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.
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Annual Support & Maintenance
Costs that are typically 15-20% of the software license costs. Where the actual license is normally a one- time fee, the support and maintenance costs are renewed on a yearly basis. This yearly fee basically covers two areas: 1) any upgrades or new releases; and 2) customer service and support. It should be noted that both vendor EHR software and third party software will need support, so it is important to determine which components the support costs cover. Also, some vendors might have more than one service level agreement representing different support options at different costs.
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CCHIT
The Certification Commission for Healthcare Information Technology or CCHIT is a recognized certification body (RCB) for electronic health records and their networks, and an independent, voluntary, private-sector initiative.
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Clinical Data Repository
The data warehouse that contains clinical data (HL7 messages) centrally.
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Clinical Decision Support
Clinical Decision Support provides clinicians, staff, patients and other individuals with knowledge and person-specific information, intelligently filtered at appropriate times, to enhance health and healthcare. It encompasses computerized alerts and reminders, clinical guidelines, order sets, patient data reports and dashboards, documentation templates, diagnostic support, and clinical workflow tools
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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).
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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.
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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.
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Computer-Based Patient Record
A computer-based patient records (CPR) system contains patient-centric, electronically maintained information about an individual's health status and care, focuses on tasks and events directly related to patient care, and is optimized for use by clinicians.
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Computerized Provider Order Entry (CPOE)
A computer application that allows a physician's orders for diagnostic and treatment services (such as medications, laboratory, and other tests) to be entered electronically instead of being recorded on order sheets or prescription pads. The computer compares the order against standards for dosing, checks for allergies or interactions with other medications, and warns the physician about potential problems.
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Connected Healthcare Community
The Connected Healthcare Community enables hospitals to thrive competitively, grow revenue, shrink costs and improve quality of care by:
- Promoting physician loyalty through the removal of key barriers to EMR adoption including cost, connectivity and ease of use.
- Empowering independent practices to share interconnected clinical data and gain access to this data anytime, anywhere.
- Enhancing the patient experience through the elimination of duplicate tests and procedures.
- Reducing patient risk by streamlining data sharing between ambulatory and acute care settings, incorporating evidence-based medicine tools in care giving and delivering clinical decision support tools to providers.
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Controlled Clinical Vocabulary
A system of standardizing the terms used in describing client-centered health and health service-related concepts.
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Conversion Services
Consulting services offered by the vendor. These services will take your original data, either in paper or electronic form, and transfer the data into the EHR system database.
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Data Center
The physical space and hardware used by the HIE to house its operations if these assets are kept within the HIE.
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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.
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Data Recovery Services
A mechanism and process to safely store duplicate databases and recreate the data should a disaster occur.
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Department of Health and Human Services
The Department of Health and Human Services is the United States government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.
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DICOM (Digital Imaging Communications in Medicine)
A standard that defines protocols for the exchange of medical images and associated information (such as patient identification details and technique information) between instruments, information systems, and health care providers. It establishes a common language that enables medical images produced on one system to be processed and displayed on another.
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Digital Hospital
A digital hospital is one in which no paper is used to record or communicate information about a patient.
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Digital Signature
A string of binary digits that is computed using an encryption algorithm. Digital signatures enable signatory authentication, confirmation of data integrity, and non-repudiation of messages.
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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.
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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).
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Electronic Billing (Claims, Eligibility, Remittance)
The ability to contact the payer before the patient is seen and get a response that indicates whether or not the services to be rendered will be covered by the payer.
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Electronic Health Record (EHR)
An electronic health record (EHR) is an aggregation of patient-centric health data that originates in the patient record systems of multiple independent healthcare organizations for the purpose of facilitating care across multiple organizations. The EHR is a long-term record for a patient, transcending his or her involvement with individual healthcare organizations and episodes of care.
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Electronic Imaging Results Delivery
The ability to accept messages from radiology sources and integrate the data for presentation to a clinician.
