cms bluebutton on fhir - himss17 update

Blue Button® API: Creating a Data-Driven Ecosystem to Benefit Medicare BeneficiariesMark ScrimshireFebruary 21, 2017

The Power of Beneficiary-Directed Data

HIMSS 2017

• CMS Blue Button® Innovator• Health Data and Cloud Technologist• Co-Founder & CTO: Medyear• Chief Instigator: HealthCa.mp• Blogger: blog.ekivemark.com• Twitter: @ekivemark

Introduction: Mark Scrimshire

2NewWave: Stand #237

33.6M2010

2016

Total UsersVA, CMS, DoD

A Brief History of Blue Button®

Blue Button Unleashes Personal Data

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1.6M CMS users

20–30kDownloads/Month

2x textdownloads

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The Current Blue Button Usage

Private sector applications already ingest, optimize, and visualize data from Blue Button text files

• Hospital• Physician• Prescription drugs

Federally InspiredBlue Button Community• VA• DoD (TRICARE)• CMS

Beneficiaries can download

up to 3 years of claims data

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• Health information is challenging to use in current PDF or plain text format

• Beneficiary has to return to MyMedicare.gov to get at least six months of data each time new information is available

• Apps like iBlueButton have entered the market to automate this process by screen scraping and borrowing beneficiary user IDs and passwords, weakening security

• Health care industry has moved to structured data formats (BlueButton+ /CCDA)

• Enhanced Blue Button service can be a powerful tool to support the drive to improve quality of care

• Interoperability is finally taking hold in health care (HL7/FHIR)

Why Change Blue Button?

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Blue Button Vision

“Build a developer-friendly, standards-based data API that enables beneficiaries to connect their data to the applications, services, and research programs they trust”

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An Enhanced Blue Button has a Critical Role in Value and Quality-based Health

V ?

Personal Applications Personal Health Record

Care Coordination

Putting patientsat the center

Research

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Blue Button API is using FHIR to create a robust data API service that enables beneficiaries to connect their health data with applications and services they trust.• For beneficiaries

– Direct control over how they share their claims data– Structured Blue Button data will unleash innovation for better health– International standard formats make sharing data easier

• For care coordination– Earlier access to beneficiary claims data for proactive care management– Access to three years of beneficiary claims history– Structured data formats improve data validation for more accurate

analytics

• Directly supporting key initiatives– Supports the adoption of industry standard APIs for improved data

interoperability– Supports the triple aim: better care, better health, and lower costs

Blue Button API

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• Each beneficiary must register with research app and authorize app access to their data

• 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 Blue Button API Enables a New Era and a New Route for Research Data Collection

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FHIR: Fast Healthcare Interoperability Resources.

The FHIR Specification is a standard for exchanging healthcare information electronically, created by HL7® International.

FHIR leverages the latest web standards (APIs and Structured Data Formats) and applies a tight focus on implementability.

FHIR features:• Secure transport• Developer friendly flexibility• Structured data• International standards

What is FHIR®?

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Why Blue Button on FHIR?

“I control who I share my data with”“I download my data”

Bi-directional

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OAuth 2.0: Trusted, Familiar, and Proven at Scale

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• A familiar and proven authorization process

• Used billions of times each day

Patients Take Ownership of Their Data

Authorize

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• FHIR extension to Chronic Condition Warehouse (CCW)

• 38M Medicare beneficiaries• Three years of Blue Button claims

information (6+ billion records)

• Jointly-developed FHIR “ExplanationOfBenefit” resource

• Integration with MyMedicare.gov• Future integration with CMS Simple

Login Service• Built on CMS Cloud Services

Lighting the FHIR at CMS

Under Construction

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Building a Tiered Blue Button Platform

CCWFHIR

Platform ….Scalable ….Scalable

BeneficiaryAccess

Blue Button OAuth Server(s)

DeveloperAccess

MyMedicare.gov

SLS

PHRPMI…

Communityof Trust</> {API}

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FHIR API Access Rules

FHIR Resource Definitions

Build Your Own Blue Button on FHIR Gateway

EMRAny EMR

FHIR API Module

PatientAccess

Blue Button OAuth Server

DeveloperAccess

Portal/CustomerAuthentication

PHRPMI…

Communityof Trust</> {API}

Open Source:Github.com/transparenthealthhhs_oauth_serverpython-poetri

https://bluebutton.cms.gov/api/v1/Patient?_format=json{"resourceType":"Patient", "id":"421118", "meta":{ "versionId":"1", "lastUpdated":"2016-03-22T16:38:17.578-04:00"}, "identifier":[ { "system":"CCW_BENE_CRNT_VW.BENE_ID", "value":"0"}], "name":[{ "family":["00013D2EFD8E45D1"], "given":["f5"]} ], "birthDate":"1923-05-01", ""address":[{ "line":["220 S Almond Court"], "city":"Manchester", "state":"MI", "postalCode":"48158"}]}

