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What the CMS Blue Button® on FHIR®
Data API Can Do for CMS
Mark Scrimshire
CMS Blue Button Innovator
Office of Enterprise ...
Blue Button in Use
1.4MCMS users
20–30k
Downloads/Month
Private sector applications
already ingest, optimize,
and visualiz...
“Build a developer-friendly, standards-based data API that
enables beneficiaries to connect their data to the applications...
What is FHIR?
Fast Health Interoperability Resources
4
What is CMS Blue Button on FHIR?
There are many FHIR structured profiles
covering infrastructure, clinical, identification...
● Permission process is familiar to beneficiaries
● Growing tools marketplace
● Data is structured with internationally ac...
● Beneficiaries explicitly give permission to share their data.
● This is a new option for data collection. All current re...
● Active development in 2016
 FHIR service for 38M FFS beneficiaries
 Data sourced from CMS Chronic
Condition Data Wareh...
● Patient profile
● Explanation of Benefit profile:
 Part A in-patient claims
 Part B professional claims
 Part D pharm...
FHIR Service
● Upgrades the current Blue Button to make it more useful to
beneficiaries
● Demonstrates API leadership by e...
● FHIR can publish AND consume data
● FHIR profiles represent internationally and industry standard data
formats
● FHIR RE...
Working with FHIR
http://fhir.bbonfhir.com/fhir-p/
http://hl7-fhir.github.io
http://fhirtest.uhn.ca
12
● What the research community can do now
 Visit for more information:
 http://go.cms.gov/bluebutton
 Attend FHIR Code-a...
● Blue Button text to JSON converter:
 https://github.com/ekivemark/python-bluebutton
● Blue Button on FHIR
 https://git...
● Mark Scrimshire
 CMS Blue Button Innovator
 Mark.Scrimshire@cms.hhs.gov
● Karl Davis
o Entrepreneurs-in-Residence:
 K...
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Blue Button On FHIR API at CMS: How the FHIR API can empower new solutions

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This is a presentation I gave to the CMS Enterprise Data Services Group about the CMS Blue Button on FHIR API Initiative and how the FHIR API offers powerful new solutions for CMS for data interoperability.

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Blue Button On FHIR API at CMS: How the FHIR API can empower new solutions

  1. 1. What the CMS Blue Button® on FHIR® Data API Can Do for CMS Mark Scrimshire CMS Blue Button Innovator Office of Enterprise Data & Analytics June 2016
  2. 2. Blue Button in Use 1.4MCMS users 20–30k Downloads/Month Private sector applications already ingest, optimize, and visualize data from Blue Button text files • Hospital • Physician • Prescription drugs Federally Inspired BlueButton Community • VA • DoD (TRICARE) • CMS 2xtext downloads Beneficiaries can download up to 3 years of claims data 2
  3. 3. “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 3
  4. 4. What is FHIR? Fast Health Interoperability Resources 4
  5. 5. 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 5 Explanation of Benefits
  6. 6. ● 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 6
  7. 7. ● 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 7
  8. 8. ● 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: 2333444555200 Provider: No Information Available Provider Billing Address: Service Start Date: 01/05/2014 Service End Date: 01/05/2014 Amount Charged: * Not Available * Medicare Approved: * Not Available * Provider Paid: * Not Available * You May be Billed: * Not Available * Claim Type: Part B Diagnosis Code 1: 2163 -------------------------------- Claim Lines for Claim Number: 2333444555200 -------------------------------- Line number: 1 Date of Service From: 01/05/2014 Date of Service To: 01/05/2014 Procedure Code/Description: 99213 - Established Patient Office Or Other Outpatient Visit, Typically 15 Minutes Modifier 1/Description: Modifier 2/Description: Modifier 3/Description: Modifier 4/Description: Quantity Billed/Units: 1 Submitted Amount/Charges: * Not Available * Allowed Amount: * Not Available * Non-Covered: * Not Available * Place of Service/Description: 22 - Outpatient Hospital Type of Service/Description: 1 - Medical Care Rendering Provider No: PARTBPROV Rendering Provider NPI: 8
  9. 9. ● 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 9
  10. 10. 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 FutureIntegrations DataCollection/DataPublishing 10
  11. 11. ● 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 11
  12. 12. Working with FHIR http://fhir.bbonfhir.com/fhir-p/ http://hl7-fhir.github.io http://fhirtest.uhn.ca 12
  13. 13. ● 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 13
  14. 14. ● 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 14
  15. 15. ● Mark Scrimshire  CMS Blue Button Innovator  Mark.Scrimshire@cms.hhs.gov ● Karl Davis o Entrepreneurs-in-Residence:  Karl.Davis@cms.hhs.gov ● Lori Pettebone-Maatta  Program Manager  Lori.Maatta@cms.hhs.gov ● Carly Medosch  Outreach  Carly.Medosch@cms.hhs.gov Contact Info 15

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