Status of Notes: DRAFT
Date: October 28, 2010
Time: 4:00pm-5:00pm EDT


Due Date

Arien Malec
  • Markle Foundation
    • Adam Bosworth
      • Lets get the data moving/fungible
    • Todd?
      • Every personal health record could press a big blue button which you could download from
      • Support from Aneesh Chopra, Peter Levith, VA
  • Priority Project for the VA
    • My Healthy Vet
    • Consumer offerings to Veterans who used VA Care
      • View into their records
      • Blue Button and download their data
  • Data format
    • Defined a sample
  • Round on Attendance:
    • Brett Peterson Visionshare
    • John Odden CGC
    • Paul Saxman Google
    • Epic - Janet Campbell, Peter DeVault
    • Microsoft - Sean Nolan
    • Meena -- ??
    • MedCommons -- ??
    • Bob Barker - NextGen
    • Dave Carlson - NoMoreClip
Peter Levin
  • CTO of the VA
  • Great government collaboration
    • White House
    • ONC
    • DoD
    • VA
  • Not prescriptive
    • Easily readable by human people
  • Downloads = goal 100,000
    • VA - 80,000
    • HHS / DoD
      • Started with a PDF (not initial intention)
  • Markle Foundation Consortium
    • 50 commercial organizations
    • First Mobile App for the Blue Button by one of their vendors
    • Delighted to see people from outside use this in new and creative ways
  • Why he is excited
    • Think its awesome to effectively do a ?? match with this ASCII flat files
      • Bring into NHIN Direct send file
      • Patient focused transport
        • Electronic
      • Clever and smart ways to insert into the NHIN network
        • Purpose of Peter Levith's involvement
Arien Malec
  • What is a simple way to bring Blue Button data into Direct Project messages
    • Whats the best way?
Peter Levith
  • Curveball:
    • His boss is calling him right now
    • Stepped away for a second
    • Won't be acoustically disturbing the call
Arien Malec
  • Two ways to proceed
    • Stuff Blue Button in a RFC message
    • Stuff Blue Button in an XDM message
  • Anyone who can do a Direct message should be able to unpack that file
  • Two questions:
    • 1: How do you identify that it is blue button data?
Fred Trotter
  • Another question: How do you bring this into the XDM functionality?
Janet Campbell
  • It is Blue Button Data, but it is text- what do we do about that?
Arien Malec
  • From the VA perspective
    • Has headers, values and sections
    • Not super-structured or not unstructured
Paul Saxman
  • What is the goal?
Fred Trotter
  • Asked question
Peter Levith
  • Go deep and long into this Google question
    • Not going into it
  • Pre-processor is okay
  • Go forward with the assumption that we are going to vigilant if not dogmatic that we will leave the file the way that it is
    • Good policy and technical reasons
Peter DeVault
  • Reference terminologies may impact the value of the message
David Carlson
  • Agrees with that
  • Asked for clarification regarding the CCR
Peter Levin
  • Pretty agnostic about it, pretty uninformed about it
  • If that is the community's preference, then knock yourself out
  • With respect to the Blue Button
    • Comes from Standards world
    • Will not be happening on this specific project
David Tao
  • Announced his presence in the call
Arien Malec
  • Peter to clarify = doesn't matter about the format, if you have IDC or STOMAT code, it would be good to include?
Peter Levin
  • Minor impendiment to do it that way
    • Looking at My Healthy Vet connecting to the Vista core
    • Some way violates the way that veterans/citizens to input their own data
    • If there was code that could achieve it, then it would be good
  • From a VA perspective, will not be happening
  • Question about the data
    • They have the data in Vista
    • Not addressing this in Blue Button
      • Recognize that this relates to the project
      • Limits the potential clinical validity
      • The idea is that you are entering data in a clinical entry in a physician visit
        • You would normally not see that data anyways
Janet Campbell
  • I think that is key
  • Good question: who we are sending to, why and where?
Arien Malec
  • Set of partners of the VA who are ready to accept Blue Button data on a download/upload purpose
    • If they also have Direct Project connectivity
    • Core Use-Case: Skipping the download/upload, and be able to direct push it
      • Assumption: the patient has a direct address (under his/her control)
    • Subordinate Use-Case: Patient has a doctor address, and wants to push to a community provider who is not the VA
Peter Levin
  • Both make sense - will not likely be happening in Blue Button in the near future
    • Sometimes is a challenge
  • Understands that download/upload is tough
    • Sophisticated users would not want to do this
    • Your use-cases make sense, but the best right now:
      • Create the download capability
      • VA can't import its own Blue Button
    • Benefit: For the first time we are pushing the data our in a liquid/accessible form to patients
    • Resource Allocation challenge:
      • Do I modernize it to offer more value-added/sophisticated interface use-models
      • Or do I focus drilling into the Vista to make it more functional
    • Blue button has sided with the latter to push more data out
Peter DeVault
  • May not make sense in this case of Direct Project then
Arien Malec
  • Those general use-cases regarding the doctors
    • Ex (made up) Google patient or epic patient pushing out files
    • We are already addressing in the Direct Project
Peter Levith
  • Just because I am not giving you structured data, doesn't mean you might not get it
  • Most of the records might even be structured
  • So many people are happy to get on their computers what they have today, maybe they haven't thought about it clinical utility
  • They are just pushing the data around, but they do not want force the structuring
Arien Malec
  • Direct patients records to be pushing to a doctor in a structured format
Peter Levin
  • Web enabled service or local installed app
    • If you want to send this to your Dr.
