Activity Diagram A UML Diagram that shows a workflow process, particularly focused on communication and the actors involved in that communication. Introduced as part of the HDF as part of the requirements analysis for HL7 standrads.
ADT – Admissions, Discharge & Transfer
ANSI American National Standards Institute. Founded in 1918, ANSI itself does not develop standards. ANSI’s roles include serving as the coordinator for U.S. voluntary standards efforts, acting as the approval body to recognize documents developed by other national organizations as American National Standards, acting as the U.S. representative in international and regional standards efforts, and serving as a clearinghouse for national and international standards development information.
Attribute Type The last part of an attribute name (suffix). Attribute type suffixes are rough classifiers for the meaning of the attribute. See also Data Type for contrast.
Authenticated Document A status in which a document or entry has been signed manually or electronically by one or more individuals who attest to its accuracy. No explicit determination is made that the assigned individual has performed the authentication. While the standard allows multiple instances of authentication, it would be typical to have a single instance of authentication, usually by the assigned individual.
Auxiliary Application An auxiliary application neither exerts control over, nor requests changes to a schedule. It is only concerned with gathering information about a particular schedule. It can be considered an “interested third- party,” in that it is interested in any changes to a particular schedule, but has no interest in changing it or controlling it in any way. It may gather information passively or actively. An auxiliary application passively collects information by receiving unsolicited updates from a filler application.
Arden Syntax an approach to specifying medical knowledge and clinical decision support rules in a form that is independent of any EHR and thus sharable across hospitals
ARRA (American Recovery and Reconstruction Act) the Obama administration’s 2009 economic stimulus bill
Blue Button an ASCII text based standard for heath information sharing first introduced by the Veteran’s Administration to facilitate access to records stored in VistA by their patients. The newer Blue Button + format provides both human and machine readable formats.
Bio-sensing wearables
A biosensor is an analytical device which converts a biological response into an electrical signal and wearables are on or in body accessories that enhance user experience. Biosensing wearables can monitor changes in physiology and the external environment. They are easy to use and provide useful, real-time information by allowing continuous physiological monitoring in a wide range of wearable forms.
CCD (Continuity of Care Document) an XML-based patient summary based on the CDA architecture
CCOW (Clinical Context Object Workshop) an HL7 standard for synchronizing and coordinating applications to automatically follow the patient, user (and other) contexts to allow the clinical user’s experience to resemble interacting with a single system, when they are using multiple, independent applications from many different systems
CCR (Continuity of Care Record) an XML-based patient summary format that preceded CDA
CCDA (Consolidated Clinical Document Architecture) the second revision of HL7’s CDA architecture that attempts to introduce more standard templates to facilitate information sharing (a mandate of Meaningful Use 2)
CDA (Clinical Document Architecture) an XML-based markup standard intended to specify the encoding, structure and semantics of clinical documents
CDC (Centers for Disease Control and Prevention) the federal agency focused on disease in the community.
CA (Certificate Authority) an entity that digitally signs certificate requests and issues X.509 digital certificates that link a public key to attributes of its owner
CIMI (Clinical Information Modeling Initiative) an independent collaboration of major health providers improve the interoperability of healthcare information systems through shared and implementable clinical information models
CMS (Centers for Medicare & Medicaid Services) the component of the Department of Health and Human Services that administers the Medicare and Medicaid programs
CommonWell Alliance a group of major health IT companies that is working to achieve interoperability among their respective software products and services
Complete EHR an EHR software product that, by itself, is capable of meeting the requirements of certification and Meaningful Use
CONNECT ONC supported open source software for managing the centralized model of health information exchange
CPT (Current Procedural Terminology) the American Medical Association’s standard for coding medical procedures
De-identified Patient Health Information PHI from which all data elements that could allow the data to be traced back to the patient have been removed
DIRECT a set of ONC supported standards for secure exchange of health information using email
DNS (Domain Name System) the naming system for computers, services, or any resource connected to the Internet (or a private network). Among other things, it translates domain names (e.g. eBay.com) to the numerical IP addresses needed to locate Internet connected resources.
eHealth
The transfer of health resources and healthcare by electronic means, encompassing three main areas:
• the delivery of health information, for health professionals and health consumers, through the Internet and telecommunications
• using the power of IT and e-commerce to improve public health services, e.g. through the education and training of health workers
• the use of e-commerce and e-business practices in health systems management
Electronic health records (EHR)
A set of records that clinicians control to co-ordinate their team work within and between healthcare teams.
