Health Information Exchange 101: Important Terms and DefinitionsSource: National eHealth Collaborative
Terms are linked to definitionList of Terms in PDF version located here.• Accountable Care Organizations • Data Use & Reciprocal Support• Beacon Community Agreement• Biosurveillance • Digital Certificate• Bundled Payments • Electronic Health Record• Certificate Authority • Electronic Medical Record• Certificate Criteria • Electronic Order Entry• Clinical Document Architecture • Federal Health Architecture• Continuity of Care Document • Health IT Policy Committee• Continuity of Care Record • Health IT Standards Committee• Conformance Testing • Health Information Organization Continues on next slide
Terms are linked to definitionList of Terms in PDF version located here.• Health Information Technology • National Health Informationfor Economic & Clinical Health NetworkAct • Nationwide Health Information• Healthcare Quality Network Exchange• Health Level 7 • Office of the National• Implementation Guides Coordinator for Health Information• Integrating the Healthcare TechnologyEnterprise • Patient-Centered Medical Home• Master Patient Index • Patient Consent• Meaningful Use• National eHealth Collaborative Continues on next slide
Terms are linked to definitionList of Terms in PDF version located here.• Patient Protection & Affordable • Regional Health InformationCare Act Organization• Personal Health Record • Registration Authority• Private HIE • Rulemaking• Provider Directory • Specifications• Public Key Infrastructure • Standards• Publish/Subscribe • Standards & Interoperability• Publish and Send Framework• Query/Retrieve • State Designed Entities• Record Locator Service • State HIE Continues on next slide
Terms are linked to definitionList of Terms in PDF version located here.• The Direct Project• Virtual Lifetime Electronic Record
Accountable Care OrganizationAn Accountable Care Organization (ACO) is a typeof payment and delivery reform model that seeks totie provider reimbursements to quality metrics andreductions in the total cost of care for an assignedpopulation of patients. A group of coordinated healthcare providers form an ACO, which then providescare to a group of patients. The ACO may use arange of payment models (capitation, fee-for-servicewith symmetric or symmetric shared savings, etc.). Continues on next slide
Accountable Care OrganizationThe ACO is accountable to the patients and thethird-party payer for the quality, appropriateness,and efficiency of the health care provided.According to the Centers for Medicare and MedicaidServices (CMS), an ACO is “an organization ofhealth care providers that agrees to be accountablefor the quality, cost, and overall care of Medicarebeneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it.
Beacon CommunityA grant program sponsored by the Office of theNational Coordinator for Health IT (ONC) forcommunities to build and strengthen their existinghealth information technology infrastructure andexchange capabilities. These communitiesdemonstrate the vision of a future where hospitals,clinicians, and patients are meaningful users ofhealth IT and together the community achievesmeasurable improvements in health care quality,safety, efficiency, and population health.
BiosurveillanceWhile there is no commonly accepted definition ofbiosurveillance, it typically refers to automatedmonitoring of existing health data sources to identifytrends that may indicate naturally occurring orintentional disease outbreaks. Such data maysupplement traditional surveillance and diseasereporting methods.
Bundled PaymentsPayments are referred to as bundled when the unitof payment includes multiple individual services. Forinstance, hospitals receive a single bundledpayment from Medicare for each discharge; thatpayment covers all of the services provided by thehospital during the stay, including nursing, room andboard, operating room fees, and so on. In general,bundled payments offer providers an incentive toreduce the costs of the services within eachcomponent of the bundle and to increase theefficiency with which they provide medical care.
Certificate AuthorityA certificate authority (CA) is an authority in a networkthat issues and manages security credentials and publickeys for message encryption. As part of a public keyinfrastructure (PKI), a CA checks with a registrationauthority (RA) to verify information provided by therequestor of a digital certificate. If the RA verifies therequestor’s information, the CA can then issue acertificate. Depending on the public key infrastructureimplementation, the certificate includes the owner’spublic key, the expiration date of the certificate, theowner’s name, and other information about the publickey.
