While there is growing awareness in both doctor’s offices and health IT markets of the critical...

The Convergence of FHIR & Blue Button
In 2011 when Australian HL7 thought-leader Grahame Grieve proposed the “Resources for Health” — the precursor to Fast Interoperability Health Resources (FHIR) — it was because the movement to build a standard language of healthcare data exchange had largely failed. The vision of exchanging, integrating, and sharing digital health information that inspired the creation of Health Level 7 International in 1987 confronted the twin challenges of its own quest for comprehensiveness and the emergence of the internet and its language as the lingua franca of all digital exchange.
However, with Grieve’s approach that emphasized developer-community defined usability over comprehensiveness and resources built on open Internet standards for data representation, the creation and promulgation of FHIR created a standard, shared language that is the catalyst for an emergent revolution in healthcare.
Another catalyst of the emergent revolution was the federal government’s movement to give information to those to whom it provided health insurance. For example, in 2011, veterans who got their health insurance through the Veterans Administration (VA) and Medicare Beneficiaries who were insured by the Centers for Medicare & Medicaid Services (CMS) were able to go to a website and download a text or PDF version of their health record. Called the “Blue Button” (for the icon that a veteran or Medicare Beneficiary could click on the website), the idea facilitated by public service leaders was a radical possibility at the time and provided access to health information that most health consumers don’t have even today.
In 2015, the twin catalysts of FHIR and government-led patient access merged when the Department of Health and Human Services (HHS) and CMS began the push to transform Blue Button into a data service using a standard language of health data exchange. The result is the Blue Button 2.0 API. Blue Button 2.0 would not only allow the digital exchange of Medicare beneficiary health data it would also give ownership of that data (through the OAuth 2.0 standard) allowing beneficiaries to share their data digitally.
As with Grahme Grieve’s vision for FHIR, what has become a Blue Button “movement” has emphasized developer-community definitions of usability and that community has now grown to over 1,500 developers from across the healthcare ecosystem. Importantly, the FHIR-based Blue Button movement has spilled out from its original federal government VA and CMS use cases and is providing a working model for private sector health insurers looking to give their customers what veterans and Medicare Beneficiaries have now.
That working model of consumer mediated exchange is being formally developed by the CARIN Alliance, in the form of the Blue Button 2.0 Implementation Guide based on the new Release 4 of HL7 FHIR.
While these are exciting developments, patients today don’t have full control of their own healthcare information. Health consumers simply don’t control their essential records, test results and basic information about those who provide them care.
This has to change. And this is the patient- and developer-led revolution that is underway.
Importantly, the FHIR-based Blue Button movement has spilled out from its original federal government VA and CMS use cases and is providing a working model for private sector health insurers looking to give their customers what veterans and Medicare Beneficiaries have now.
Also leading the way in defining the emerging landscape of health data interoperability is CMS and the Office of the National Coordinator for Health IT (ONC). Here are a few critical intersections where activist health technologists will find engagement and emerging markets:
We often think the present moment is one of digital natives and technological sophistication. In healthcare that is not the case. However, change is happening. Change is coming. The disruptive possibilities of FHIR and consumer-mediated exchange are as important as the policy debates about Medicare-for-All and the future of the Affordable Care Act. We are at the beginning of this revolution.
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