Electronic patient health records (EPR)
A set of records that the patient controls and which allows the patient to work with their clinical team across institutional boundaries.
EDI/X12 a format for electronic messaging that utilizes cryptic but compact notation primarily to support computer-to-computer commercial information exchange
eHealth Exchange a set of standards, services and policies that enable secure nationwide, Internet-based health information exchange using CONNECT or one of the commercial HIE products that support eHealth Exchange
EHR (Electronic Health Record) a stakeholder wide electronic record of a patient’s complete health situation
EHR Certification a set of technical requirements developed by ONC that, if met, quality an EHR to be used by an Eligible Professional to achieve Meaningful Use
Eligible Professionals (Medicaid) health providers who are eligible for Medicaid Meaningful Use payments: doctors of medicine, osteopathy, dental surgery, dental medicine, nurse practitioners, nurse certified nurse-midwifes, and physician assistants who working in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant
Eligible Professionals (Medicare) health providers who are eligible for Medicare Meaningful Use payments: doctors of medicine, osteopathy, dental surgery, dental medicine, podiatry, optometry and chiropractic
EMPI an enterprise master patient index
EMR (Electronic Medical Record) an electronic record used by a licensed professional care provider
GELLO a programming language intended for use as a standard query and expression language for clinical decision support. Now compatible with the HL7 version 3.0 Reference Information Model (RIM).
HDF (HL7 Development Framework) the framework used by HL7 to produce specifications for data, messaging process and other standards
Health System a network of providers that are affiliated for the more integrated delivery of care
Healtheway an ONC supported public-private partnership to promote nationwide health information exchange via the eHealth Exchange
HIE (Health Information Exchange) the sharing of digital health information by the various stakeholders involved, including the patient
HIMSS (Healthcare Information and Management Systems Society) describes itself as a “a global, cause-based, not-for-profit organization focused on better health through information technology (IT)”
HIPAA (Health Insurance Portability and Accountability Act of 1996) legislation intended to secure health insurance for employees changing jobs and simplify administration with electronic transactions. It also defines the rules concerning patient privacy and security for PHI
HISP (Health ISP) a component of Direct that provides a provider directory, secure email addresses and public-key infrastructure (PKI)
HIT (Health Information Technology) the set of tools needed to facilitate electronic documentation and management of healthcare delivery
HITSP (Healthcare Information Technology Standards Panel) a public/private partnership to promote interoperability through standards
HL7 (Health Level 7) a not-for-profit global organization to establish standards for interoperability
HMO (Health Maintenance Organization) an organization that provides managed healthcare on a prepaid basis. Employers with 25 or more employees must offer federally certified HMO options if they offer traditional healthcare options
hQuery an ONC funded, open source effort to develop a generalized set of distributed queries across diverse EHRs for purposes such as clinical research
HTTP (Hypertext Transfer Protocol) a query-response protocol used to transfer information between web browsers and connected servers. HTTPS is the secure version.
ICD (International Classification of Disease) the World Health Organization’s almost universally used standard codes for diagnoses. The current version is ICD-10 and it was adopted in the US on October 1, 2015 — well after most other advanced countries had moved to it.
IHTSDO (International Health Terminology Standard Development Organisation) the multinational organization that maintains SNOMED
IHIP Integrated Health Information Platform. An Integrated Health Information Platform (IHIP) is being setup by the Ministry of Health and Family Welfare (MoHFW). The primary objective of IHIP is to enable the creation of standards compliant Electronic Health Records (EHRs) of the citizens on a pan-India basis along with the integration and interoperability of the EHRs through a comprehensive Health Information Exchange (HIE) as part of this centralized accessible platform.
IP Address a 32 bit (the standard is changing to 128 bit to accommodate Internet growth) number assigned to each device in an Internet Protocol network and that indicates where it is in that network.
I2b2 (Informatics for Integrating Biology and the Bedside) a scalable query framework for exploration of clinical and genomic data for research to design targeted therapies for individual patients with diseases having genetic origins
Interoperability the ability of diverse information systems to seamlessly share data and coordinate on tasks involving multiple systems.
LDAP (Lightweight Directory Access Protocol) is a protocol for accessing (including searching) and maintaining distributed directory information services (such as an email directory) over an IP network.
