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What the CMS Blue Button® on FHIR® Data API Can Do for CMS
Mark ScrimshireCMS Blue Button Innovator
Office of Enterprise Data & AnalyticsJune 2016
Blue Button in Use
1.4MCMS users
20–30kDownloads/Month
Private sector applications already ingest, optimize, and visualize data from Blue Button text files
• Hospital• Physician• Prescription drugs
Federally InspiredBlueButton Community• VA• DoD (TRICARE)• CMS
2x textdownloads
Beneficiaries can download up to 3 years of claims data
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“Build a developer-friendly, standards-based data API that enables beneficiaries to connect their data to the applications, services, and research programs they trust”
Blue Button on FHIR Vision
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What is FHIR?
Fast Health Interoperability Resources
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What is CMS Blue Button on FHIR?
There are many FHIR structured profiles covering infrastructure, clinical, identification,
workflow, conformance, and financial.CMS Blue Button uses a limited subset of
these profiles based on the data we publish
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Explanation of Benefits
ConsentPatient
●Permission process is familiar to beneficiaries
●Growing tools marketplace
●Data is structured with internationally accepted meaning
Making Consent and Data Donation Simple for the Beneficiary and Researcher
Prototype: Post-Authentication Application Permission Screen
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●Beneficiaries explicitly give permission to share their data.
●This is a new option for data collection. All current research data acquisition options are still available.
●There is no cost for downloading an individual beneficiary’s data once a data collection app has been developed and registered.
CMS Blue Button on FHIR Data API is a New Channel for Research Data Collection
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● Active development in 2016 FHIR service for 38M FFS beneficiaries
Data sourced from CMS Chronic Condition Data Warehouse (CCW)
● Use HL7 FHIR Explanation of Benefits
● Reformat of current Blue Button file Three years of claims data history
in FHIR format
Mapping data to FHIR profiles
● Making prototype API available at Code-a-thons
April 1–2, Washington DC
Sept 15–16, Baltimore (Proposed) Get more info & register
http://healthca.mp/onfhir/
CMS’ Plans for Blue Button on FHIR
Claim Number: 2333444555200Provider: No Information AvailableProvider Billing Address: Service Start Date: 01/05/2014Service End Date: 01/05/2014Amount Charged: * Not Available *Medicare Approved: * Not Available *Provider Paid: * Not Available *You May be Billed: * Not Available *Claim Type: Part BDiagnosis Code 1: 2163--------------------------------Claim Lines for Claim Number: 2333444555200--------------------------------Line number: 1Date of Service From: 01/05/2014Date of Service To: 01/05/2014Procedure Code/Description: 99213 - Established Patient Office Or Other Outpatient Visit, Typically 15 MinutesModifier 1/Description: Modifier 2/Description: Modifier 3/Description: Modifier 4/Description: Quantity Billed/Units: 1Submitted Amount/Charges: * Not Available *Allowed Amount: * Not Available *Non-Covered: * Not Available *Place of Service/Description: 22 - Outpatient HospitalType of Service/Description: 1 - Medical CareRendering Provider No: PARTBPROVRendering Provider NPI:
Current Blue Button Claims
Information Layout
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●Patient profile
●Explanation of Benefit profile: Part A in-patient claims
Part B professional claims
Part D pharmacy claims
●Typical content of a FHIR EOB/Claim record: Provider
Diagnosis code
Costs and charges
What Data Will Be Published
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FHIR Service
●Upgrades the current Blue Button to make it more useful to beneficiaries
●Demonstrates API leadership by example to the industry
●Blue Button is a flexible tiered architecture
Why Blue Button on FHIR is important to CMS
FHIR ServiceCCW
BlueButton Front-endSLS Auth
Configurable Resource Mapping
Futu
re In
tegr
atio
nsD
ata
Col
lect
ion
/ Dat
a P
ublis
hing
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●FHIR can publish AND consume data
●FHIR profiles represent internationally and industry standard data formats
●FHIR REST API can be used to handle simple searches
●REST API with OAuth2 scopes allows controlled access to data
●REST API can be easily integrated with other platforms and workflow
Why FHIR is a CMS Game Changer
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Working with FHIR
DEMOhttp://fhir.bbonfhir.com/fhir-p/
http://hl7-fhir.github.io
http://fhirtest.uhn.ca12
●What the research community can do now Visit for more information:
http://go.cms.gov/bluebutton Attend FHIR Code-a-thon
Sept 15–16, Baltimore, MD (Proposed) http://healthca.mp/onfhir/
Learn more about FHIR http://hl7-fhir.github.io
Participate in pilot
Next Steps
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● Blue Button text to JSON converter: https://github.com/ekivemark/python-bluebutton
●Blue Button on FHIR https://github.com/TransparentHealth/hhs_oauth_server https://github.com/HHSIDEALab/poet
●HL7 FHIR http://www.hl7.org/implement/standards/fhir/http.html
●HL7 WIKI http://hl7-fhir.github.io/index.html
●HAPI Server: https://github.com/jamesagnew/hapi-fhir
Follow Our Progress, Join Us, and Contribute
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● Mark Scrimshire CMS Blue Button Innovator
● Karl Daviso Entrepreneurs-in-Residence:
● Lori Pettebone-Maatta Program Manager
● Carly Medosch Outreach
Contact Info
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