cms bluebutton on fhir for researchers - presentation to nih and pcori researchers

Donate My Data:What Blue Button on FHIR

Can Do for Research

Mark ScrimshireCMS, Office of Enterprise Data & AnalyticsJanuary 2016

● A brief history of Blue Button

● What are Blue Button and FHIR?

● What is CMS Blue Button on FHIR?

● Blue Button on FHIR: Consumer consent and data donation

● CMS plans for Blue Button on FHIR

● How researchers can get involved

Agenda

2

A Brief History of Blue Button

3

Blue Button Unleashes Personal Data

1.2MMedicare

Users

Blue Button in Use

1.2M CMS 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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How Could We Improve Blue Button?

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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

Consent*Patient

*Recorded in FHIR ContractResource

1. Patient focused

2. Self-contained

3. Include reference Identifiers

4. Include patient profile subset

5. Contains a claim header & lines

6. One Claim per EOB

7. Each EOB has a GUID

Creating the HL7 EOB

5

4

3

2

1

6

7

Under Construction

Research team registers with CMS

Research institution obtains unique access ID

Research team embeds ID in data

collection app

Medicare user agrees to join research study

Medicare user uses data collection app

Blue Button on FHIR API

requires Medicare user to authenticate

Medicare user gives app data access

permission via API

Blue Button on FHIR API issues

user access key to data collection app

Data collection app uses ID and key to

automate data collection for user

Consumer Consent and Data Donation

1 2 3

4 5 6

7 8 9

● Permission process familiar to smartphone and social media users

● Growing tools marketplace

● Data is structured with internationally accepted meaning

Benefits of a Standard API

Prototype: Post-Authentication Application Permission Screen

● Beneficiary Consent opens the door for: No cost access to their claims information

● Benefits to Researchers: Avoid the Data Use Agreement

No payment to CMS

Refreshed Data

Weekly – Part A / B

Monthly – Part D

The BlueButton API enables a new era and a new route for Research Data Collection

● 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 Health DataPalooza Code-a-Thon April 1–2, Washington DC

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: PartBDiagnosis 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

● What the research community can do now Subscribe for updates – contact Carly.Medosch@cms.hhs.gov

Attend Code-a-thon

April 1–2, Washington DC

http://healthca.mp/onfhir/

Learn more about FHIR

http://hl7-fhir.github.io

Participate in pilot (Anticipated Spring/Fall)

Next Steps

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●  BlueButton Text to JSON Converter: https://github.com/ekivemark/python-bluebutton

● BlueButton on FHIR https://github.com/ekivemark/BlueButtonFHIR_API https://github.com/ekivemark/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

● Mark Scrimshire Entrepreneurs-in-Residence:

Mark.Scrimshire@cms.hhs.gov

Karl.Davis@cms.hhs.gov

● Carly Medosch Outreach

Carly.Medosch@cms.hhs.gov

Contact Info