Certification CriteriaCertification of Health IT products will provideassurance to purchasers and other users that anHER system, or other relevant technology, offers thenecessary technological capability, functionality, andsecurity to help them meet the meaningful usecriteria established for a given phase. Providers andpatients must be confident that the electronic healthIT products and systems they use are secure, canmaintain data confidentiality and can work with othersystems to share information. Continues on next slide
Certification CriteriaConfidence in health IT systems is an important partof advancing health IT system adoption and allowingfor the realization of the benefits of improved patientcare.vii Certification criteria are determined byregulations led by ONC.
Clinical Document ArchitectureThe HL7 Clinical Document Architecture (CDA) is anXML-based markup standard intended to specify theencoding, structure and semantics of clinicaldocuments for exchange.
Continuity of Care DocumentA CCD is an HL7 CDA implementation of theContinuity of Care Record (CCR). It is generallypossible to convert a CCR document into, howeverit is not always possible to perform the inversetransformation as some CCD features are notsupported in CCR. A CCD is a document thatcontains the most relevant and timely core healthinformation about a patient. Continues on next slide
Continuity of Care DocumentThis document is transmitted electronically from onecaregiver to another. It contains various sectionssuch as patient demographics, insuranceinformation, diagnoses and problem list,medications, allergies and care plan. Theserepresent a "snapshot" of a patients health data.
Continuity of Care RecordA CCR is a document that contains the mostrelevant and timely core health information about apatient. This document is transmitted electronicallyfrom one caregiver to another. It contains varioussections such as patient demographics, insuranceinformation, diagnoses and problem list,medications, allergies and care plan. Theserepresent a "snapshot" of a patients health data.
Conformance TestingConformance is usually defined as testing to see ifan implementation faithfully meets the requirementsof a standard or specification. There are many typesof technical testing available, including testing forperformance, robustness, behavior, functions andinteroperability. Although conformance testing mayinclude some of these kinds of tests, it has onefundamental difference - the requirements orcriteria for conformance must be specified in thestandard or specification.
Data Use & Reciprocal SupportAgreementThe DURSA is the legal multi-party trust agreementthat is entered into voluntarily by all entities,organizations and Federal agencies that desire toengage in electronic health information exchangewith other members of the Nationwide HealthInformation Network Exchange.
Digital CertificateA digital certificate is an electronic “credit card” thatestablishes an individual’s credentials when doingbusiness or other transactions on the Web. It isissued by a certificate authority (CA). It contains thecertificate holder’s name, a serial number, expirationdates, a copy of the certificate holder’s public key(used for encrypting messages and digitalsignatures), and the digital signature of thecertificate-issuing authority so that a recipient canverify that the certificate is real. Continues on next slide
Digital CertificateSome digital certificates conform to a standard,X.509. Digital certificates can be kept in registries sothat authenticating users can look up other users’public keys.xii See also: certificate authority,registration authority, public key infrastructure.
Electronic Health Record (EHR)An electronic record of health-related information onan individual that conforms to nationally recognizedinteroperability standards and that can be created,managed, and consulted by authorized cliniciansand staff across more than one health careorganization.
Electronic Medical Record (EMR)An electronic record of health-related information onan individual that can be created, gathered,managed, and consulted by authorized cliniciansand staff within one health care organization.
Electronic Order EntryComputerized physician order entry (CPOE) (alsosometimes referred to as computerized providerorder entry or electronic order entry) is a process ofelectronic entry of medical practitioner instructionsfor the treatment of patients under his or her care.These orders are communicated over a computernetwork to the medical staff or to the departments(pharmacy, laboratory, or radiology) responsible forfulfilling the order. Continues on next slide
Electronic Order EntryCPOE decreases delay in order completion,reduces errors related to handwriting ortranscription, allows order entry at the point of careor off site, provides error checking for duplicate orincorrect doses or tests, and simplifies inventoryand posting of charges.
Federal Health ArchitectureThe Federal Health Architecture (FHA) is an E-Government Line of Business initiative managed bythe Office of the National Coordinator for Health IT(ONC). FHA was formed to coordinate health ITactivities among the more than 20 federal agenciesthat provide health and healthcare services tocitizens. FHA and its federal partners are helpingbuild a federal health information technologyenvironment that is interoperable with private sectorsystems. Continues on next slide
Federal Health ArchitectureThis also supports the President’s plan to enablebetter point-of-service care, increase efficiency andimprove overall health in the U.S. population. FHA isresponsible for supporting federal efforts to deployhealth IT standards and ensuring that federalagencies can seamlessly exchange health dataamong themselves, with state, local and tribalgovernments, and with the private sector.