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Electronic Medical Record (EMR)
An electronic medical record (EMR) contains patient-centric, electronically maintained information about an individual's health status and care, focuses on tasks and events directly related to patient care, and is optimized for use by clinicians to support ambulatory settings.
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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.
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Electronic Quality Data Submission (Performance and Accountability Measures)
Support the capture and reporting of quality, performance, and accountability measures to which providers/facilities/delivery.
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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
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Electronic Signature
A digital signature, which serves as a unique identifier for an individual.
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Enterprise Master Patient Index (EMPI)
The EMPI identifies all patients who have been treated in a facility or enterprise and lists the medical record or identification number associated with the name.
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E-Prescribing
Provides features to enable secure bidirectional communication of information electronically between practitioners and pharmacies or between practitioner and intended recipient of pharmacy orders.
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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.
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. They are:
- Be 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.
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Healthcare Information Technology Standards Panel
The Healthcare Information Technology Standards Panel (HITSP) is a multi-stakeholder coordinating body designed to provide the process within which affected parties can identify, select, and harmonize standards for communicating healthcare information throughout the healthcare spectrum.
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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.
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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.
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IHE
IHE is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information. IHE promotes the coordinates use of established standards such as DICOM and HL7 to address specific clinical need in support of optimal patient care.
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Implementation Services
Consulting services offered by the vendor. These services will provide planning and actual implementation of an EHR system. It is important when comparing quoted implementation costs that physicians understand which detailed cost line items a particular vendor will be supplying. Also, make sure and take a look at their project plans.
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Informatics
The application of computer science and information science to the management and processing of data, information, and knowledge.
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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.
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Interface to ASP EHR System
The interface between an HIE and Electronic Health Records (EHRs) that are maintained on ASP platforms (i.e. NexGen, AllScripts).
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Interface to Laboratory System
The interface between an HIE and systems that are sources of laboratory data.
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Interface to Pharmacy System
The interface between an HIE and the systems that are sources for prescription data or that are resident within dispensing pharmacies, pharmacy benefit management companies and hospitals.
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Interface to Practice Management System
The interface between an HIE and the systems that are sources for the financial management systems of physician practices.
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Interface to Provider Office EHR System
The interface between an HIE and EHRs that are maintained in practice-specific systems (e.g. EPIC).
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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.
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The International Organization for Standardization (ISO)
It is a worldwide federation of national standards bodies from some 130 countries, one from each country. ISO's work results in international agreements that are published as International Standards.
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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.
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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.
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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.
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Meritocracy
Type of society that is characterized in an Open Source development community where wealth, position, and social status are in part assigned through competition or demonstrated talent and competence, on the premise that positions of trust, responsibility and social prestige should be earned, not inherited or assigned on arbitrary quotas.
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MPI
The Master Patient Index is the link tracking patient, person, or member activity within an organization (or enterprise) and across patient care settings. The MPI identifies all patients who have been treated in a facility or enterprise and lists the medical record or identification number associated with the name.
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National Health Information Network
An interoperable, standards-based network across the nation for the secure exchange of heath care information.
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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).
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Open Source
Open Source is an open and collaborative development method for software that harnesses the power of distributed peer review, highlighted through a system of meritocracy and characterized through transparency of process. The promise of Open Source is better quality, higher reliability, relevancy, more flexibility, lower cost and an end to predatory vendor lock-in.
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Open Source Values
Characterized by being transparent in the community; offering relevant software code and solutions, and working within a community that rewards those who actually do something versus those who simply pontificate. Credit and community respect is awarded by the community based on a system of meritocracy.
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OSI (Open Systems Interconnection)
An international standard for networking adopted by the ISO (International Organization for Standardization). This 7-layer model offers the widest range of capabilities for networking.
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Outbreak Surveillance
Support clinical health state monitoring of aggregate patient data for use in identifying health risks from the environment and/or population.
