Glossary of Terms
Access: The process of obtaining data from, or placing into a computer system or storage device. It refers to such actions by any individual or entity who has the appropriate authorization for such actions.
American National Standards Institute (ANSI): ANSI is a broad based agency charged with overseeing voluntary standards development for everything from computers to household products. ANSI accredits standards development organizations (SDO) based on their consensus process, then reviews and officially approves the SDO recommendations.
American Society for Testing and Materials (ASTM): American Society for Testing and Materials develops standards on characteristics and performance of materials, products, systems, and services. There are numerous standards-writing technical committees. E31 is the Committee on Computerized Systems and E31.28 is the subcommittee on Healthcare Informatics responsible for the Continuity of Care (CCR) standard.
Architecture: The orderly arrangement of parts; structure.
ASTM: See American Society for Testing and Materials.
Asymmetric Key System: A system that uses different keys for encryption and decryption. Within such a system, it is computationally infeasible to determine the decryption key (which is kept private) from the encryption key (which is made publicly available).
Attribute: A characteristic or property.
Audit trail: Chronological record of system activity which enables the reconstruction of information regarding the creation, distribution, modification, and deletion of data.
Authentication: Verification of the identity of a person or process.
Authorization: The role or set of permissions for information system activity assigned to an individual.
Biometric Authentication Technology: Technology that uses some human biological feature (e.g. fingerprint, voice pattern, retina scan, or signature dynamics) to uniquely identify an individual.
CA (certification authority): The entity providing third party trust within PKI.
Certification/Conformance Testing: Testing a product for the existence of specific features, functions, or characteristics required by a standard in order to determine the extent to which that product satisfies the standard requirements.
Clinical Messaging: The communication among providers involved in the care process that can range from real time communication (for example, fulfillment of an injection while the patient is in the exam room), to asynchronous communication (for example, consult reports between physicians). Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. www.hl7.org/ehr/downloads/index.asp
Clinical Messaging #1: Continuity of Care Data Exchanges (Inter-Provider Communication): Communication among providers involved in the care process can range from real time communication (for example, fulfillment of an injection while the patient is in the exam room), to asynchronous communication (for example, consult reports between physicians). Some forms of inter-practitioner communication will be paper based and the EHRS must be able to produce appropriate documents. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. www.hl7.org/ehr/downloads/index.asp
Clinical Reminders (Clinical Guideline Prompts): The ability to remind clinicians to consider certain actions at a particular point in time, such as prompts to ask the patient appropriate preventive medicine questions, notifications that ordered tests have not produced results when expected, and suggestions for certain therapeutic actions, such as giving a tetanus shot if one has not been given for 10 years. Reference: eHealth Initiative Foundation. "Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations." Washington: eHealth Initiative Foundation, 2005.
Clinical User Authentication: The process used by the HIE to determine the identity of the person accessing the system with adequate certainty to maintain security and confidentiality of personal health information and to administer with certainty of identity a regulated process such as e-prescribing and chart signing.
Confidentiality: A 3rd party's obligation to protect the personal information with which it has been entrusted.
Data Integrity: The accuracy and completeness of data, to be maintained by appropriate security measures and controls. Preservation of the original quality and accuracy of data, in written or in electronic form.
Data Recovery Services: A mechanism and process to safely store duplicate databases and recreate the data should a disaster occur.
Decision Support: Computerized functions that assist users in making decisions in their job functions. In the practice of medicine, these functions include providing electronic access to medical literature, alerting the user to potential adverse drug interactions, and suggesting alternative treatment plans for a certain diagnosis.
Decryption: The technique of using mathematical procedures to "unscramble" data so that an unintelligible (encrypted) message becomes intelligible.
Demographics: Information about name, address, age, gender, and role used to link patient records from multiple sources in the absence of a unique patient identifier.
Doctor Matching: The process of cross-linking the multiple provider identifiers in a community from a variety of provider identifier sources and creating a master doctor identifier with a key for cross-referencing the various community identifiers.
Document Review, Edit, Sign: A software process that allows for the secure review, editing, and signature through electronic, distributed technology of electronic health record components, such as operative reports, discharge summaries, and consultations.
eLaboratory: The electronic delivery of laboratory results to practices so that such data may be integrated into electronic patient records in a full EHR system, or used by a dedicated application to view structured, context-rich, and/or longitudinal laboratory results on a patient. eLaboratory includes closing the orders loop, documenting the review of results by clinicians, and documenting that the results have been communicated to the patient. The full benefits of eLaboratory are not achieved until the results are used as input into clinical decision support systems (CDSS).
