The Blue Button API aims to enhance data sharing for Medicare beneficiaries by allowing them to connect their claims data with trusted applications through a structured, standards-based API. This functionality promotes patient control over their health data and supports improved care coordination, research, and overall healthcare quality. The API utilizes FHIR standards to ensure interoperability and streamline access to health information.

1. Blue Button® API: Creating
a Data-Driven Ecosystem
to Benefit Medicare Beneficiaries
Mark Scrimshire
February 21, 2017
The Power of Beneficiary-Directed Data
HIMSS 2017

2. • 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
2
NewWave: Stand #237

3. Total Users
VA, CMS, DoD3
A Brief History of Blue Button®
Blue Button
Unleashes
Personal
Data
®

4. 1.6MCMS users
20–30k
Downloads/Month
2xtext
downloads
®
4
The Current Blue Button Usage
Private sector applications
already ingest, optimize,
and visualize data from
Blue Button text files
• Hospital
• Physician
• Prescription drugs
Federally Inspired
Blue Button Community
• VA
• DoD (TRICARE)
• CMS
Beneficiaries can download
up to 3 years of claims data

5. 5
• 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?

6. ®
6
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”

7. 7
An Enhanced Blue Button has a Critical Role
in Value and Quality-based Health
Personal Applications Personal Health Record
Care Coordination
Putting patients
at the center
Research

8. 8
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

9. 9
• 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

10. 10
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®?

11. 11
Why Blue Button on FHIR?
“I control who
I share my data with”
“I download my data”
Bi-directional

12. 12
OAuth 2.0: Trusted, Familiar, and Proven at Scale

13. 13
• A familiar and proven
authorization process
• Used billions of
times each day
Patients Take Ownership of Their Data
Authorize

14. 14
• 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

15. 15
Building a Tiered Blue Button Platform
CCW
FHIR
Platform
….Scalable ….Scalable
Beneficiary
Access
Blue Button OAuth
Server(s)
Developer
Access
MyMedicare.gov
SLS
PHR
PMI…
Community
of Trust</> {API}

16. FHIR API
Access Rules
FHIR Resource
Definitions
16
BuildYourOwnBlueButtonon FHIRGateway
EMR
Any EMR
FHIR API Module
Patient
Access
Blue Button OAuth
Server
Developer
Access
Portal/Customer
Authentication
PHR
PMI…
Community
of Trust</> {API}
OpenSource:
Github.com
/transparenthealth
hhs_oauth_server
python-poetri

17. 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
17

18. ®
18
{"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

19. 19
Get to Know the FHIR REST API
https://{server}/api/v1/Patient
https://{server}/api/v1/ExplanationOfBenefit?_format=xml
?_format=json|xml
&{Search_parameters}

20. 20
The Power of the FHIR API
http://bluebutton.cms.gov/baseDstu2/
Practitioner?family=smith&gender=F&_pretty=true
&_format=json
Results 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"}],
…

21. 21
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"}}, ....
…
…

22. 22
• 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

23. 23
• 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

24. 24
• 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 Info
Learn more about Blue Button API using FHIR
http://go.cms.gov/bluebutton