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CCD to Blue Button StyleSheet Tooling Project

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Project Overview

This project is a response to the U.S. Office of Personal Management’s (OPM) recent requirement that U.S. Federal Employees Health Benefit Program (FEHBP) health insurance carriers support the U.S. Department of Veterans Affairs (VA) Blue Button® text file format as a means of conveying personal health information to federal employees.
The scope of this project is to define the conversion of an HL7 Continuity of Care Document (CCD) to the Blue Button format via an XSLT style sheet tool. Because most Meaningful Use–certified health information exchange systems already possess CCD-export capabilities, the tool will be able to leverage those capabilities as a simple and effective way for many carriers to meet OPM’s new requirement.
The Blue Button, developed by the VA in collaboration with the Centers for Medicare and Medicaid Services (CMS), empowers Veterans to access and download their health information as an ASCII text file or PDF® document. The Blue Button initiative was made nationally available in October 2010. In December 2011, OPM issued a formal request to all carriers in the FEHBP to add Blue Button functionality to their web-based personal health record systems. (See:,1744.aspx )

The Blue Button service participates in the health information exchange continuum by enabling Veterans and consumers to share their data with clinicians and other caregivers via a simple text file. The service is part of the expanding landscape of national and local initiatives such as the Office of the National Coordinator’s Standards and Interoperability Framework and the Beacon Community Programs.

HL7 intends to offer licenses to the XSLT style sheet tool at no cost as part of its ongoing commitment to respond to the industry’s needs in a timely and cost-effective manner.”

HL7’s Electronic Health Record Work Group and Structured Documents Work Group, co-sponsors of the project, expect to offer the file conversion tool and User’s Guide in April 2012. Doug Dormer, President of SPINNphr and member of the EHR WG stated, “I am pleased to be involved in this project. This tool will reduce my technical team’s effort to offer a data download channel to consumers in the Blue Button format and help our clients meet OPM’s requirement.”

Project Need

VA developed the Blue Button in collaboration with the Centers for Medicare and Medicaid Services (CMS), and the Department of Defense, along with the Markle Foundation's Consumer Engagement Workgroup. VA’s Blue Button feature allows Veterans to access and download their information into a very simple text file. However most EHR and PHR vendors have focused their development efforts on certification for Meaningful Use (MU) and support for industry interoperability based on the S&I Framework initiatives of ONC. As a result, most certified EHR & PHR vendors support CCD. To take full advantage of the existing CCD capabilities of MU certified vendors and support the Blue Button goal for a “very simple� ASCII text file, it would be helpful for the healthcare industry if it were possible to transform an existing MU-certified CCD export file into a VA Blue Button ASCII text file. The intended result would be with a common, consistent-format ASCII file – without any substantive additional coding effort for MU-certified systems. NOTE: The scope of this project explicitly excludes transforming Blue Button ASCII into CCD, because ASCII text does not have the capacity to carry key privacy, security and data integrity meta-data needed to help ensure the reliability and quality of the patient data for secure computer-to-computer interoperability.

The stylesheet on usage content will include purpose, audience, approach, usage recommendations, a discussion of limitations and issues, and an appendix with the XML transform (XSLT stylesheet) and a sample CCD and the related Blue Button ASCII text output.

Project Success Criteria

A XSLT stylesheet that can transform a CCD export from a Meaningful Use-certified EHR or PHR into a VA Blue Button ASCII text file.

Currently Out of Scope

Project Leaders

Lenel James
Keith Boone

EHR Workgroup Co-Chair

Don Mon

Meeting Information

Upcoming CCD to Blue Button Text Project Working Calls: The following list of calls is to help EHR WG members and other interested parties participate in ongoing CCD to Blue Button Project development and discussion. Please contact the call leaders if you have any questions. All EHR WG or interested members are welcome to participate in these calls.

  1. date/time TBD
    • Leaders: Lenel James (, Keith Boone (
    • Subject: Project status, wrap-up and publishing
    • Call Information: (559) 546-1200 ID: 138-264-572

Project Documents

Project Status

Project Plan Draft

This project is slated to follow an iterative development pattern. to be completed...

Current Activities

Development of XSLT files are under way. A proof of concept has been completed. Development of a user guide is well under way.


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