Introducing Blue Button+

Since launching the Automate Blue Button Initiative External Links Disclaimer six months ago, we have been working toward two aims:

  1. Ensure that every American can get access to their digital health information.
  2.  Help application developers use that data to build products and services that help individuals make use of their health data to better manage their health.

Blue Button is a symbol for patient access to their personal health information in a useable and safe digital format. It has spread from the federal government to the private sector.

Thanks to the efforts of the U.S. Department of Veterans Affairs, the Office of Personnel Management, and Blue Button pledge community, more than 80 million Americans can now download their health information with a click of a button from either their health insurer or health care provider.

Blue Button Improvements

While it’s been a positive movement for consumers, developers have made us aware of certain weaknesses:

1)    The files lack structure, and

2)    Consumers must manually move the files from the provider or payor to their third party applications.

Over the past six months, through a public-private collaborative process and building off of Meaningful Use Stage 2 standards, we have developed common implementation guidance for providers, payors, and developers to overcome these weaknesses. It’s called Blue Button+ External Links Disclaimer.

What is Blue Button+?

Blue Button+ is a blueprint for the structured and secure transmission of personal health data on behalf of an individual consumer. It meets and builds on the view, download, and transmit requirements in Meaningful Use Stage 2 for certified EHR technology.

Structure: The recommended standard for clinical health data is the HL7 Consolidated Clinical Document Architecture External Links Disclaimer also known as the Consolidated CDA. The C-CDA is a XML-based standard that specifies the encoding, structure, and semantics of a clinical document. Blue Button+ adopts the requirements for sections and fields from Meaningful Use Stage 2. For health plans sharing financial and claims data with their members, there is no existing standard – but the guide recommends critical data fields and suggested formats for sharing this data with consumers as well.

Transmit: In alignment with Meaningful Use Stage 2 standards, Blue Button+ uses Direct protocols to securely transport health information from providers to third party applications. Direct uses SMTP, S/MIME, and X.509 certificates to achieve security, privacy, data integrity, and authentication of sender and receiver.

Automation: To support meaningful applications for patients, health data needs to be seamlessly transmitted when their record is updated. Blue Button+ makes it possible for a patient to request an “on-going” share of their information.

Trust: The community has begun to assemble the digital certificates that identify third party applications and “bundling” them together into easy-to-install packages. These packages can be automatically loaded into your system, so patients can be confident that their data can be transmitted to the destination of their choice.

Privacy & Security: We worked with HHS’s Office for Civil Rights to assemble a Q&A that relates to the Blue Button+ use cases.

We must thank the 68 committed organizations in the Automate Blue Button Initiative and Standards and Interoperability Framework developed by ONC. This guide would not have been possible without the amazing contributions of many EHR vendors, health plans, health systems, patient advocacy groups, application developers, and government leaders.

Next Steps

If you are an EHR vendor, payor, or provider: read the guidance, provide feedback, and let us know how you are implementing these standards. Leading data holders are already implementing these capabilities today; we will be demonstrating them at the HIMSS 2013 Annual Conference and Exhibit External Links Disclaimer in March, and throughout the year, as they are put into practice.

If you are a third party application developer: we hope you are excited about the prospect of more data flowing from consumers who will be looking for new tools to help them make use of their health information.  Check out the guide, there is section for you External Links Disclaimer.

And if you are a consumer or patient, go ahead and ask for your health information via the Blue Button – it’s your right to access the information your doctor or health plan has about you!

Join Us for a Webinar to Learn More

Join us on February 19 from 3:00 – 4:00PM ET for a webinar External Links Disclaimer where we’ll discuss the guide in more detail and answer questions.  Click here External Links Disclaimer to register.

Learn more at: External Links Disclaimer.


  1. Kaunda says:

    I like the fact that the open format is a xml technology, it tallies well with the thoughts of tim berner lee on structured data and the semantic web.

  2. nir says:

    hi ryan, so i think i’m missing something here.. the BB+ library that parses a cCCA and converts it into a data structure (JSON) is not available for download? every time anyone wants to make patient records readable it will be a direct message against the ONCs servers? maybe i’m missing something here…

  3. Casey McClure says:

    Thank you for the excellent information! As we head towards a “structured and secure transmission of personal health data on behalf of an individual consumer” we’ll need more studies like this!

  4. Ryan Panchadsaram says:

    Hi Nir. BB+ is a description of how personal health information is structured and how it can be transmitted securely from EHRs to Third Party Applications. All the pieces like the application and Direct component are hosted and run by external parties, not ONC.

    I have a feeling you may be thinking about the work we are doing with the Health Design Challenge ( For that, we are in the process of creating a “Boostrap”-like framework to better visualize a C-CDA.

    • nir says:

      thanks ryan,

      i was more hoping the with support for structured data (JSON and not just ASCII) there will be a library/utility/code to be used to transform a ccd/ccda into json.



  5. Ryan Panchadsaram says:

    Hi Nir – Check this project out. One of the Presidential Innovation Fellows put it together. It’s not perfect, but it is a start to CCDA to JSON conversion:

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