Sunday, June 24, 2007

THE GLOSSARY

My apologies for the delay in getting this posted. It is a rather long one, but contains a lof of information for "newbies" I suggest you copy and paste it into a word document.....then if you have google desktop you can search for "glossary".


GLOSSARY


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.
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.
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.

Chief Complaint Mapper: A software product that maps chief complaints, captured as text, and transforms them into useful digital data that can be used in functions such as public health outbreak surveillance.
Clinical Classification:
A method of grouping clinical concepts in order to represent classes that support the generation of indicators of health status and health statistics.
Clinical Data Repository: The data warehouse that contains clinical data (HL7 messages) centrally.
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. http://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. http://www.hl7.org/ehr/downloads/index.asp)
Clinical Messaging #2:
Secure Patient/Physician e-mail (Provider and Patient or Family Communication): Trigger or respond to electronic communication (inbound and outbound) between providers and patients or patient representatives with pertinent actions in the care process. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004.
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.
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. Reference: United States Department of Health and Human Services. Office of the National Coordinator for Health Information Technology (ONC) Glossary: http://www.hhs.gov/healthit/glossary.html.
Confidentiality:
A 3rd party's obligation to protect the personal information with which it has been entrusted.
Controlled Clinical Vocabulary: A system of standardizing the terms used in describing client-centered health and health service-related concepts.
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.
Data Center:
The physical space and hardware used by the HIE to house its operations if these assets are kept within the HIE.
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.
DICOM (Digital Imaging Communications in Medicine): A standard which 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.
Digital Signature:
A string of binary digits which is computed using an encryption algorithm. Digital signatures enable signatory authentication, confirmation of data integrity, and non-repudiation of messages.
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 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. Reference: eHealth Initiative Foundation. "Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations." Washington: eHealth Initiative, 2005.
Electronic Billing Support:
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. Reference: eHealth Initiative Foundation. "Second Annual Survey of State, Regional and Community-based HIE Initiatives and Organizations." Washington: eHealth Initiative Foundation, 2005.
Electronic Health Record: Electronically maintained information about an individual's lifetime health status and health care.
Electronic Imaging Results Delivery:
The ability to accept messages from radiology sources and integrate the data for presentation to a clinician. 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 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. http://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. Reference:
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: 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. http://www.hl7.org/ehr/downloads/index.asp
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. They are:
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 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 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.
ICD-10 (International Statistical Classification of Diseases and Related Health Problems, 10th Revision): The 1992 revision of the international disease classification system developed by the World Health Organization.
ICD-10-CM (International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification): The American modification of the ICD-10 classification system, for field review release in 1998.
ICD-10-PCS (International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Procedural Classification System): A classification system for reporting clinical procedures, to accompany ICD-10-CM, developed in the US, for 1998 field review release.
ICD-9 (International Classification of Disease, 9th Revision): The 1972 revision of the international disease classification system developed by the World Health Organization.
ICD-9-CM (International Classification of Disease, 9th Revision, Clinical Modification): The American modification of the ICD-9 classification system for both diagnoses and procedures.
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.
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 (i.e. NexGen, AllScripts).
Interface to Claims System: The interface between an HIE and the systems that are sources for or routing pathways for claims data that are resident within health plans and claims clearinghouses.

Interface to EKG System: The interface between an HIE and the systems that are sources for EKG results that are resident within dispensing physician offices and hospitals.
Interface to Eligibility System: The interface between an HIE and the source data of which people have eligibility for which type of benefits that are resident within health plans and are not infrequently web-enabled.

Interface to Formulary System: The interface between an HIE and the systems that are sources for formulary status of specific drugs for specific health benefit designs and that are resident within pharmacy benefit management companies and hospitals.

Interface to Laboratory System: The interface between an HIE and systems that are sources of laboratory data.

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.

Interface to Practice Management System: The interface between an HIE and the systems that are sources for the financial management systems of physician practices.
Interface to Provider List System: The interface between an HIE and the systems that track the multiple providers and their identifying data that are resident within health plans, dispensing pharmacies, pharmacy benefit management companies laboratories, physician practices, and hospitals.

Interface to Provider Office EHR System: The interface between an HIE and EHRs that are maintained in practice-specific systems (e.g. EPIC).

Interface to Radiology System: The interface between an HIE and systems that are sources for radiological data.

Interface to Transcribed Reports System: The interface between an HIE and the systems that are sources for transcribed reports. Typically these systems are based at a transcription service or at a hospital and contain admission and discharge notes and consultations, operative reports, and pathology and radiology results.
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.

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 which are published as International Standards.
Key Certificate: A data record that authenticates the owner of a public key for an asymmetric algorithm. It is issued by a certification authority and is protected by a digital signature allowing the certificate to be verified widely. The certificate may also contain other fields beside the value to the key and the name of the owner, for example an expiration date.
Keys: A sequence of symbols that controls the operations of encryption and decryption.
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.

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. http://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.

Messaging to Providers: The process of communicating electronically with providers. This typically includes the cost of communication lines and processes between the HIE and provider terminals.

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.
Order Entry: The process of communicating health care provider orders through electronic, computerized processes.

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.

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. http://www.hl7.org/ehr/downloads/index.asp

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.

