Geographies Blue Button Conversation 2010-10-28

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

Actions

#	Date	Action	Status	Owner	Due Date
1

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

Adrien?

• 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

Adrien

• 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

• va.gov/bluebutton
  • 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