Health IT Policy CommitteeThe Health IT Policy Committee is an advisorycommittee, as defined in the Federal AdvisoryCommittee Act, created for the purpose of makingrecommendations to the National Coordinator forHealth IT on a policy framework for the developmentand adoption of a nationwide health informationinfrastructure, including standards for the exchangeof patient medical information.
Health IT Standards CommitteeThe Health IT Standards Committee, a federaladvisory committee like the Health IT PolicyCommittee, is charged with makingrecommendations to the National Coordinator forHealth IT on standards, implementationspecifications, and certification criteria for theelectronic exchange and use of health information.
Health Information OrganizationAn HIO is an organization that oversees andgoverns the exchange of health-related informationamong organizations according to nationallyrecognized standards.xxi See also: healthinformation exchange (HIE) and regional healthinformation organization (RHIO).
Health Information Technologyfor Economic & Clinical Health ActThe Health Information Technology for Economicand Clinical Health (HITECH) Act seeks to improveAmerican health care delivery and patient carethrough an unprecedented investment in healthinformation technology. The provisions of theHITECH Act are specifically designed to worktogether to provide the necessary assistance andtechnical support to providers, enable coordinationand alignment within and among states, establish Continues on next slide
Health Information Technologyfor Economic & Clinical Health Actconnectivity to the public health community in caseof emergencies, and assure the workforce isproperly trained and equipped to be meaningfulusers of EHRs. Combined, these programs build thefoundation for every American to benefit from anelectronic health record, as part of a modernized,interconnected, and vastly improved system of caredelivery.
Healthcare qualityThe Institute of Medicine defines healthcare qualityas the extent to which health services provided toindividuals and patient populations improve desiredhealth outcomes. The care should be based on thestrongest clinical evidence and provided in atechnically and culturally competent manner withgood communication and shared decision making.
Health Level 7A non-profit organization involved in thedevelopment of international healthcare informaticsinteroperability standards. "HL7" is also used to referto some of the specific standards created by theorganization.
Implementation GuidesPublications listing electronic data interchangemessages that are in use in a particular industry orapplication. It indicates how the information in thosemessages should be presented on a segment-by-segment, and data-element-by-data-element basis,including which segments and data elements areneeded, which are not and what code values will beexpected in the application.
Integrating the HealthcareEnterpriseAn initiative by healthcare professionals and theindustry to improve the way computer systems inhealthcare share information. IHE promotes thecoordinated use of established standards to addressspecific clinical need in support of optimal patientcare.
Master Patient IndexHealthcare organizations or groups of them willimplement a master patient index (MPI) to identify,match, merge, de-duplicate, and cleanse patientrecords to create a master index that may be usedto obtain a complete and single view of a patient.The MPI will create a unique identifier for eachpatient and maintain a mapping to the identifiersused in each records’ respective system.
Meaningful UseThe American Recovery and Reinvestment Act of2009 specifies three main components of MU:2)The use of a certified EHR in a meaningfulmanner, such as e-prescribing;3)The use of certified EHR technology for electronicexchange of health information to improve quality ofhealthcare;4)The use of certified EHR technology to submitclinical quality and other measures. Continues on next slide
Meaningful UseSimply put, “meaningful use” means providers needto show that they are using certified EHR technologyin ways that can be measured. The criteria for MUwill be staged in three steps over the course of thenext five years: Stage 1 (2011 and 2012) sets thebaseline for electronic data capture and informationsharing; Stage 2 (expected to be implemented in2014) and Stage 3 will continue to expand on thisbaseline and be developed through futurerulemaking.
National eHealth CollaborativeNational eHealth Collaborative (NeHC) is a public-private partnership focused on acceleratingprogress toward widespread, secure andinteroperable nationwide health informationexchange to improve health and healthcare. NeHC’sneutrality and diverse multi-stakeholder participationprovides a unique platform for collaboration. NeHCeducates, connects, and encourages healthcarestakeholders to advance health informationtechnology and health information exchange Continues on next slide
National eHealth Collaborativenationwide through its NeHC University web-basededucation program, its Consumer Consortium oneHealth, its support of theNationwide HealthInformation Network Exchange, its collaborativeonline community and its ongoing study of leadinghealth information exchanges. National eHealthCollaborative is a cooperative agreement partner ofthe Office of the National Coordinator for Health ITwithin the U.S. Department of Health and HumanServices.
