Table 3.

Summary of themes by provider responses with illustrative quotes.

Theme		Provider quote
Knowledge of Blue Button
	All: limited knowledge of Blue Button	“I’ve not seen that...this is not what I get from a VA patient. What I get from him is akin to an office visit summary.” (non-VA)
Ease of use, content, and readability of Blue Button printout
	All: improve information display	“...it’s not that the information is not useful, it’s just that it’s displayed over too many pages.” (non-VA)
	Non-VA: useful information; missing patient VA visit information (last visit note)	“You’re not showing me the ‘patient visit’ here. The one thing that’s missing.” (non-VA)
Relative advantage of Blue Button for accessing and sharing VA information
	All: sharing information often relies on the patient	“I will print out stuff and give it to the patient, I say, ‘Here, go give this to your urologist, okay?.’...and sometimes ...we tell the patients, ‘You could have anything you want sent to whomever you want. Just go out to the business desk and those folks will take care of it.’” (VA)
	Non-VA: difficult to get information from VA and patients sharing this information can help bridge the gap	“With VA, we get nothing...[W]e need something we have to call the VA or have the patient acquire it...Nothing is ever sent automatically from VA...and most of the time I don’t even know that they see the VA...” (non-VA)
		“...we haven’t had real good luck getting information from VA, so I think this is...better, the Blue Button.” (non-VA)
Perceived value of Blue Button
	All: tool for patient education and value of self-report information	“Because people who are really reading or going through their records they are more involved in their health...they will learn more about their own health and their own medication.” (VA)
		“Having the self-report is important, because that allows you to figure out what you think is going on and what they think is going on is different. And bringing together different sources, like looking at their pill bottles...” (VA)
	Non-VA: improved efficacy	“...it would increase our accuracy and decrease our duplication of tests... it would make ...more economical sense for the patient insurance system as well.” (non-VA)
	Non-VA: abstract and incorporate relevant information in own electronic medical record	“It’s not just this sort of scanned PDF, but rather something that becomes useable and actionable.” (non-VA)
Provider perspectives on workflow and data quality
	All: mixed response to how it would impact workflow of clinical encounter, however information was valued	“It would help...I don’t think it would add a lot of time...to have the information is important.” (non-VA)
		“If they’re very knowledgeable and could tell me all this verbally, then it probably doesn’t necessarily save time...if this was a very long printout, it could take longer, but I don’t think that’s necessarily a bad thing. Because if you you’re getting a fuller picture...then I think that would be beneficial.” (VA)
	All: generally trust Blue Button report and self-entered information; however, may depend on the data reported and patient	“We ask patients to give us their history of what’s happened to them, and we trust that. There are times we have to go corroborate that, so I see no reason why I wouldn’t trust this any less than my encounter when I ask, ‘So what’s happened in the last year?’” (non-VA)
		“[the self-entered information] I get a little nervous...did they enter right? ...it’s a data quality issue.” (VA)
Preferences for sharing and receiving information
	All: prefer electronic receipt of data and easy sharing between systems	“What would be really ideal is if there were an interface between the community and the VA system where if a patient gets lab work done at the VA, or diagnostic studies done at the VA, or a colonoscopy done at the VA, right? Then, that stuff would come in and integrate with my system.” (non-VA)
	All: hard copy could be used for patient education	“I’d like them to bring it in their hand...We make notes on it, it goes back home with them. It’s incredibly valuable for them to have stuff in their hands.” (VA)
	All: receipt of information in advance of clinical encounter	“It’s always nice to have it ahead of the visit... then you can review it before the visit and highlight the important things that you want to address...” (non-VA)
	All: mixed support for delegate access to patient’s PHR	“In certain cases, I would...depends on the patient... and their problems.” (VA)
		“...it spills on the wrong side of patients embracing responsibility for their health record. And therefore, it probably spills on the wrong side of where the liability is...” (non-VA)
	All: open to patients logging in and sharing their personal health record data at a visit; however, possible work flow and technology barriers	“It’s going to take some time, but chronic illness management requires some time. You need to take time and talk to people about these things during visits, and I think this would be a way of making it more efficient, not less...it’s a tradeoff, you would save time by not doing it, but I think that not doing it is not a good option.” (VA)
		“Right now, they can’t log in to our computer, that would have to change...but, even so, I think that would sort of bog you down...in the office.” (non-VA)