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Parallel Pathways for Quality Healthcare
eHI has developed a set of principles and framework for alignment of incentives with both quality and efficiency goals, as well as HIT capabilities within the physician practice and health information exchange capabilities across markets. This Framework—entitled "Parallel Pathways for Quality Healthcare" offers significant guidance to states, regions and communities who are exploring health information exchange as a foundation to address quality, safety and efficiency challenges.
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Computer-Based Patient Record
A computer-based patient records (CPR) system contains patient-centric, electronically maintained information about an individual's health status and care, focuses on tasks and events directly related to patient care, and is optimized for use by clinicians.
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Electronic Health Record
An electronic health record (EHR) is an aggregation of patient-centric health data that originates in the patient record systems of multiple independent healthcare organizations for the purpose of facilitating care across multiple organizations. The EHR is a long-term record for a patient, transcending his or her involvement with individual healthcare organizations and episodes of care.
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Electronic Medical Record
An electronic medical record (EMR) contains patient-centric, electronically maintained information about an individual's health status and care, focuses on tasks and events directly related to patient care, and is optimized for use by clinicians to support ambulatory settings.
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Pay-for-Performance/Quality Data Reporting
Supports the capture and reporting of quality, performance, and accountability measures to which providers/ facilities/ delivery systems/communities are held accountable including measures related to process, outcomes, and/or costs of care, may be used in 'pay for performance' monitoring and adherence to best practice guidelines.
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Personal Health Record (PHR)
An electronic application through which individuals can maintain and manage their health information (and that of others for whom they are authorized) in a private, secure, and confidential environment.
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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.
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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.
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Service Level Agreement
A documented track record of how well the vendor is meeting its customer support commitments. This usually includes a definition of how a problem migrates through the support system and the different resources that get involved along the way. If a problem can’t be resolved in a certain amount of time, then it escalates until it is resolved. Different types of problems have different levels of urgency and importance. The severity level of a problem is usually noted when a support ticket is opened up. Resolution guarantees are based on severity levels. For example, CPOE down would be a high severity level while a patient education database not working might be a lower level of severity.
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SNOMED CT® (Systematized Nomenclature of Medicine-Clinical Terms)
Considered to be the most comprehensive, multilingual clinical healthcare terminology in the world. It provides the core general terminology for the electronic health record (EHR) and contains more than 357,000 concepts with unique meanings and formal logic-based definitions organized into hierarchies. When implemented in software applications, SNOMED CT represents clinically relevant information consistently, reliably and comprehensively as an integral part of producing electronic health records.
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Service Oriented Architecture
A service-oriented architecture (SOA) is the underlying structure supporting communications between services.
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Software as a Service
Software as a Service (SaaS) is a software distribution model in which applications are hosted by a vendor or service provider and made available to customers over a network, typically the Internet.
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Stages of Health Information Exchange Development
- Stage One: Recognition of the need for HIE among multiple stakeholders in your state, region, or community
- Stage Two: Getting organized by defining shared vision, goals, & objectives, identifying funding sources, and setting up legal & governance structures
- Stage Three: Transferring vision, goals, & objectives to tactics and business plan, defining needs and requirements and securing funding
- Stage Four: Well under-way with implementation – technical, financial, and legal
- Stage Five: Fully operational health information organization. Transmitting data that is being used by healthcare stakeholders sustainable business model.
- Stage Six: Demonstration of expansion of organization to encompass a broader coalition of stakeholders than present in the initial operational model
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Web 2.0
Web 2.0 refers to a trend in web design and development. It can be defined as a perceived second generation of web-based communities and hosted services that aim to facilitate creativity, collaboration, and sharing between users.
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X12
A committee chartered by the American National Standards Institute (ANSI) to develop uniform standards for inter-industry electronic interchange of business transactions—electronic data interchange (EDI).
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X12N
The principle responsibilities of ASC X12N Insurance Subcommittee are development and maintenance of X12 standards, standards interpretations, and guidelines for the insurance industry, including health insurance. Most electronic transactions regarding health insurance claims are conducted using these standards, many of which are mandated by HIPAA.
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