very sensitive information. This includes fertility, surgical procedures, emotional and psychological disorders, and diseases, which many patients are reluctant to share even voluntarily. Various threats exist to patient information confidentiality: Technological and regulatory issues play important roles in

8820-582: The technology, including United Health Care, Humana, Patients Like Me, Walgreens, and others. 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 offering Blue Button downloads to its commercial health plan beneficiaries in July 2012, rolling out

8918-428: The twenty-first century have indicated that anywhere between 63 and 73% would be willing to share at least some personal health information with public health officials for detecting disease outbreaks and other purposes. However, caveats about retaining control of how the information is presented and used remain strong among respondents, with concerns about anonymity, government insensitivity, and discrimination. Given

9016-695: The use of this data, such as the application offered by Northrop Grumman . 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,

9114-545: The web-based solution as the platform. A large number of companies have emerged to provide consumers the opportunity to develop online PHRs. Some have been developed by non-profit organizations, while others have been developed by commercial ventures. These web-based applications allow users to directly enter their information such as diagnosis, medications, laboratory tests, immunizations and other data associated with their health. They generate records that can be displayed for review or transmitted to authorized receivers. Despite

9212-542: 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 stakeholders. In September 2012,

9310-434: Was disestablished and Tricare responsibility was transferred to the newly established Defense Health Agency. The Department of Defense operates a health care delivery system that served approximately 9.4 million beneficiaries in 2018. The Department of Defense's unified medical program represents $ 50.6 billion or 8% of total FY2019 U.S. military spending. With the exception of active duty service members (who are assigned to

9408-874: Was first noted. To address this problem, Congress passed the Dependents Medical Care Act of 1956 and the Military Medical Benefits Amendments of 1966. These acts allowed the Secretary of Defense to contract with civilian health care providers . This civilian health care program became known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) in 1966. In the late 1980s, because of escalating costs, paperwork demands, and general beneficiary dissatisfaction, DoD initiated

9506-486: Was provided in military medical facilities as promised by the military, and through a referral system by civilian medical personnel where military physicians were not available in a certain specialty, or when and where overcrowding of a military medical facility occurred. Active duty military personnel always have priority for care in military medical facilities. After World War II and the Korean War , especially with

9604-517: Was to award three competitively bid contracts covering six states, only one bid, made by Foundation Health Corporation (now Health Net ) covering California and Hawaii , was received. Foundation delivered services under this contract between August 1988 and January 1994. In late 1993, in response to requirements in the National Defense Authorization Act for Fiscal Year 1994, the DoD announced plans for implementing

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