LOINC (Logical Observation Identifiers Names and Codes) the Regenstrief Institute’s standard for laboratory and clinical observations
Meaningful Use a set of usage requirements defined in three stages by ONC under which eligible professionals are paid for adopting a certified EHR
MedDRA (Medical Dictionary for Regulatory Activities) the International Conference on Harmonisation’s classification of adverse event information associated with the use of biopharmaceuticals and other medical products
Medicaid the joint federal/state program to provide healthcare services to poor and some disabled US citizens
Medicare the federally operated program to provide healthcare services to US citizens over the age of 65
MIME (Multipurpose Internet Mail Extensions) the Internet standard for the format of email attachments used in Direct. S/MIME is the secure version.
MLM (Medical Logic Module) the basic unit in the Arden Syntax that contains sufficient medical knowledge and rules to make one clinical decision.
Modular EHR a software component that delivers at least one of the key services required of a Certified EHR
Moodle (Modular Object-Oriented Dynamic Learning Environment) is one of the most popular open source Course Management Systems (CMS). It is written in PHP programming language and distributed under the GNU General Public License. Moodle was created by Martin Dougiama to help educators to create online courses with a focus on interaction and collaborative construction of content, and it is in continual evolution.
Mobile health (mHealth)
Medical and public health practice supported by mobile devices (mobile phones, smart phones and tablets), patient monitoring devices, personal digital assistants (PDAs), and other wireless devices. Utilising a mobile phone’s core voice and short messaging service (SMS) and more complex functionalities and applications including general packet radio service (GPRS), third and fourth generation mobile telecommunications (3G and 4G systems), global positioning system (GPS), and Bluetooth technology.
Mobile applications (apps)
A software application that can run on a mobile platform (i.e. a handheld commercial off-theshelf computing platform, with or without wireless connectivity) or a web-based software application that is tailored to a mobile platform but is executed on a server.
MPI (Master Patient Index) software to provide correct matching of patients across multiple software systems, typically within a health enterprise
MUMPS (Massachusetts General Utility Multi-Programming System) an integrated programming language and file management system designed in the late 1960’s for medical data processing that is the basis for some of the most widely installed enterprise health information systems
NDC (National Drug Codes) the Food and Drug Administration’s numbering system for all medications commercially available in the US
ONC (Office of the National Coordinator for Health Information Technology) the agency created in 2004 within the Department of Health and Human Services to promote the deployment of HIT in the US
Online patient communities
Online discussion groups allowing patients to learn from peers and professionals including how to understand their own data. They provide access to relevant, timely information and support others with similar conditions.
Outcomes-based Contract an approach to pay for healthcare that rewards physician performance against certain defined quality metrics when combined with a lower than predicted cost of care
Participatory medicine
Patients and clinicians work together to improve the patient’s health – in which patients have equal access to all data, are case managers of their own illness and co-producers of their own health. Primary care professionals become gateways not gatekeepers.
Patient portal
A website that gives patients access to the data and information in their electronic health record. Can also be used to book appointments and order repeat prescriptions.
Personal health records (PHRs)
P4P (Pay for Performance) an approach to pay for healthcare that rewards physician performance against certain defined quality metrics
PCMH (Patient-Centered Medical Home) a team based healthcare delivery model often particularly focused on the management of chronic disease
PCP (Primary Care Physician) the generalist in a patient’s care team who assumes overall responsibility for all their health issues and often the gatekeeper who must generate referrals to specialists
PHI (Protected Health Information) any health or health related information that can be related back to a specific patient. PHI is subject to HIPAA regulations.
PKI (Public Key Infrastructure) a widely used system for protection of documents, messages and other data that rests on a pair of public and private keys to allow for a variety of use cases
Private Key the protected (known only to its owner) part of the special pair of numbers used to encrypt documents using PKI
Provider health professionals including physicians, nurse practitioners, physicians’ assistants that are engaged in direct patient care
Public Key the public part of the special pair of numbers used to encrypt documents using PKI
RA (Registration Authority) an entity that collects information for the purpose of verifying the identity of an individual or organization and produces a certificate request
Synthetic Health Data facsimile clinical data created by a software system to realistically resemble actual patient data
Templates (CDA) the reusable basic XML-based building blocks of a CDA document that can represent the entire document, its sections or the data entries within a section
Read Codes a hierarchical clinical terminology system used in General Practice in the United Kingdom
Resource Description Framework (RDF) a method for describing or modeling of information on the web using subject-predicate-object expressions (triples) in the form of subject-predicate-object expressions that could be used to represent health ontologies (SNOMED, ICD-1)
RIM (Reference Information Model) a pictorial representation of the HL7 clinical data (domains) that illustrates the life cycle of an HL7 message or groups of related messages
Semantic web the proposed next generation of web in which technologies like RDF would create a “web of data” in which browsers (and other tools) could “understand” the content of web pages
SMTP (Simplified Mail Transport Protocol) the Internet standard for email used by Direct. The secure version is S/SMTP
SNOMED (Standard Nomenclature of Medicine) a comprehensive, hierarchical healthcare terminology system.
