How to best integrate Blue Button with EHR?

The Blue Button initiative was aimed at allowing patients to download their EHR information from their MyHealth accounts and opening up the healthcare content from inaccessible sources. The aim was to make this file ‘very simple’ and hence this information was provided in a plain text or PDF format. These formats are only usable for a person to read, not for another computer to parse and use. This is a big drawback which has been realized today, with many EHR systems aiming to incorporate Blue Button and allowing it to communicate with various providers.

What is a suitable Blue Button output format?

The Blue Button data format at its start was an untagged text file, which was decided upon as a quick solution to ensure that patients have access to the data in a simple format. Now, a conscious decision needs to be made to ensure that the file format used is compatible with other EHRs, as per the Certified EHRs requirement. With Meaningful Use criteria, all certified EHR systems should be able to view and exchange a Continuity of Care Document (CCD). With this ruling, the CCD document has since become an accepted way to transfer health information among providers and with patients. CCD has the unique capability of satisfying human readability and machine readability. Hence, ideally, this would have been the suitable solution for Blue Button output format also. But, this output format was not taken up by Blue Button team, which has left many vendors to get their EHR systems, Blue Button compatible. HL7 was also working on building a transformation bridge, to help convert CCD data to Blue Button, which will help reduce the unnecessary load on providers to go through another round of updated and compatibility checks.

HL7 builds CCD to Blue Button Transform tool

The HL7 CCD to BlueButton Transformation Tool is a set of xslt transforms that enable the transformation of CCD, and Consolidated CDA CCD (DSTU release 1.0) files into a Blue Button text file that closely resembles the Blue Button text file extracts. This set of transformation files, when applied to one of the aforementioned CCD versions will create a Blue Button text file that a patient can use to view their own clinical data as well as pass it on to a care giver or provider.

How can you ensure interoperability?

If you look closely, the new output format for Blue button is in reality a backward step in terms of system interoperability. Then, why was such a decision taken? Probably for quicker implementation and maybe to keep it more patient focused. As most systems and providers support CCD, it is very essential that the Blue Button system is also designed to accept and export a CCD format. This will ensure that interoperability grows, where patients will receive their health information in the PDF/text formats and the machines in the CCD format.

Previously, we had done a 2 part blog series (Part 1 & Part 2), wherein we have explained why it is important to have Blue Button to talk to your EHR system. Read more about how to export the data, implement the transmission and register and integrate the Blue Button API for a complete patient care solution.