This is a presentation given to researchers from PCORI and NIH (Precision Medicine Initiative) about the potential benefits to researchers that comes from letting CMS Medicare Beneficiaries share their Claims information with a research study using the Proposed CMS BlueButton data formats built on the HL7 Fast Health Interoperability Resources Specification.

1. Donate My Data:
What Blue Button on FHIR
Can Do for Research
Mark Scrimshire
CMS, Office of Enterprise Data & Analytics
January 2016

2. ● 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

3. A Brief History of Blue Button
3
Blue Button
Unleashes
Personal
Data

4. Blue Button in Use
1.2MCMS 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
4

5. How Could We Improve Blue Button?
5

6. “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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7. What is FHIR?
Fast Health Interoperability Resources
7

8. 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
*Recorded in FHIR Contract
Resource

9. 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
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10. 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

11. ● 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

12. ● 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

13. ● 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: 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: PartB
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:

14. ● 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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15. ● 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

16. ● 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