Electronic Health Record: Electronically maintained information about an individual's lifetime health status and health care.
Electronic Prescribing (Pharmacy Communication): Provides features to enable secure bidirectional communication of information electronically between practitioners and pharmacies or between practitioner and intended recipient of pharmacy orders. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. www.hl7.org/ehr/downloads/index.asp
Electronic Quality Data Submission (Performance and Accountability Measures): Support the capture and reporting of quality, performance, and accountability measures to which providers/facilities/delivery.
Electronic Referral Management: The ability to generate and/or receive summaries of relevant clinical information on a patient that are typically transferred between healthcare providers when a patient is referred to a specialist or admitted or discharged from a hospital. Reference: eHealth Initiative Foundation. "Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations." Washington: eHealth Initiative Foundation, 2005.
Electronic Referrals and Authorizations: The ability to generate and/or receive summaries of relevant clinical information on a patient that are typically transferred between healthcare providers when a patient is referred to a specialist or admitted or discharged from a hospital. Reference: eHI* Foundation. "Second Annual Survey of State, Regional and Community-based HIE Initiatives and Organizations. " Washington: eHealth Initiative Foundation, 2005.
Electronic Signature: A digital signature, which serves as a unique identifier for an individual.
Encryption: The process of enciphering or encoding a message so as to render it unintelligible without a key to decrypt (unscramble) the message.
E-Prescribing: The transmission, using electronic media, of prescription or prescription-related information between a prescriber, dispenser, pharmacy benefit manager or health plan, either directly or through an intermediary, including an e-prescribing network. Reference: Centers of Medicare and Medicaid Services (CMS).
Health Care Interoperability: Assures the clear and reliable communication of meaning by providing the correct context and exact meaning of the shared information as approved by designated communities of practice. This adds value by allowing the information to be accurately linked to related information, further developed and applied by computer systems and by care providers for the real-time delivery of optimal patient care.
Health Information Exchange (HIE): The mobilization of healthcare information electronically across organizations within a region or community.
HIE provides the capability to electronically move clinical information between disparate healthcare information systems while maintaining the meaning of the information being exchanged. The goal of HIE is to facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, equitable, patient-centered care.
Formal organizations are now emerging to provide both form and function for health information exchange efforts. These organizations (often called Regional Health Information Organizations, or RHIOs) are ordinarily geographically-defined entities which develop and manage a set of contractual conventions and terms, arrange for the means of electronic exchange of information, and develop and maintain HIE standards.
Although HIE initiatives differ in many ways, survey results and eHI experiences with states, regions and communities indicate that those who are experiencing the most success share the following characteristics:
- Governed by a diverse and broad set of community stakeholders;
- Develop and assure adherence to a common set of principles and standards for the technical and policy aspects of information sharing, addressing the needs of every stakeholder;
- Develop and implement a technical infrastructure based on national standards to facilitate interoperability;
- Develop and maintain a model for sustainability that aligns the costs with the benefits related to HIE; and
- Use metrics to measure performance from the perspective of: patient care, public health, provider value, and economic value.
Reference: eHealth Initiative. "Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations." Washington: eHealth Initiative, 2005.
Health Level Seven (HL7): An ANSI approved American National Standard for electronic data exchange in health care. It enables disparate computer applications to exchange key sets of clinical and administrative information.
Informatics: The application of computer science and information science to the management and processing of data, information, and knowledge.
Interface: Shared boundary between two functional units defined by various characteristics pertaining to the functions, physical interconnections, signal changes, and other characteristics as appropriate.
Interface to ADT System: The interface between an HIE and the systems that are sources for admission, discharge and transfer (ADT) of patients in the care delivery setting and that are resident within care delivery institution.
Interface to ASP EHR System: The interface between an HIE and Electronic Health Records (EHRs) that are maintained on ASP platforms.
Interoperability: The ability of two or more systems or components to exchange information and to use the information that has been exchanged accurately, securely, and verifiably, when and where needed.
LOINC (Logical Observation Identifiers, Names, and Codes): The LOINC databases provide sets of universal names and ID codes for identifying laboratory and clinical test results. The purpose is to facilitate the exchange and pooling of results, such as blood hemoglobin, serum potassium, or vital signs, for clinical care, outcomes management, and research.
