The Argonaut Project addresses the recommendations of the JASON Task Force, a joint task force of the ONC‘s HIT Standards and Policy Committees and is a joint project between HL7 International and several vendor and provider organizations. The purpose of the Argonaut Project is to develop a first-generation API and Core Data Services specification to enable expanded information sharing for electronic health records, documents, and other health information based on the FHIR specification.
The Blue Button initiative was first introduced by the VA, and subsequently began being promoted by many healthcare vendors. VA’s Blue Button allows a patient to access and download their information from a personal health record (PHR) into a very simple text file or PDF that can be read, printed, or saved on any computer. This enables patients to share this data with their health care providers, caregivers, or other people they trust.
The downloaded format is not in an industry standard format, such as CCD or CCR, which makes it less interoperable from an EHR-to-EHR sharing standpoint. The downloaded file is more targeted for human viewing and sharing.
Continuity of Care Document (CCD) The HL7 CCD is the result of a collaborative effort between the Health Level Seven and American Society for Testing Materials (ASTM) to “harmonize” the data format between ASTM’s Continuity of Care Record (CCR) and HL7’s Clinical Document Architecture (CDA) specifications. Read HL7 and Continuity of Care Document white paper.
Synonyms: Continuity of Care Document
Continuity of Care Record (CCR) is an XML-based standard for the movement of “documents” between clinical applications. Furthermore, it responds to the need to organize and make transportable a set of basic information about a patient’s health care that is accessible to clinicians and patients. Read Understanding the Continuity of Care Record white paper.
Synonyms: Continuity of Care Record
Clinical Document Architecture (CDA) HL7 CDA uses XML for encoding of the documents and breaks down the document in generic, unnamed, and non-templated sections. Documents can include discharge summaries, progress notes, history and physical reports, prior lab results, etc. HL7’s CDA defines a very generic structure for delivering “any document” between systems. CDA was previously known as the Patient Record Architecture (PRA).
Synonyms: Clinical Document Architecture
Clinical Document Repository (CDR) enables hospitals to build a life-long health record environment using stored health records for the purpose of better treatment, clinical research and health statistics for policy making.
Synonyms: Clinical Document Repository
Certified Health IT Product List (CHPL) – The Office of the National Coordinator has organized a Certified Health IT Product List for Ambulatory and Inpatient facilities looking to purchase a complete EHR or EHR module certified for the Meaningful Use incentive program. Each complete EHR and EHR module listed has been certified by an ONC-ATCB and reported to the ONC for use in the list. You can find a list of the reported certified complete EHR and EHR modules at http://onc-chpl.force.com/ehrcert.
Synonyms: Certified Health IT Product List
Conformance checking or gap analysis for HL7 messages is a logical process used to determine whether a message from one particular medical device or application is compatible to the selected HL7 standard messaging format, or a custom format adopted by another device or application. Read Conformance Checking for HL7 white paper for more details.
An HL7 Fast Healthcare Interoperability Resources (FHIR®) Connectathon is a two-day event of hands-on FHIR development and testing held in conjunction with Working Group Meetings. The event provides a great opportunity for implementers and developers to gain experience developing FHIR-based solutions and exchange data with other FHIR interfaces.
The Connectathon is not a formal tutorial and there are no lectures or presentations. Participants engage in hands-on, heads down development and testing, working directly with other FHIR developers and senior members of the FHIR standards development team. This is a chance to get your hands dirty and learn by helping evolve the FHIR specification.
Connectathon participants can select one of several tracks, and will be asked to confirm which track prior to the event (based on level of readiness and area of interest).
The Direct Project was launched by the ONC within Health and Human Services (HHS) on March 1, 2010. It was initially called NHIN Direct. The object of the Direct Project is to replace the use of faxes, phones, and paper transactions with a simple and secure point-to-point communication over the Internet.
The Direct Project achieves this in one of two ways:
Applicability Statement for Secure Health Transport: This is the primary Direct Project specification which uses the SMTP e-mail protocol with secure S/MIME attachments and x509 certificates.