CMS FHIR Patient Profile

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{"resourceType":"ExplanationOfBenefit", "id":"421383", "meta":{"versionId":"1", "lastUpdated":"2016-03-22T16:38:17.578-04:00"}, "identifier":[{"system":"CCW_PDE_FACT.PDE_ID", "value":"233324492503674"}], "provider":{"reference":"Practitioner/421386"}, "prescription":{"reference":"MedicationOrder/421384"}, "patient":{"reference":"Patient/421118"}, "coverage":{"coverage":{"reference":"Coverage/421134"}}, "item":[{"sequence":1, "type":{"system":"http://hl7.org/fhir/v3/ActCode", "code":"RXDINV"}, "servicedDate":"2008-12-05", "adjudication":[{"category":{"system":"CMS Adjudications", "code":"Patient Pay Amount"}, "amount":{"value":10,"system":"USD"}}, {"category":{"system":"CMS Adjudications", "code":"Total Prescription Cost"}, "amount":{"value":350,"system":"USD"} }] }]}

CMS Blue Button Claim Profile

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Get to Know the FHIR REST API

https://{server}/api/v1/Patienthttps://{server}/api/v1/ExplanationOfBenefit?_format=xml

?_format=json|xml&{Search_parameters}

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The Power of the FHIR API

http://bluebutton.cms.gov/baseDstu2/Practitioner?family=smith&gender=F&_pretty=true&_format=jsonResults in…{ "resourceType":"Bundle", "id":"46412a0d-1ea5-4b85-93b0-baaad21e3edb", "type":"searchset", "base":"http://fhir.bbonfhir.com/fhir-p/baseDstu2",

"total":449,

"link":[ {"relation":"self", "url":"http://fhir.bbonfhir.com/fhirp/baseDstu2/Practitioner?family=smith&gender=F&_pretty=true& _format=json"}, {"relation":"next", "url":"http://fhir.bbonfhir.com/fhir-p/baseDstu2?_getpages=c396f683-8e45-4b5d-8da8-3e7540f32f2c&_getpagesoffset=10&_count=10&_format=json&_pretty=true"}],…

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One Record from the 449 Found by the Search

"entry":[ {"resource":{"resourceType":"Practitioner", "id":"623624", "meta":{"versionId":"1", "lastUpdated":"2015-08-25T19:51:17.420-04:00"}, "text":{"status":"additional", "div":"<div><div id='narrative'>AMY SMITH.&lt;br/&gt;Tel:5867740393&lt;br/&gt;Practice Address:&lt;br/&gt;21711 GREATER MACK AVE&lt;br/&gt;ST CLAIR SHORES MI&lt;br/&gt;480802418&lt;br/&gt;</div></div>"},

"name":{"use":"usual", "text":"AMY L SMITH MD ", "family":["SMITH"], "given":["AMY", "L"]}, "telecom":[{"system":"phone", "value":"5867740393", "use":"practice"}, {"system":"phone", "value":"5867740393", "use":"business"}], "address":[ {"use":"practice", "text":"21711 GREATER MACK AVE, ST CLAIR SHORES, MI 480802418, US.", "line":["21711 GREATER MACK AVE"], "city":"ST CLAIR SHORES", "state":"MI", "postalCode":"480802418", "country":"US"}, {"use":"business", "text":"21711 GREATER MACK AVE, ST CLAIR SHORES, MI 480802418, US.", "line":["21711 GREATER MACK AVE"], "city":"ST CLAIR SHORES", "state":"MI", "postalCode":"480802418", "country":"US"}],

"gender":"F"}, "search":{"mode":"match"}}, ....…

…

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• Building on industry and web standards• Providing a blueprint for patient access to their data• Designing solutions with the health care community

• Utilizing open source solutions• Using FHIR positions CMS at the heart of

health interoperability

CMS Blue Button API: The Summary

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• Visit our web page and subscribe for updates: http://go.cms.gov/bluebutton

• Learn more about FHIR: http://hl7-fhir.github.io

Learn More

subscribe

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• Mark Scrimshire– Blue Button Innovator– Mark.Scrimshire@cms.hhs.gov

• Karl Davis– Associate Entrepreneur-in-Residence– Karl.Davis@cms.hhs.gov

• Lori Pettebone-Maatta– Program Manager, Blue Button API – Lori.Maatta@cms.hhs.gov

• Carly Medosch– Outreach, Blue Button API– Carly.Medosch@cms.hhs.gov

Contact InfoLearn more about Blue Button API using FHIR

http://go.cms.gov/bluebutton