Tag Archives: development

After #ONC2015 it is back to working on #BlueButton

This week I attended the #ONC2015 Annual meeting. It was a great event with a lot of buzz and plenty of people passionate to make health care better through the application of technology. Interoperability was at the top of the agenda and infused every aspect of the meeting. After an intense two days it is time to get back to work at CMS and focus on the “coal face” of interoperability: Updating BlueButton for Medicare beneficiaries.

BlueButton Claims Data

I am taking a look at Medicare BlueButton data as it is formatted in plain ASCIII text files. I have also been looking at Consolidated Clinical Document Architecture (C-CDA) Standards Documents which are the basis of BlueButton Plus structured text documents. After delving in to the intricacies of the standard and of NIST test documents I feel the need to confirm my understanding with the BlueButton community at large. The clarification I am looking for originates from the very name of the core document – Consolidated CLINICAL Document Architecture. The CMS BlueButton data also includes CLAIMS data and if you search the CCDA standards there appears to be no mention of Claims information in the document. After looking through some of the parsing libraries that have been built my suspicion seems to be confirmed. Amida-tech’s CMS Parser for Blue Button identifies sections that do not have a data model. it also identifies self-entered data sections that can be mapped to existing clinical sections. However many of those sections are generated from self-entered data and should not be allocated the same level of provenance as data entered from clinical sources. An example here might be self-reported implantable devices or self-reported immunizations.

The HL7 standards do have documentation for a Claims Attachment XML Package. However, these are not part of the core standard.

Josh Mandel has a repository of sample C-CDA documents. These typically cover EHR vendors and not payer organizations and their claims data.

As I look to creating a Data-as-a-Service for BlueButton data at CMS I need to adopt a structured data format. In doing this I want to minimize re-work out in the community. I also want to avoid getting bogged down in protracted standards definition work. I am therefore reaching out to the BlueButton and FHIR development community to gather your views, guidance and sage advice.

My thinking is this…

In upgrading from text and pdf file formats to offer XML and JSON as additional formats I should do the following:

  1. Where sections of the CMS BlueButton data directly map to established data models in the CCDA standard the CMS structure will adopt the same coding standard and naming conventions.
    Examples of these sections include:

– demographics
– providers

  1. Where data can be directly mapped to established clinical sections we should use the same coding and naming conventions, as per item 1. However, where those sections identify a source we will add a “source” identifier to the section. Eg. Self-entered. This should help to maintain data provenance.
    Examples of these sections include:

– implantable devices mapped to medical devices with a source of “self-entered”

  1. Where sections are not mapped to an established CCDA section we will:

– identify the data source. Eg. Medicare Part A etc.
– use fields names that carry through the grammar, simplifying and avoid internal acronyms wherever possible based on the original source field names. Eg. Cost, Allowed, Paid, Diagnostic Code 1 etc.

  1. Once we have an XML format we will take the format and use it as a basis for a JSON data format.

My questions to the community:

  • is this a sensible approach?
  • am I missing any critical document standards that I should be applying?
  • is there a better way to do this?

You can submit a comment to this post, or email me at mscrimshire AT gmail DOT com.

Mark Scrimshire

Health & Cloud Technology Consultant

Mark is available for challenging assignments at the intersection of Health and Technology using Big Data, Mobile and Cloud Technologies. If you need help to move, or create, your health applications in the cloud let’s talk.
Blog: http://blog.ekivemark.com
Stay up-to-date: Twitter @ekivemark


I am currently HHS Entrepreneur-in-Residence working on an assignment to update BlueButton for Medicare Beneficiaries. The views expressed on this blog are my own.

I am also a Patient Engagement Advisor, CTO and Co-Founder to Medyear.com. Medyear is a powerful free tool that helps you collect, organize and securely share health information, however you want. Manage your own health records today.

Medyear: Less hassle. Better care.



CPT_Advanced_Custom_Fields_Meetup | SlideRocket, Online Presentation Tools

You can do some cool things with Advanced Custom Fields and Post Types in WordPress. Here is Marjorie Roswell’s presentation from Monday’s Baltimore WordPress Meetup Group.


@cyberslate: INFOSEC Preso on Security and Privacy in SharePoint 2010: Healthcare – Life in Caps Lock: cyberslate’s posterous

Some great information here about using SharePoint in HealthCare.

Compartmentalization with a robust security grouping strategy can pay dividends. in many cases SharePoint can be used to manage workflow because the process of managing the workflow does not require visibility to PHI/PII information. In these cases separate and compartmentalize the PHI/PII data and control access through security groups.

I built this capability in SharePoint 2007 using associated lists. This allowed teams to review case workload and progress without having to see member information. Yet the member information was accessible via a simple hyperlink, providing the viewer had adequate security rights.

As is correctly pointed out, this needs Administrator involvement from the outset and ideally the creation of utilities and web parts that support this approach so that we make it easy for site administrators/developers to create departmental and team workflows that remain HIPAA client and don’t divulge PHI or PII to unauthorized personnel.

The iPad Falls Short as a Creation Tool Without Coding Apps | Gadget Lab

At Apple???s tablet event last week, there was one noticeable absence: games.

Apple frequently uses games to show off the computing power of its mobile devices, but this time, Steve Jobs was driving home the message that the iPad is a tool for creation, not just a fancy plaything.

???This is not a toy,??? Jobs said after a demonstration of iMovie for iPad. ???You can really edit movies on this thing.???

Later, after a demonstration of GarageBand for iPad, Jobs repeated it: ???Again, this is no toy.???