These protocols ensure the secure delivery of messages between two trusted endpoints for a variety of purposes including transfer of patient health information in the form or a CCD document.
See also: Meaningful Use
Digital Imaging and Communications in Medicine (DICOM) is a common format for image storage. It allows for handling, storing, printing, and transmitting information in medical imaging. Visit DICOM website.
Synonyms: Digital Imaging and Communications in Medicine
Electronic Data Interchange (EDI) is a standard format for exchanging business data. The standard is ANSI X12, developed by the Data Interchange Standards Association. An EDI message contains a string of data elements; each represents a singular fact, such as a price, product model number, and is separated by delimiter. The entire string is called a data segment. One or more data segments framed by a header and trailer form a transaction set, which is the EDI unit of transmission (equivalent to a message). A transaction set often consists of what would usually be contained in a typical business document or form. The parties who exchange EDI transmissions are referred to as trading partners.
Synonyms: Electronic Data Interchange
Electronic Health Record (EHR), as defined in Defining Key Health Information Technology Terms (The National Alliance for Health Information Technology, April 28, 2008): An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization.
Synonyms: Electronic Health Recor
Electronic Medical Record (EMR), as defined in Defining Key Health Information Technology Terms (The National Alliance for Health Information Technology, April 28, 2008): An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization.
Synonyms: Electronic Medical Record
The Eligible Professionals (EP) HITECH Act recognizes three types of payers eligible for incentive payments under Meaningful Use. Those types are 1) Medicare Fee For Service (FFS), 2) Medicare Advantage (MA) and 3) Medicaid. The subsequent definition of an eligible professional differs according to Medicare and Medicaid.
Eligible hospitals can be acute care (excluding long term care facilities), critical access hospitals and children’s hospitals.
Eligible providers include non-hospital-based physicians who receive reimbursement through Medicare FFS program or a contractual relationship with a qualifying MA organization. Eligible providers are widely considered to be physicians whose practices are less than 90% inpatient and ER.
Visit Everything HITECH for detailed information on eligible professionals.
Synonyms: Eligible Professionals
An HL7 standard that is short for Fast Healthcare Interoperability Resources and pronounced “Fire”. The standard defines a set of “Resources” that represent granular clinical concepts. The resources provide flexibility for a range of healthcare interoperability problems, and they are based on simple XML with an HTTP-based RESTful protocol where each resource has a predictable URL.
See also: HL7 FHIR
Each resource contains an element "meta", of type "Meta", which is a set of metadata that provides technical and workflow context to the resource. The metadata items are all optional, though some or all of them may be required in particular implementations or contexts of use. See Metadata.
Firewall refers to a hardware- or software-based method for controlling incoming and outgoing network traffic, based upon a predetermined rule set, to ensure that only trusted content is passed.
Under the American Recovery and Reinvestment Act of 2009 (ARRA), The Health IT Policy Committee will make recommendations to the National Coordinator for Health Information Technology – ONC – on a policy framework for the development and adoption of a nationwide health information infrastructure, including standards for the exchange of patient medical information.
The Health IT Standards Committee will make recommendations to the National Coordinator for Health Information Technology (HIT) on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information. In developing, harmonizing, or recognizing standards and implementation specifications, the HIT Standards Committee will also provide for the testing of the same by the National Institute for Standards and Technology (NIST).
Health Information Exchange (HIE) focuses on the mobilization of healthcare information electronically across organizations within a region or community. HIE provides the capability to electronically move clinical information between disparate health care 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 safe, and efficient patient-centered care.
Synonyms: Health Information Exchange
The Health Insurance Portability and Accountability Act (HIPAA) was enacted by the U.S. Congress in 1996. Title II of HIPAA, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers. This is intended to help people keep their information private, though in practice, it is normal for providers and health insurance plans to require the waiver of HIPAA rights as a condition of service.
The Administration Simplification provisions also address the security and privacy of health data. The standards are meant to improve the efficiency and effectiveness of the nation’s health care system by encouraging the widespread use of electronic data interchange in the U.S. health care system.
