CMS Blue Button® 2.0 Fueling FHIR®

In the last blog, we discussed how large tech companies like Microsoft, Google and Apple are working with FHIR. While Microsoft and Google are focused towards providing FHIR SAAS solutions for healthcare organizations, Apple is targeting healthcare consumers with app(s) to utilize data from those FHIR implementations. This discussion would be incomplete without the mention of probably the largest FHIR solution in the country today managed by a (non-tech) organization. I am talking about Blue Button 2.0 by Centers for Medicare and Medicaid Services (CMS).

 
HL7® and FHIR® and the are registered service marks owned by Health Level Seven. Blue Button® is a registered service mark owned by the U.S. Department of Health and Human Services.

HL7® and FHIR® and the are registered service marks owned by Health Level Seven. Blue Button® is a registered service mark owned by the U.S. Department of Health and Human Services.

 

Blue Button 2.0 is  an initiative by CMS to make their healthcare data more readily available to healthcare consumers. Usually the only way to get data from Medicare and other payers has been through an “Explanation of Benefits (EOB)”. The EOB formats can vary significantly from payer to payer which makes it tough to integrate with other applications. CMS Blue Button 2.0 team took this massive initiative to map over 1,300 fields from CMS claims data into Explanation of Benefit FHIR Resource and make that available through a FHIR based API.

 

Most of the data through Blue Button 2.0 is available through the EOB resource. In addition to this EOB resource, Blue Button 2.0 supports the Patient and the Coverage resources as well. As I had discussed in the previous blog, Apple’s FHIR solution currently only supports 8 resources as compared to over 100 resources currently available under FHIR. Blue Button 2.0 support for only the 3 resources may seem very limited. However, EOB resource is a very data rich resource that can include all of the Medicare Part A, B and D claims information in a single resource. This single resources can be utilized to reveal a variety of information about a beneficiary’s health such as medications, problems, procedures, and encounters in addition to all the cost information.

 

By supporting FHIR, CMS has made it really easy for developers to integrate this information into existing or new apps to help patients access and share their information. Blue Button 2.0 contains four years of Medicare Part A, B and D data for 53 million Medicare beneficiaries. As described by the CMS Administrator Seema Verma, CMS has really led by example for other payers (and EHR vendors) and has burnt all the excuses around technical feasibility for leveraging FHIR to implementing a large-scale data sharing solution.

 

Commitment to FHIR by organizations like Microsoft, Google, Apple and CMS is very encouraging. As we discussed in a previous blog, FHIR is hopefully the answer to the billion dollar question around solving interoperability issues in healthcare. As promised in the previous blog, we will start doing a deep-dive from the next blog on how you could leverage the investment by these large organizations to implement FHIR solutions for your own organization. Stay tuned.