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 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+ 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. = Origins =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 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 participantsnot 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 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.