By Pierce Graham-Jones, West Health Innovator-in-Residence, U.S. Department of Health and Human Services and Ryan Panchadsaram, Presidential Innovation Fellow, Office of the National Coordinator for Health IT
Since launching the Automate Blue Button Initiative six months ago, we have been working toward two aims:
- Ensure that every American can get access to their digital health information.
- Help application developers use that data to build products and services that help individuals with their health.
Blue Button is a symbol for patient access to their personal health information in a useable and safe digital format. It has spread from the federal government to the private sector.
Thanks to the efforts of the U.S. Department of Veterans Affairs, the Office of Personnel Management and Blue Button pledge community, more than 80 million Americans can now download their health information with a click of a button.
Blue Button Improvements
While it’s been a positive movement for consumers, developers have made us aware of certain weaknesses:
- The files lack structure, and
- Consumers must manually move the files from the provider or payor to their third party applications.
Over the past six months, through a public-private collaborative process and building off of Meaningful Use Stage 2 standards, we have developed common implementation guidance for providers, payors, and developers to overcome these weaknesses. It’s called Blue Button+.
What is Blue Button+?
Blue Button+ is a blueprint for the structured and secure transmission of personal health data on behalf of an individual consumer. It meets and builds on the view, download, and transmit requirements in Meaningful Use Stage 2 for certified EHR technology.
Structure: The recommended standard for clinical health data is the HL7 Consolidated Clinical Document Architecture also known as the Consolidated CDA. The C-CDA is a XML-based standard that specifies the encoding, structure, and semantics of a clinical document. Blue Button+ adopts the requirements for sections and fields from Meaningful Use Stage 2. For health plans sharing financial and claims data with their members, there is no existing standard – but the guide recommends critical data fields and suggested formats for sharing this data with consumers as well.
Transmit: In alignment with Meaningful Use Stage 2 standards, Blue Button+ uses Direct protocols to securely transport health information from providers to third party applications. Direct uses SMTP, S/MIME, and X.509 certificates to achieve security, privacy, data integrity, and authentication of sender and receiver.
Automation: To support meaningful applications for patients, health data needs to be seamlessly transmitted when their record is updated. Blue Button+ makes it possible for a patient to request an “on-going” share of their information.
Trust: The community has begun to assemble the digital certificates that identify third party applications and “bundling” them together into easy-to-install packages. These packages can be automatically loaded into your system, so patients can be confident that their data can be transmitted to the destination of their choice.
Privacy & Security: We worked with HHS’s Office for Civil Rights to assemble a Q&A that relates to the Blue Button+ use cases.
We must thank the 68 committed organizations in the Automate Blue Button Initiative and Standards and Interoperability Framework developed by ONC. This guide would not have been possible without the amazing contributions of many EHR vendors, health plans, health systems, patient advocacy groups, application developers, and government leaders.
Next Steps
If you are an EHR vendor, payor, or provider: read the guidance, provide feedback, and let us know how you are implementing these standards. Leading data holders are already implementing these capabilities today; we will be demonstrating them at the HIMSS 2013 Annual Conference and Exhibit in March, and throughout the year, as they are put into practice.
If you are a third party application developer: we hope this is the opportunity for access to personal health information that you have been looking for. Check out the guide, there is section for you.
And if you are a consumer or patient, go ahead and ask for your health information via the Blue Button – it’s your right to access the information your doctor or health plan has about you!
Learn more at: http://bluebuttonplus.org.
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