Thursday, January 12, 2012

Blue Button

Chris W. brings up Blue Button on the Ask me a Question page, and a few weeks ago it popped up again into my radar screen.  In case you've been in hiding for the past year, Blue Button is the name of a VA initiative to enable vets to download their clinical information in an ASCII text format from the VA patient portal MyHealtheVet.  It's based on a Markle Foundation specification which has gotten quite a bit of attention.

Recently the Office of Personnel Management sent a letter to health plans participating in the Federal Employee Health Benefit Program (FEHBP).  I found an interesting quote in the letter (I underlined the interesting part):

Supplying your members with the simple, low-cost and readily available Blue Button function will strengthen your contractual HIT obligations under FEHBP, align with the Meaningful Use standards laid out by Health and Human Services (HHS), and most importantly, empower your members to know their health information and make informed choices based on that information. 
According to the letter, you would assume that you could download the records in the electronic standard formats suggested by HHS under Meaningful Use.  But wait, the Blue Button specification is just ASCII text.  It doesn't follow that standard at all, and many provider and payer organizations have already implemented according the HITSP C32 Version 2.5 (one of the two allowed standards under Meaningful Use Stage 1).  Sometimes I wish the left hand and the right hand would communicate a little bit better.

Chris's main point is this (and I quote):
... it occurs to me that the effort is promising (for the intended use cases) precisely because of the standardization that HL7 has been driving behind the scenes. That is, the tag sets and value formats (and vocabularies) will have a fairly high level of consistency across organizations right out of the box because of their prior work on adopting a variety of standards internally, and especially HL7 standards
In fact, there's an HL7 project which is working its way through channels to create an XSL Stylesheet that will translate the semantically interoperable, Meaningful Use conforming HITSP C32 into the Blue Button format. Structured Documents approved it today, and it goes next to the steering division and then the TSC for final approval.

The scope of the project is to:
... produce a sample XSLT schema and background text on usage that will transform a CDA R2 CCD file into a U.S. Department of Veteran Affairs (VA) Blue Button ASCII text file. 
It's likely going to have to make some sacrifices to fit within the specifications required for Blue Button, because there's more that you can say and do in CDA and CCD that Blue Button accounts for.

From my perspective, Blue Button is beneficial to patients, but not as big a step forward as it could be.  (my S4PM friends may want to disown me for saying so, but hey, that's the way I feel).  I'd much rather spend my energy on CDA Release 3 and HTML 5.

Given the importance of this project, I will be paying attention to it, and Chris is so right.  Because of all the work that has already been done in CCD, this will be pretty easy.  I just wish I could get some focused time on what will really move things forward.

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