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Friday, June 12, 2015

FHIR and BlueButtonPlus for Newbies

This one is for ePatient Dave, who asks:

Blue Button Plus (BB+) is an initiative that started at a White House sponsored meeting several years ago (I got to attend with my daughter).  I've written a number of posts about this particular effort, and participated in the Blue Button Plus Pull initiative of the ONC Standards Initiative project.  That workgroup produced an API based on an early draft of the HL7 FHIR Standard.  Integrating the Healthcare Enterprise further developed that into a specification called Mobile Access to Health Documents (MHD for short).  BB+ Pull and MHD are specifications that meet the requirements of the ONC Certification and Standards regulations for EHR systems to support View and Download. A sister specification BB+ Push uses a different protocol (call Direct) based on e-mail to support the "Transmit" requirement of that regulation.

BB+ Pull and VDT capabilities allow you to access the same kinds of clinical data at nearly the same level of fidelity that healthcare providers have in their EHR systems.  This allows patients to use this data in ways of their own choosing, including sharing the data with other healthcare providers, or tracking and using it in applications on their own computers and mobile devices.

As a standard, FHIR has really taken off, reaching awareness heights in the trade press, academic organizations, and medical professionals that many standards organizations would drool with envy over.  HL7 and its creators have much to be proud about in this.  I've awarded several of the developers with an Ad Hoc Harley award, including Grahame Grieve, its chief Architect, and Josh Mandel (who was also very involved in the BB+ work).  However, FHIR is also still in the early adoption stages.  Several vendors are supporting its development and incorporating it into products, but it will take some time for those versions of the products to reach a doctor near you.  From product release to mainstream deployment across a customer base can take several years.

While FHIR has really taken off, Blue Button Plus still has yet to reach similar dizzy heights.  The Blue Button Connector page lists 140 hospitals, 9 pharmacies, 4 labs, and 39 payers who provide BB+ access, but few of these allow you (as BB+ Pull does) to send those records to your favorite application.  There are also about 13,000 physicians who have attested to MU Stage 2 which provide some access for download, but likely don't provide the BB+ Pull capabilities.

Both of these specifications have a lot to offer patients, and we are likely to see even more utilization of FHIR, Blue Button Plus, and IHE's Mobile Access to Health Documents, as well as another FHIR related ONC initiative; the Data Access Framework, which will provide access to granular health data instead of documentation of encounters in the future.  However, at the current rates of development and deployment, it will probably be five years or more until I, as a resident in a rural community, can have a nearby physician who uses a system that supports these standards.  If I were to drive an hour to a Boston-based physician, I might have to way only three years for wide-enough deployment to be readily able to find a physician that could give me my damn data.

   -- Keith


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