Synonyms: Health Insurance Portability and Accountability Act
Protected health information (PHI) under HIPAA, is any information about an individual’s health status that identifies or relates to an individual’s past, present or future physical or mental health, the provision of health care to the individual, or the past, present or future payment for health care. Information is deemed to identify an individual if it includes either the individual’s name or any other information that could enable someone to determine the individual’s identity.
Address (all geographic subdivisions smaller than state, including street address, city, county, ZIP code)
All elements (except years) of dates related to an individual (including birth date, admission date, discharge date, date of death and exact age if over 89)
Social Security number
Medical record number
Health plan beneficiary number
Any vehicle or other device serial number
Device identifiers or serial numbers
Internet Protocol (IP) address numbers
Finger or voice prints
See also: HIPAA
Hospital Information System (HIS) is the main system in a hospital used by most caregivers. Sends ADT broadcasts to all ancillary applications. The HIS is typically the patient administrative system and order entry system for a hospital.
Synonyms: Hospital Information System
HISP, or Health Information Service Provider, is an email service provider that follows Direct Project standards and provides a mechanism to grant users a Direct email address. The HISP provides the framework to secure messages and define a circle of trust for secure communications.
As a part of the America Recovery and Reinvestment Act (ARRA) of 2009, Health Information Technology for Economic and Clinical Health (HITECH) refers to the portion of the ARRA that is used to increase the use of Electronic Health Records (EHR) by physicians and hospitals. This legislation provides immediate funding for health information technology infrastructure, training, dissemination of best practices, telemedicine, inclusion of health information technology in clinical education, and State grants to promote health information technology.
Synonyms: Health Information Technology for Economic and Clinical Health
HITRUST Common Security Framework
In an effort to normalize the security requirements of healthcare organizations, the HITRUST organization developed the CSF (Common Security Framework) which combines standards and regulations from 17 authoritative sources. The CSF is not a new standard, but rather a comprehensive tool that provides clarity and consistency among all the authoritative sources.
The CSF provides an online tool that can be used by a healthcare organization to help determine compliance of a system or the organization against the appropriate standards and regulations. The baseline assessment of the CSF provides a HIPAA scorecard and can scale for organizations large or small. The assessment can be a self-assessment, or one conducted by an authorized HITRUST assessor.
HL7 is a Standards Developing Organization accredited by the American National Standards Institute (ANSI) to author consensus-based standards representing a board view from healthcare system stakeholders. HL7 has compiled a collection of message formats and related clinical standards that define an ideal presentation of clinical information, and together the standards provide a framework in which data may be exchanged. Visit the HL7 organization website (www.hl7.org) or www.HealthStandards.com for more HL7 information.
FHIR stands for Fast Healthcare Interoperable Resource. This emerging standard combines the best features of HL7 V2, HL7 V3, and CDA, while leveraging the latest web service technologies. The design of FHIR is based on RESTful web services. With RESTful web services, the basic HTTP operations are incorporated including Create, Read, Update and Delete. FHIR is based on modular components called “resources,” and these resources can be combined together to solve clinical and administrative problems in a practical way. The resources can be extended and adapted to provide a more manageable solution to the healthcare demand for optionality and customization. Systems can easily read the extensions using the same framework as other resources.
See also: FHIR
ICD-9 is a classification used in the medical field that stands for International Classification of Diseases, 9th revision. This classification is predominately the standard classification of diseases, injuries, and cause of death for the purpose of health records. The World Health Organization (WHO) assigns, publishes, and uses the ICD to classify diseases and to track mortality rates based on death certificates and other vital health records. Medical conditions and diseases are translated into a single format with the use of ICD codes.
Synonyms: International Classification of Diseases, 9th revision
Institute of Electrical and Electronics Engineers (IEEE) is accredited by ANSI to submit its documents for approval as American National Standards. IEEE subcommittee P1073 develops standards for healthcare informatics: MEDIX (P1157) and MIB (P1073).