SNOMED CT (Standard Nomenclature of Medicine) SNOMED subset for the electronic health record. SNOMED CT: Is the most comprehensive, multilingual clinical healthcare terminology in the world. Is a resource with comprehensive, scientifically validated clinical content. Enables consistent, processable representation of clinical content in electronic health records. Is mapped to other international standards. Is already used in more than fifty countries
When implemented in software applications, SNOMED CT can be used to represent clinically relevant information consistently, reliably and comprehensively as an integral part of producing electronic health information.
Technology enabled Care (TEC)
The use of technology to enhance the quality and cost-effectiveness of care and support and improve outcomes for individuals through the application of technology (including, but not limited to, the use of telecare, telehealth, and mobile health and wellbeing) as an integral part of the care and support process.
Telecare
The continuous, automatic and remote monitoring of activity/lifestyle changes over time, providing real time alerts or calls for help in emergencies and helping to manage the risks associated with independent living, enabling people to live independently for longer, particularly those who require a combination of health and social care.
Telehealth and Telehealth
Telehealth involves the consistent and accurate remote monitoring and management of a health condition including vital signs monitoring. It involves the exchange of information between patient and HCPs to identify trends or changes in the patient’s condition, helping to avoid hospital admissions, support early discharge and improve self-care. Telehealth helps educate, train and support people to self-care.
Telemedicine
Telemedicine uses telecommunication and electronic information technologies to provide clinical healthcare at a distance, improving access to medical services and specialists. It permits communications between patient and medical staff as well the transmission of medical, imaging and health informatics data from one site to another. New forms of telemedicine include videotelephony, advanced diagnostics and telemedical devices to support home care.
ToC (Transition of Care Initiative) the effort to develop a standard electronic clinical summary for transitions of care from one venue to another
TPO HIPAA exception for providers, insurance companies and other health-care entities to exchange information necessary for Treatment, Payment or Operations of healthcare businesses
VDT (View, Download, Transmit) a requirement of Meaningful Use Stage 2 that patients view, download or transmit their health information
VistA (Veterans Health Information Systems and Technology Architecture) the Veteran’s Administration’s system wide, MUMPS based health information infrastructure
X.509 digital certificate the technical name for an electronic document issued by a CA that uses a digital signature to bind a public key with an identity based on information from an RA
XDR (External Data Representation) an operating system and transport method agnostic mechanism for exchanging data that is encoded/decoded into/from the XDR format.
XDM (IHE Cross Enterprise Document Media Interchange) a standard mechanism for including both documents and meta-data in zip format using agreed upon conventions for directory structure and location of files.
XDS (Cross-Enterprise Document Sharing) the use of federated document repositories and a document registry to create a longitudinal record of information about a patient
XML (Xtensible Markup Language) a widely used standard for machine and human readable electronic documents and the language used to define CDA templates
XMPI a cross organizational master patient index capable of dealing with many unaffiliated hospitals and health systems
LMIS – laboratory information management system
RIS – Radiology Information System
PACS – Picture Archival and Communications System
DICOM – Digital Imaging and Communications in Medicine
References
[1]: Glossary of Terms on HL7:
https://www.hl7.org/documentcenter/public/calendarofevents/FirstTime/Glossary%20of%20terms.pdf
[2]: HEALTH INFORMATICS ON FHIR: https://www.coursera.org/learn/fhir
[3]: pwc AI: https://www.pwc.com/ai
[4]: Connected health: How digital technology is transforming health and social care:
https://www2.deloitte.com/content/dam/Deloitte/uk/Documents/life-sciences-health-care/deloitte-uk-connected-health.pdf