Master Patient Index (MPI): is a database that maintains an index for registered patients. An MPI can be used as a tool to assure that clinical and demographic information can be cross-referenced between different facilities in a health system. A MPI is considered an important resource because it is the link that tracks patient, person, or member activity within an organization and/or across patient care settings. Reference: “Master Patient Index (MPI)” Florida State University Center for Health Informatics, healthinformatics.wikispaces.com/Master+Patient+Index
Medication Matching: The process of cross-linking the multiple possible medication identifiers naming conventions in a community from a variety of systems housing medication information and creating a master medication identifier with a key for cross-referencing the various community identifiers. For example there are hundreds of NDC codes for identical drugs as well as HCPCS codes that identify the same drug as NDC codes.
Medication Reconciliation: Alerts providers in real-time to potential administration errors such as wrong patient, wrong drug, wrong dose, wrong route and wrong time in support of medication administration or pharmacy dispense/supply management and workflow. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. www.hl7.org/ehr/downloads/index.asp
Message Integrity: Protecting a message against its unauthorized modification, often by the originator of the message generating a digital signature.
Messaging to Pharmacies: The process of communicating electronically with pharmacies. This typically includes the cost of communication lines and processes between the HIE and pharmacies. This is necessary to support the e-prescribing function when that function includes the process of electronically sending a digital prescription to the pharmacy.
National Health Information Network: An interoperable, standards-based network across the nation for the secure exchange of heath care information. Reference: HHS Awards Contracts to Develop Nationwide Health Information Network. 2005.
Network Connectivity: The process used for maintaining connection for communication between the HIE and a data source (laboratory, radiology practice, physician practice, or hospital) and data user (physician practice or hospital).
Network: A set of connected elements. For computers, any collection of computers connected together so that they are able to communicate, permitting the sharing of data or programs.
Outbreak Surveillance: Support clinical health state monitoring of aggregate patient data for use in identifying health risks from the environment and/or population. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. www.hl7.org/ehr/downloads/index.asp
Participant Roles: Examples of roles that may be recognized by the health system that participate in events affecting the health of people:
- Provider
- Governor
- Manager
- Recipient
- Researcher
- Educator
- Worker
- Family Member
Roles may be used to authorize an individual's access to information system functionality.
Privacy: Right of an individual to control the circulation of information about him/herself within social relationships; freedom from unreasonable interference in an individual's private life; an individual's right to protection of data regarding him/her against misuse or unjustified publication.
Public Health Outbreak Surveillance: Supports clinical health state monitoring of aggregate patient data for use in identifying health risks from the environment and/or population. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. www.hl7.org/ehr/downloads/index.asp
Registration Authority: An entity (group or agency) that has been delegated by a CA to perform a specific set of ‘trusted authority’ functions within PKI.
Results Answer Matching: The process of cross-linking the multiple possible answers to asking for a given result. For instance, asking for the results of a chest x-ray could yield a dictated report or a digital image of an x-ray. In any case, the case received must be matched across the type of result to a term identifying a common result.
Results Name Matching: The process of cross-linking the multiple possible names of data results that can contain the same information. For instance a blood glucose reading can be called up by a blood glucose test, an SMA panel, or a glucometer result.
Results Review: The ability to interpret the clinical data that is entered about a patient using a set of rules or algorithms which will generate warnings or alerts at various levels of severity to a clinician. These are intended to make the clinician aware of potentially harmful events, such as drug interactions, patient allergies, and abnormal results, which may affect how a patient is treated, with the intention of speeding the clinical decision process while reducing medical errors.
Risk Assessment: An evaluation of the chance of vulnerabilities being exploited based on the effectiveness of existing or proposed safeguards or countermeasures.
Rules Engine: A set of rules defined within a software process that converts clinical and administrative data streams into a meaningful representation of clinical quality markers to be used in functions such as pay for performance/quality data reporting.
Security: In information systems, the degree to which data, databases, or other assets are protected from exposure to accidental or malicious disclosure, interruption, unauthorized access, modification, removal or destruction.
SNOMED International: A nomenclature for use by all health services professionals developed in the US and updated at least semi-annually.
Third Party-EHR Specific: Applications that are essential to the basic infrastructure of the system. They are the building blocks, such as the technical platform upon which the EHR system is built (e.g.,Windows, Linux, or MacIntosh, etc.) Also what kind of database structure controls the system (e.g, SQL, Oracle, etc.). When comparing license costs, note if there are separate general system license costs or if these are rolled into the main cost. Also, ask whether there will be additional costs when the vendor upgrades their software and it becomes necessary to install a new version of the database or operating system. Make sure your infrastructure software will support any features you wish to add later on.
Training Services: Consulting services offered by the vendor. They provide hands on training for all aspects of the system.
* ehealth initiative www.ehealthinitiative.org