Bill, suggests it may be done by hand. The quilting is phenomenal. The buttonhole stitch is done the opposite of how it is traditionally done. I hope you can see closer by clicking on the photo.
And here is my first block of Beyond the Cherry Trees by Sentimental Stitches. I've been wanting to do a red and green quilt for awhile and this one was just funky enough so my applique skills wouldn't have to be perfect. The little dots inside the berries are done with reverse applique. I used several different methods to try and get the red cherries somewhat round and resorted to this method that Barb described.