Synonyms: Institute of Electrical and Electronics Engineers
Synonyms: Integrating the Healthcare Enterprise
Interoperability refers to the ability of two or more systems or components to exchange information and to use the information that has been exchanged.
Logical Observation Identifiers Names and Codes (LOINC) applies universal code names and identifiers to medical terminology related to the EHR and assists in the electronic exchange and gathering of clinical results (such as laboratory tests, clinical observations, outcomes management and research). See What are LOINC Codes?
Synonyms: Logical Observation Identifiers Names and Codes
All artifacts in FHIR are assigned a "Maturity Level", known as FMM (after the well known CMM grades). The FMM level can be used by implementers to judge how advanced - and therefore stable - an artifact is. The following FMM levels are defined:
0. The resource or profile (artifact) has been published on the current build. This level is synonymous with Draft.
1. PLUS the artifact produces no warnings during the build process and the responsible WG has indicated that they consider the artifact substantially complete and ready for implementation
2. PLUS the artifact has been tested and successfully exchanged between at least three independently developed systems leveraging at least 80% of the core data elements using semi-realistic data and scenarios based on at least one of the declared scopes of the resource (e.g. at a connectathon). These interoperability results must have been reported to and accepted by the FMG
3. PLUS the artifact has been verified by the work group as meeting the Trial Use Quality Guidelines and has been subject to a round of formal balloting; has at least 10 implementer comments recorded in the tracker drawn from at least 3 organizations resulting in at least one substantive change
4. PLUS the artifact has been tested across its scope (see below), published in a formal publication (e.g. a FHIR Release), and implemented in multiple prototype projects. As well, the responsible work group agrees the resource is sufficiently stable to require implementer consultation for subsequent non-backward compatible changes.
5. PLUS the artifact has been published in two formal publication release cycles at FMM1+ (i.e. Trial Use level) and has been implemented in at least 5 independent production systems in more than one country
6. "Normative": the artifact is now considered stable
The National Council for Prescription Drug Programs (NCPDP) creates and promotes the transfer of data related to medications, supplies, and services within the healthcare system through the development of standards and industry guidance. Visit the NCPDP website at www.ncpdp.org.
Synonyms: National Council for Prescription Drug Programs
Nationwide Health Information Network (NHIN) is one of the ONC‘s major initiatives. As defined by the ONC, NHIN is: “a set of standards, services and policies that enable secure health information exchange over the Internet. The NHIN will provide a foundation for the exchange of health IT across diverse entities, within communities and across the country, helping to achieve the goals of the HITECH Act.”
Synonyms: Nationwide Health Information Network
National Institute of Standards and Technology – Founded in 1901, NIST is a non-regulatory federal agency within the U.S. Department of Commerce. NIST’s mission is to promote U.S. innovation and industrial competitiveness by advancing measurement science, standards, and technology in ways that enhance economic security and improve our quality of life. NIST have made solid contributions to image processing. Visit the NIST website at www.nist.gov.
Synonyms: National Institute of Standards and Technology
Office of the National Coordinator for Health Information Technology (ONC) – Located within the Office of the Secretary for the U.S. Department of Health and Human Services (HHS), the Office of the National Coordinator (ONC) coordinates nationwide efforts to support the adoption of health information technology and the promotion of health information exchange to improve health care. The ONC position was established in 2004 with an Executive Order and legislatively mandated in the Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009.
Synonyms: Office of the National Coordinator for Health Information Technology
ONC-Authorized Testing and Certification Bodies – Following the Meaningful Use stage one final rule in July of 2010, the Office of the National Coordinator selected six organizations to assume responsibility for the certification of complete EHR and EHR modules. These ONC-ATCB are required to certify based upon the certification requirements outlined in the Standards and Certification Criteria Final Rule. According to the ONC, “Certification by an ATCB will signify to eligible professionals, hospitals, and critical access hospitals that an EHR technology has the capabilities necessary to support their efforts to meet the goals and objectives of Meaningful Use.”
See also: ONC
Synonyms: ONC-Authorized Testing and Certification Bodies
Payload refers to the content of the message being sent (i.e., the message body).
