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Section 1a: Clinical Document Architecture (CDA®)

HL7 CCD to ASCII Blue Button Transform, Release 1


The healthcare system is in the midst of a revolution in healthcare information technology. Central to this revolution are technologies that facilitate health information exchange between providers and promote patient engagement and self-management. The Blue Button®, developed by the U.S. Veterans Administration (VA) in collaboration with the U.S. Centers for Medicare and Medicaid Services (CMS), allows people to access and download their personal health  information as an ASCII text file or PDF® document simply by “clicking on the Blue Button®”.

The HL7 CCD to BlueButton Transformation Tool is a set of xslt transforms that enable the transformation of CCD, and Consolidated CDA CCD (DSTU release 1.0) files into a Blue Button text file that closely resembles the VA’s own Blue Button text file extracts. This set of transformation files, when applied to one of the aforementioned CCD versions will create a Blue Button text file that a patient can use to view their own clinical data as well as pass it on to a care giver or provider.

To support the original Blue Button® goals of providing the consumer with a ‘very simple’ ASCII text file and taking full advantage of the existing CCD capabilities of Meaningful Use (MU) certified vendors at the same time, HL7 volunteers have developed a CCD to Blue Button® Transform Tool (the “Tool”). The Tool transforms a CDA R2 CCD file into a U.S. Department of Veteran Affairs (VA) Blue Button® ASCII text file. The use of the Tool results in a common, consistently-formatted ASCII text file – without substantive, additional coding effort for MU certified systems.



  • Software developers and consultants
  • Healthcare providers, with consumer access to clinical information
  • Healthcare insurers, with member access to clinical information


  • Minimizes coding effort for MU certified systems to create common, consistently-formatted ASCII text files for Blue Button.
  • Enable software developers to add the support of create Blue Button text files into their own already existing CCD implementations
  • Enables creation of Blue Button text files with minimal effort and configuration


S&I Framework’s ABBI


The Blue Button® initiative was made nationally available in October 2010. In December 2011, United States Office of Personnel Management (OPM) issued a formal request to all carriers in the Federal Employee Health Benefit Program (FEHBP) to add Blue Button® functionality to their web-based PHR systems, thereby expanding the usage of the Blue Button® beyond the VA and CMS. Subsequently, the Office of the National Coordinator for Health Information Technology (ONC), within the Department of Health and Human Services, formed a work group within its Standards and Interoperability Framework Initiative (S&I Framework) called the Advanced Blue Button® Initiative (ABBI). ABBI is intended to “identify, define and harmonize content structures and specifications so that  downloaded information is machine readable and human readable.” This charter extends the present Blue Button® program to this larger purpose.

A team of volunteers particpants were recruited from the VA, CMS, and the vendor community, with representation from nationally-recognized insurers and healthcare providers. Vendor representation included both EHR systems used by providers and PHR systems and patient portals focused on consumers. The team began by identifying the sources of information (CCD) and the desired output (VA ASCII TXT).  Considering various approaches, the team determined that the best method of accomplishing the desired solution was to use eXtensible Stylesheet Language Transformations (XSLT) as the method and technology for the transform.


HL7 CCD to ASCII Blue Button Transform, Release 1



Electronic Health Records

Structured Documents


  • Tools


  • CDA


  • Retired


  • US Realm