Priced at $5 each, iMovie and GarageBand were the only apps demo???d last Wednesday on the iPad 2. These apps aren???t brand-new, because they were previously Mac apps, but bringing them to the iPad is a significant move.

Touchscreen tablets may become an ideal platform for multimedia creation with tools like these.

Historically, iMovie and GarageBand have been popular on the Mac because of their affordability and ease of use. With these two apps, Apple pioneered tools for Joe Schmo to create music and movies ??? skills that were previously exclusive to professional musicians and moviemakers with expensive hardware and software.

As a professional Final Cut Pro videomaker myself, I was personally frustrated that Apple kept making it easier and easier for anyone to replicate my technical skills with much simpler tools. (To be clear, beyond my selfish needs, I did view iMovie as extremely beneficial for creators.)

Now Apple???s making these same creative tools more accessible to an even broader audience, on an even more affordable device, the $500 iPad. The touchscreen interface is so intuitive that even children and grandparents have been able to pick up iPads and figure out how to use them in a few minutes. Now they could potentially launch iMovie or GarageBand and create some movies or music.

While touchscreen tablets are less than ideal for typing out long blog posts or writing novels, they may become an ideal platform for multimedia creation with tools like these. For that reason, these apps may be even more important than the iPad 2 itself.

But Apple still has a lot of room to improve if it wants the iPad to be a platform for creation. Going forward, one key area of creation that Apple should focus on is a tool to create apps.

Creative Coding

Programming is one of the most creative things you can do with a computer, and the iPad could potentially be a powerful tool to introduce this form of creativity to many people, particularly children.

Currently there is no way for people to use the iPad to make programs. Furthermore, the touchscreen interface already doesn???t seem ideal for traditional coding, and there???s no easy way to look under the hood of an iPad to understand how to create software.

Without a proficient programming environment readily accessible on the iPad, Apple???s tablet paints a bleak portrait for the future of programming.

???I think the iPad generation is going to miss out on software programming,??? said Oliver Cameron, developer of the Friends iPhone app. ???Kids don???t need Macs anymore.???

It doesn???t help that Apple enforces strict rules around how iOS apps must be programmed, which occasionally results in some collateral damage.

Take for example Apple???s rejection of Scratch early last year. Scratch for iPhone was an app for kids to view programs coded with MIT???s Scratch programming platform.

Apple rejected the app, citing a rule that apps may not contain code interpreters other than Apple???s. This rule appears to be specifically designed to prevent meta platforms such as Adobe Flash from appearing on the iPad, thereby allowing Apple to keep its iOS platform to itself.

The young community of Scratch programmers, however, doesn???t pose a threat to Apple???s business, and the rejection of the Scratch app shows how Apple???s developer rules can harm the art of programming.

???I think the iPad generation is going to miss out on software programming.???

???I think it???s terrible,??? said Andr??s Monroy-Hern??ndez, a Ph.D. candidate at the MIT Media Lab and lead developer of the Scratch online community, when Scratch was rejected April 2010. ???Even if the Scratch app was approved, I still think this sends a really bad message for young creators in general. We have a forum where kids post comments, and they were really upset about this.???

Furthermore, Apple has especially frowned on the act of hacking iOS devices. It???s worth noting that programmers can still tinker on the iPad by writing code for ???jailbroken??? (i.e., hacked) devices.

But Apple has created the sentiment that hacking iOS devices is a criminal activity. Jobs has described Apple???s cracking down on iPhone hacks as a ???game of cat and mouse.???

In the past Apple vigorously fought attempts to legalize jailbreaking on mobile phones. The company eventually failed in that effort when the U.S. Copyright Office added jailbreaking to a list of exemptions to the Digital Millennium Copyright Act???s anticircumvention provisions, making jailbreaking cellphones lawful. However, the iPad is not covered by that exemption, because it???s not considered a phone, and therefore the lawfulness of hacking an iPad remains uncertain.

The criminal stigma surrounding iOS hacking is disappointing, because many of our best coders learned a great deal by thinking outside the box, breaking the rules and hacking around with systems. Take for example, Alex Payne, an engineer at Twitter.

???The thing that bothers me most about the iPad is this: if I had an iPad rather than a real computer as a kid, I???d never be a programmer today,??? Payne said in a blog post last year when the original iPad debuted. ???I???d never have had the ability to run whatever stupid, potentially harmful, hugely educational programs I could download or write. I wouldn???t have been able to fire up ResEdit and edit out the Mac startup sound so I could tinker on the computer at all hours without waking my parents.???

And then there???s software programmer Mark Pilgrim, who reminisced about the days when personal computers were truly ???personal,??? meaning a user could do anything he wanted with his device without feeling like a rebellious rule breaker.

???You could turn on the computer and press Ctrl-Reset, and you???d get a prompt. And at this prompt, you could type in an entire program, and then type RUN, and it would motherfucking run,??? Pilgrim said in his post last year when the iPad launched. Pilgrim and Payne agree that children learning to program with an iPad won???t get the enlightening tinkering experience they had.

That???s unfortunate, because in our digitally driven economy, programmers are more important than ever before, and it???d be beneficial for people of all ages to learn some code.

If Jobs really wants the world to view the iPad as a platform for creation, it seems like an opportune time for Apple to release a suite of basic programming tools for iOS devices. This could be a simple tool that creates some rudimentary iOS apps (plenty of apps in the App Store would be considered subpar anyway), and purchasing it should include a free developer???s license for kids to get started programming.

?s great that Apple???s iPad will give birth to some more musicians and moviemakers, but we can???t forget the people who make hardware extra special: the programmers.

Hey, Apple – why not at least give us an AppleScript Editor for the iPad/iPhone…