    • Click this Button to allow us to read your Blue Button download
      • We will then send this
David Tao
  • A lot emphasis was given to Blue Button
  • You are from the VA, how about if a lot of other providers start offering Blue Button
    • If every Blue Button has no ASCii standard to it, then it would be very unproductive
      • Could be structured format from the get-go - not right now
    • Maybe if everyone used a similar format, then hundreds of conversions would not be necessary
  • What do we do to prevent this in the long-term?
Peter Levin
  • Short term = no one knows
  • Long term = be useful to get used to it
    • Let them create the Blue Button standard
  • Formatting = unstructured/poorly = unlikely to change as of now
    • Just going to continue to concatenating from Vista onto the documents generated
  • Almost certainly going to look different
    • Kaiser
    • Blue Cross
  • Strength/Weakness of the idea
    • If one of theirs dominates, then that is okay
  • The community has underestimated how hard it is to write those parsers
    • The person most vocal against them, tried writing it and found out it was okay
    • 3-4 conversions are okay
Fred Trotter
  • If we could have a MIME type and an extension
    • Depending on how you download it
    • Something that it will download Blue Button
  • Direct Project to make it easy for patients to put the PHR into their account
  • Computer going to the VA and downloading the Blue Button
    • Significant point of discussion in Markle Foundation conversation
    • Need to address simple use case- typical user trying to fetch such a file
Arien Malec
  • Then we would know the path, and structured messages could be sent
    • Without downloading
  • Peter is saying that getting data into the file is the priority over skipping the downloading
  • Entering my Healthy Vet password, and from that point on I would expect the file will be drawn from the HISP
Peter Levin
  • Uoff - can't tell you when, but high on his list is the automated authentication
    • Soon they will be having the conversation
    • Its on their roadmap - putting their value on it
    • Recognize that they have similar goals, just prioritized in different levels
Arien Malec
  • Focus more on the patient controlled health records/ systems
    • Focus on the u-off
Peter Levin
  • Interim Step
    • Writing the Direct Project pre-processor
      • In your VA pilot
  • There will be a Blue Button to CCR
John Odden
  • Raised concern about the hundred of blue buttons that could show up
  • Raised concern about the parsers that will have to be written
    • Stay away from doctors using it
Janet Campbell
  • We are not talking about a service system
Arien Malec
  • Could be from PHR to VA to Uoff
Janet Campbell
  • The only thing that is missing
Peter DeVault
  • Blue button is getting backing from government because it is reasonable
  • Need a way to map all of the blue buttons
    • Need to develop a standardized way to do it
David Tao
  • Could be a CCR/CCD if the patient could read it
  • They really don't care about it
Arien Malec
  • Many portals already have that functionality
David Tao
  • So the Blue Button concept could live on even if that functionality exists
  • If they actually care about the format/standard, then they mave create competing standards
    • No one wants that
  • Is there an example somewhere?
Arien Malec
    • Long ASCii document with headers, sections, pairs
    • Competing data can be parsed out
  • Structured values will be tough, structured interoperable format will be tougher
  • Textual description of the drug
Peter DeVault
  • Don't know where the prescription is coming from necessarily
John Odden
  • Most easily accessible?
    • How can we do that with the Direct Project?
  • Some how or another, the issue of how patients interact with the Direct Project vendors keeps getting pushed further into the future
Will Ross
  • We do not have any patients asking to participant
    • Still talking to the community health partners who have the patient facing activities
    • Hopeful that they did find the partner in the local IDN
    • Wants to ask those type of questions
      • IDN has a tethered PHR
Janet Campbell
  • Do not need consent right?
Arien Malec
  • Confirmed Janet's quesiton
  • Agreed with Adrien about getting structured patient data rather than focusing on the Blue Button
Fred Trotter
  • Suggested anyone feel free to e-mail him about it
  • He is working on exploring this
John Odden
  • This is what we need to do to safely send to patients
    • Major question of Blue Button
Arien Malec
  • Indicated that is his major goal - discovering the use-cases where we can center efforts on patients