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Data at the Point of Care Frequently Asked Questions

Guidance for Blue Button Data at the Point of Care Frequently Asked Questions

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: June 01, 2012

What types of providers is CMS looking for to join the synthetic sandbox?

  • Fee-for-Service (FFS) providers who treat Medicare patients
  • Providers who already receive claims from other payers and who have successfully integrated the information into existing clinical workflows
  • Providers who have experience using Blue Button 2.0 or the Beneficiary Claims Data API project
  • Providers who already use or test with FHIR, especially Bulk FHIR

How can I access the synthetic sandbox and begin testing workflows?

  • Any Fee-for-Service provider or Health IT vendor can request access to synthetic data via Request access

How can I get more information?

  • Technical documentation is available in the API Documentation.
  • A DPC Google Group has been created to provide answers to questions and to support providers and developers who are implementing Data at the Point of Care.

How is the Data at the Point of Care pilot program different from Blue Button 2.0 and Beneficiary Claims Data API (BCDA)?

  • Blue Button 2.0 provides FHIR-formatted data for one individual Medicare beneficiary at a time, to registered applications with beneficiary authorization. See https://bluebutton.cms.gov/.
  • BCDA provides FHIR-formatted bulk data files to Medicare Shared Savings Program Accountable Care Organizations (MSSP ACOs) for all of the beneficiaries assigned to a given ACO. See https://bcda.cms.gov/.
  • Data at the Point of Care provides FHIR-formatted bulk data files to fee-for-service providers for their active patients as needed for treatment purposes under HIPAA. With DPC, providers identify their own rosters of patients to track, and no action is required from the beneficiary to authorize sharing of data. Data is shared between covered entities for treatment purposes as defined under HIPAA.

Is there a cost to get the claims information in the Data at the Point of Care pilot?

There is no cost for the data.

What type of information does CMS want as feedback?

  • Usefulness of the data to evaluate how helpful CMS claims data is for impacting treatment, provider burden, and quality of care for Fee-for-Service (FFS) providers at the point of care
  • Ease of implementation for vendors and providers to evaluate how easy it is to configure and get started with requesting and receiving claims data
  • Practicality and effectiveness of attribution logic that determines which providers can request and receive claims data for which patients and for how long
  • Ease and effectiveness of ways that vendors and providers can collaborate to access the data
  • Measure of the frequency of use and an evaluation of performance in different use cases to determine infrastructure decisions
  • Any other feedback, additions, or changes

How will CMS make sure that the data is secure and protected?

  • Data at the Point of Care secures Protected Health Information (PHI) and Personally Identifiable Information (PII) and has multiple layers of protection, such as encryption in transit and at rest, security certification requirements of connecting vendors, auditing and analytics to look for suspicious activity, terms of service restrictions, public and private security keys, and IP address restriction.
  • Data at the Point of Care is built based on privacy requirements defined by HIPAA.

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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.