Nationwide Health InformationNetworkThe nationwide health information network is theportfolio of nationally recognized services,standards and policies that enable secure healthinformation exchange over the Internet. Often alsoused as an umbrella term to describe the result ofstandards harmonization and pilot testing activitiesled by the ONC Office of Standards andInteroperability.
Nationwide Health InformationNetwork ExchangeThe Nationwide Health Information NetworkExchange (“Exchange”) is a group of federalagencies and non-federal organizations that cametogether under a common mission and purpose toimprove patient care, streamline disability benefitclaims, and improve public health reporting throughsecure, trusted, and interoperable health informationexchange.
Office of the National Coordinatorfor Health Information TechnologyThe Office of the National Coordinator for HealthInformation Technology (ONC) is the principalFederal entity charged with coordination ofnationwide efforts to implement and use the mostadvanced health information technology and theelectronic exchange of health information. Theposition of National Coordinator was created in2004, through an Executive Order, and legislativelymandated in the HITECH Act of 2009.
Patient-Centered Medical HomeA patient centered medical home integrates patientsas active participants in their own health andwellbeing. Patients are cared for by a physician wholeads the medical team that coordinates all aspectsof preventive, acute and chronic needs of patientsusing the best available evidence and appropriatetechnology. These relationships offer patientscomfort, convenience, and optimal healththroughout their lifetimes.
Patient ConsentThere are five generally accepted models fordefining patient consent to participate in an HIE. Thenon-consent model does not require any agreementon the part of the patient to participate in an HIE.The opt-out model allows for a predetermined set ofdata to be automatically included in an HIE but apatient may still deny access to information in theexchange. Continues on next slide
Patient ConsentThe opt-out with exceptions exchange enables thepatient to selectively exclude data from an HIE, limitinformation to specific providers, or limit exchangeof information to exchange only for specificpurposes. The opt-in model requires patients tospecifically affirm their desire to have their datamade available for exchange within an HIE. The opt-in with restrictions model allows patients to make allor some defined amount of their data available forelectronic exchange.
Patient Protection & AffordableCare ActThe federal Patient Protection and Affordable CareAct (P.L. 111-148), signed March 23, 2010, asamended by the Health Care and EducationReconciliation Act, signed March 31, 2010, is alsoreferred to as the Affordable Care Act (ACA), orsimply as “federal health reform.” The 900+ pageact contains many provisions, with various effectivedates. Continues on next slide
Patient Protection & AffordableCare ActProvisions included in the ACA are intended toexpand access to insurance, increase consumerprotections, emphasize prevention and wellness,improve quality and system performance, expandthe health workforce, and curb rising health carecosts.
Personal Health Record (PHR)An electronic record of health-related information onan individual that conforms to nationally recognizedinteroperability standards and that can be drawnfrom multiple sources while being managed, shared,and controlled by the individual.
Private HIEThe term “private” HIE generally refers to HIEswhich operate under the governance of anintegrated delivery network (IDN) or a singlehealthcare system. The term “enterprise HIE” isoften substituted in this context.
Provider DirectoryProvider directories are like an electronic “yellowpages” of healthcare providers. A provider directoryis a core requirement for accomplishing securedirected exchange to a previously unknown entity.
Public Key InfrastructureA PKI (public key infrastructure) enables users of abasically unsecure public network such as theInternet to securely and privately exchange dataand money through the use of a public and a privatecryptographic key pair that is obtained and sharedthrough a trusted authority. The public keyinfrastructure provides for a digital certificate thatcan identify an individual or an organization anddirectory services that can store and, whennecessary, revoke the certificates.
Publish/SubscribeOften abbreviated to pub/sub, publish/subscribe is amessaging pattern where senders of messages,called publishers, do not program the messages to besent directly to specific receivers, called subscribers.Published messages are characterized into classes,without knowledge of what, if any, subscribers theremay be. Subscribers express interest in one or moreclasses, and only receive messages that are ofinterest, without knowledge of what, if any, publishersthere are. Pub/sub is often used to submit publichealth information.
