The Blue Button began as a Department of Veterans Affairs initiative in response to an executive order but has grown into a driving force behind the patient-centered care movement. By placing people before software, the Blue Button offers lessons in customer-focused service for executives in all markets.
Technology priorities drive integration and architecture decisions, leaving customers out in the cold. Executives are indignant. "We must be more customer-focused!" they shout. Somewhere along the line, though, this message becomes muddled, customers suffer and, in the end, the bottom line takes the brunt of the attack.
The good news: It doesn't have to be this way. Sometimes, executive mandates for better customer focus-even when mandating better use of technology-can lead to profound improvements in customer service. While executive leadership is critical, refocusing a large organization requires good decisions at multiple levels. Difficult, yes, but it can be done.
Take, for example, the U.S. Department of Veterans Affairs' Blue Button Initiative. At its core, Blue Button lets veterans download their personal health records (PHRs) from the VA in a simple, readable format that they can share with their doctors or other people they trust.
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It's a simple idea and relatively straightforward for the VA to implement, but the strategic benefits of Blue Button continue to grow. Blue Button is impacting patient care well beyond the community of veterans, perhaps even improving customer focus at organizations outside the healthcare industry entirely. The executive mandate that fostered Blue Button, and the critical decisions along the way that took this simple idea and turned it into a transformative force for business at large, present a lesson that all executives can take to heart.
Blue Button Empowers Veterans, Not Software
The Blue Button story began in April 2011, when President Barack Obama signed Executive Order 13571: Streamlining Service Delivery and Improving Customer Service. This Executive Order called on U.S. government agencies to improve how they delivered customer service, and furthermore, required each agency to announce a "signature initiative" to improve customer service using technology.
Two aspects of this order highlighted its efficacy-first, the call for a single, signature open initiative, instead of a simple order for improved customer service, and second, the requirement to use technology without being any more specific about what technology or how to use it. This combination of strategic mandates encouraged agencies to be creative, while at the same time presenting to each agency a reasonable challenge with a high chance of success.
The VA, in turn, made two critical strategic decisions when selecting Blue Button as its signature initiative. First, the agency specified a simple, ASCII text-based format for the PHRs. Second, it put the power and responsibility for PHRs into the hands of the veterans themselves.
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From the technologist's perspective, the choice of a simple, human-readable text format is counterintuitive. After all, we have XML, JSON and other markup systems, as well as complex semantic models for electronic health records (EHRs) like those specified in the HL7 standards. Shouldn't we base Blue Button on one of those?
In short, no. The simple format the VA chose is instead fully human readable, which means that everyone can read PHRs. Yes, a format without complex markup is more difficult for software to interpret, but creating such software is still reasonably straightforward using today's sophisticated tools. The VA's choice of a common framework for PHR makes life easier for people, not for software. XML and HL7 and their brethren may empower software, but the point to Blue Button is to empower the veteran.
The VA's second strategic decision is even more significant. By essentially putting the power and responsibility for PHRs into the hands of veterans, the agency enabled patient-centered care-the new mantra for more efficient, customer-focused healthcare. There are many elements to this approach, but from the perspective of IT, patient-centered care shifts the focus from applications, providers and specialties to a longitudinal view of the patient that cuts across systems and applications over time as the veteran (or any patient) interacts with healthcare providers during the course of his or her lifetime.
Improving patient-centered care for our veterans is important and life-changing for the lives it impacts, but the success of Blue Button doesn't stop there. The VA has registered the trademark but also licensed it for free to anyone who wants to use it.
Dozens of for-profit businesses in the healthcare, software and other industries, seeing the hundreds of thousands of downloads of PHRs, took notice. A Blue Button ecosystem soon formed, consisting of a range of Blue Button-related products and services, first for veterans and then, inevitably, for patients at large. After all, if Blue Button works for veterans, why can't it work for all Americans? Today, this ecosystem is just gaining steam, having recently been extended to federal employees and Medicare patients, and we have yet to see how far-reaching its effects will be.
Improving Customer Service Is Only the Beginning
There are important lessons here for any organization in any industry. What healthcare calls patient translates to customer, and care translates to service. So, by extension, the notion of patient-centered care is an example of customer-focused service.
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Does your organization truly offer customer-focused service? Perhaps, but far too many companies and public sector organizations struggle with this concept. Customer-focused service, after all, is quite different from traditional notions of customer service, especially in large organizations where customer service is little more than a cost center, a money sink best managed by outsourcing call centers to India. We've all been on the customer side of this equation, and we can all testify to the lack of customer focus in most purported customer service.
If you're an executive at such an organization, and you want to improve your customer focus, then your challenge is to learn the lessons of Blue Button so that you can apply them internally. How many of the following lessons are you willing and able to bring to your own shop?
Finally, ask yourself this question: Is the VA's Blue Button Initiative a good use of our tax dollars? By all accepted measures, the answer is a resounding yes-Blue Button is leading to reduced costs, better care for veterans and even fewer medical errors. Everybody's a winner here.
Now take a look at the customer-focused initiative that you're considering. If you don't have the same confidence that it's also a win-win for everyone involved, it's time to go back to the drawing board.
Jason Bloomberg is the president of ZapThink, a Dovel Technologies Company. ZapThink is a service-oriented architecture (SOA) advisory and analysis firm. Bloomberg focuses on enterprise architecture, SOA and cloud computing. Follow everything from CIO.com on Twitter @CIOonline, on Facebook, and on Google +.
Read more about government use of it in CIO's Government use of IT Drilldown.
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