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.
Patient Matching: The process of cross-linking the multiple patient identifiers in a community from a variety of patient identifier sources and creating a master patient identifier with a key for cross-referencing the various community identifiers. This is also referred to as a record locator service.

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. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. http://www.hl7.org/ehr/downloads/index.asp

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. Reference: United States Department of Health and Human Services. Office of the National Coordinator for Health Information Technology (ONC) Glossary: http://www.hhs.gov/healthit/glossary.html. 2005

Public Key Infrastructure (PKI): A conceptual framework that enables the encryption, decryption and electronic "signing" of data transmissions in a secure fashion within an open network environment.

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.

Private Key: In asymmetric cryptography, the key which is held only by the user for signing and decrypting messages.

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. http://www.hl7.org/ehr/downloads/index.asp
Public Health Processor: A software product that processes extracted data from health care provider systems for the purpose of tracking, trending, and reporting for public health reasons.

Public Key Certificate: A data record that authenticates the owner of a public key for an asymmetrical key system. It is issued by a CA and is protected by a digital signature, allowing the certificate to be verified widely.

Public Key: In asymmetric cryptography, the key which is published by the user to encrypt messages and so that others may verify his/her signature.
Recommend Treatment and Monitoring: The basis of cost, local formularies or therapeutic guidelines and protocols. Reference: Health Level Seven, Inc. "HL7 EHR-S Functional Model and Standard." July 2004. http://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 (Alerts to Providers): 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 that may affect how a patient is treated, with the intention of speeding the clinical decision process while reducing medical errors. Reference: eHealth Initiative Foundation. "Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations." Washington: eHealth Initiative Foundation, 2005.

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.

Risk: The chance of a vulnerability being exploited.

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.

Service Level Agreement-Compliance: A documented track record of how well the vendor is meeting it’s customer support commitments.

Service Level Agreement-Customer Responsibilities and Duties: The steps that the customer needs to take in order to ensure that the vendor has all the information they need to resolve an issue.

Service Level Agreement-Hours of Support: Methods that will be used for communicating and resolving issues. Typical methods are email, phone, and online chat. Ask whether remote diagnostics and/or on site visits by support analysts are available.

Service Level Agreement-Methods of Support: Will be used for communicating and resolving issues. Typical methods are email, phone, and online chat. Remote diagnostics can be available and, in some instances, it might be necessary to have a support analyst come on site.
Service Level Agreement-Problem Escalation & Triage: The mechanism that defines 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.

Service Level Agreement-Response Times: Different functions of the system might warrant different response times based on severity level. There should be a schedule of response times for different types of problems, and the service level agreement should define this accountability.

Service Level Agreement-Severity/Priority Classification: 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.
SNOMED International: A nomenclature for use by all health services professionals developed in the US and updated at least semi-annually.

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
Reference: eHealth Initiative Foundation. "Second Annual Survey of State, Regional and Community-based Health Information Exchange Initiatives and Organizations." Washington: eHealth Initiative Foundation, 2005.


Standard:

Documented agreements containing technical specifications or other precise criteria to be used consistently as rules, guidelines, or definitions of characteristics to ensure that materials, products, processes, and services are fit for their purpose. A standard* specifies a well defined approach that supports a business process and:
Has been agreed upon by a group of experts
Has been publicly vetted
Provides rules, guidelines, or characteristics
Helps to ensure that materials, products, processes and services are fit for their intended purpose
Available in an accessible format
Subject to ongoing review and revision process
*This differs from the healthcare industry's traditional definition of "standard of care."

Statistical Deviation Detector:

Identifies variances from patient-specific and standard care plans, guidelines, and protocols.
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 which are published as International Standards.

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.
Third Party-General System: Applications that are essential to the basic infrastructure of the system. They are the building blocks such as the technical platform the EHR system is built on such as, Windows, Linux, or MacIntosh, etc. Also what kind of database structure controls the system – 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, will there be additional costs when the vendor upgrades their software and it is 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.
UMLS (Unified Medical Language System):

A long-term research project developed by the US National Library of Medicine to assist health professionals and researchers to retrieve and integrate clinical vocabularies from a wide variety of information sources. The goal is to link information from scientific literature, patient records, factual databases, knowledge-based expert systems, and directories of institutions and individuals in health and health services.
Vendor Software Licenses: License cost of various modules. Typically, modules will be licensed on a concurrent or named user basis. For example, with a concurrent license, if there are 4 providers and 8 employees, a minimum of 12 concurrent licenses would be needed. However, if the providers were halftime [meaning, they only used the system half time] (and all 4 never used the system at any one time, only 10 licenses would be needed). If using a named user license under the same circumstances, 12 licenses would always be needed – as licenses are not shared among different people. There can be a provision though for “active” and “inactive” providers (which means they could look at information, but not enter it in the system). Under an ASP (monthly rental agreement), software licenses are not being purchased, but rented However, the same issues exist for determining number of ASP licenses as with a license purchase.
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).
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.
The website development and some of the content in the Toolkit have been made possible by grant number 1D1BTM00095-01 and 02, through the Health Resources and Services Administration HRSA Office of the Advancement of Telehealth (HRSA/OAT). The contents are solely the responsibility of the authors and do not necessarily represent the official view of HRSA/OAT.
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