Push and SendPush and send refers to one-directional electronicmessaging such as those for which The DirectProject has developed standards and specificationsfor secure transport. In push messaging, as in email,the receiver of the message must be a known entity.
Query/RetrieveOften used in the context of the Nationwide HealthInformation Network Exchange, query/retrieve refersto a messaging pattern in which a query is initiatedfrom one participating health informationorganization to another, requesting a list of availabledocuments meeting the given query parameters fora particular patient for later retrieval.
Record Locator ServiceIn an HIE, a record locator service is the part of thesystem that determines what records exist for amember and where the source data is located. Therecord locator service includes these distinctfunctions: manage participating provider identities;maintain and publish a patient index; match patientsusing an algorithm; look up patient record locations(but not the records themselves); communicatesecurely and maintain an audit log; and managepatient consent to record sharing (under state lawsand ARRA).
Regional Health InformationOrganization (RHIO)A health information organization that bringstogether health care stakeholders within a definedgeographic area and governs health informationexchange among them for the purpose of improvinghealth and care in that community.
Registration AuthorityA registration authority (RA) is an authority in anetwork that verifies user requests for a digitalcertificate and tells the certificate authority (CA) toissue it. RAs are part of a public key infrastructure(PKI), a networked system that enables companiesand users to exchange information and moneysafely and securely. The digital certificate contains apublic key that is used to encrypt and decryptmessages and digital signatures.
RulemakingRulemaking refers to the process that executive andindependent agencies use to create, or promulgate,regulations. In general, legislatures first set broadpolicy mandates by passing statutes, then agenciescreate more detailed regulations throughrulemaking. Legislatures typically rely on rulemakingto add more detailed scientific, economic, orindustry expertise to a policy—fleshing out thebroader mandates of authorizing legislation.
SpecificationsA specification (often abbreviated as spec) is anexplicit set of requirements to be satisfied by amaterial, product, or service. Specs are a type oftechnical standard. A technical specification may bedeveloped by any of various kinds of organizations,both public and private. Example organization typesinclude a corporation, a consortium, a tradeassociation, a national government (including itsregulatory agencies and national laboratories andinstitutes), a professional association, or a purpose-made standards organization such as ISO.
StandardsThe term “standard,” or “technical standard” ascited in the National Technology Transfer andAdvancement Act (NTTAA), includes all of thefollowing: common and repeated use of rules,conditions, guidelines or characteristics for productsor related processes and production methods, andrelated management systems practices; and thedefinition of terms; classification of components;delineation of procedures; specification of Continues on next slide
Standardsdimensions, materials, performance, designs, oroperations; measurement of quality and quantity indescribing materials, processes, products, systems,services, or practices; test methods and samplingprocedures; or descriptions of fit and measurementsof size or strength.
Standards & InteroperabilityFrameworkThe Standards and Interoperability (S&I) Frameworkis a set of integrated functions, processes, and toolsbeing guided by the healthcare and technologyindustry to achieve harmonized interoperability forhealthcare information exchange.
State Designated EntitiesOrganizations appointed by each state that receivedARRA/HITECH funding through the HIECooperative Agreement Program to establish orexpand statewide exchange.
State HIEThe state HIE provides alignment of architecture,technology and policy throughout an individualstate. Currently there are fifty-six states andterritories planning and coordinating state levelexchanges through a State Designated Entity. Thestate HIE typically manages funding provided by theOffice of the National Coordinator (ONC) andassists specific HIEs within the state.
The Direct ProjectThe Direct Project specifies a simple, secure,scalable, standards-based way for participants tosend authenticated, encrypted health informationdirectly to known, trusted recipients over theInternet.
Virtual Lifetime ElectronicRecords (VLER)The VLER initiative launched following PresidentObama’s April 9, 2009 direction to the Departmentof Defense (DoD) and the Department of VeteransAffairs (VA) to create a unified lifetime electronichealth record for members of the U.S. ArmedServices. VLER will contain both administrative(i.e. personnel and benefits) and medicalinformation for Service members and Veterans. Continues on next slide
Virtual Lifetime ElectronicRecords (VLER)VLER will provide access to information from dayone of a Service member’s military career throughtransition to Veteran status and beyond.
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