Patient Demographics Query (PDQ) – What it’s used for: Requesting patient ID‘s from a central patient information server based on patient demographic information. It is used when a system has only demographic data for patient identification.
Example: Hospital A admits Patient Y, who has not been at the hospital before. Hospital A submits a request to the local HIE, based on demographic information such as name, birth date, sex, etc., to obtain the appropriate HIE patient ID for Patient Y.
Synonyms: Patient Demographics Query
Personal Health Record (PHR), as defined in Defining Key Health Information Technology Terms (The National Alliance for Health Information Technology, April 28, 2008): An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.
Synonyms: Personal Health Record
Patient Identifier Cross Referencing (PIX) What it is used for: Cross-referencing multiple local patient ID‘s between hospitals, sites, health information exchange networks, etc. Used when local patient ID’s have been registered with a PIX manager.
Example: Hospital A transmits Patient D’s ID information to the HIE for cross referencing. Hospital A receives Patient D’s local ID for Hospital B which they can use to request information from Hospital B, based on need.
Synonyms: Patient Identifier Cross Referencing
Practice Management System (PMS) applications facilitate the day-to-day operations of a medical practice. PMS software enables users to capture patient demographics, schedule appointments, maintain lists of insurance payers, perform billing tasks, and generate reports. It handles the administrative and financial matters for a practice.
Synonyms: Practice Management System
A point-to-point interface is one in which the receiving vendor provides a specification on what data it can receive and in what format it needs to be in. The sending application then builds an interface to that specification for that application. It is a one-to-one relationship. For each application requiring an interface, there is a new request and point-to- point interface developed. Read What is Your Healthcare Interface Method white paper.
|Provenance||Provenance of a resource is a record that describes entities and processes involved in producing and delivering or otherwise influencing that resource. Provenance provides a critical foundation for assessing authenticity, enabling trust, and allowing reproducibility. Provenance assertions are a form of contextual metadata and can themselves become important records with their own provenance. Provenance statement indicates clinical significance in terms of confidence in authenticity, reliability, and trustworthiness, integrity, and stage in lifecycle (e.g. Document Completion - has the artifact been legally authenticated), all of which may impact security, privacy, and trust policies. See Provenance.|
The Public IP Address (vs. Private or LAN Address) The public IP address is the outward-facing IP address that is presented to the internet by the router hardware. A private IP address is an internal IP address that is discernible only by devices on the same local network. (See NAT and PAT.)
RadLex is a controlled terminology for radiology. The purpose of RadLex is to provide a uniform structure for capturing, indexing, and retrieving a variety of radiology information sources. This may facilitate a first step toward structured reporting of radiology reports. The RadLex project – to develop a comprehensive radiology lexicon – is sponsored by the Radiological Society of North America (RSNA), along with the collaboration of the American College of Radiology (ACR) and other subspecialty societies. Read more about RadLex.
Regional Health Information Organization (RHIO) – The terms “RHIO” and “Health Information Exchange” or “HIE” are often used interchangeably. A RHIO is a group of organizations with a business stake in improving the quality, safety and efficiency of healthcare delivery. RHIOs are the building blocks of the proposed National Health Information Network (NHIN) initiative proposed by David Brailer, MD, and his team at the Office of the National Coordinator for Health Information Technology (ONCHIT). To build a national network of interoperable health records, the effort must first develop at the local and state levels. The concept of NHIN requires extensive collaboration by a diverse set of stake holders. The challenges are many to achieve success for a health information exchange or a RHIO.
Synonyms: Regional Health Information Organization
SOAP (Simple Object Access Protocol) is a web services protocol used heavily in healthcare to implement IHE profiles. SOAP is an enterprise standard that is typically used by business applications to exchange information across the enterprise.
See also: IHE
SOAP Envelope refers to the outermost wrapper of a SOAP message, containing addressing and security information.
See also: SOAP
See also: TLS
Transmission Control Protocol/Internet Protocol (TCP/IP) is a low-level communications protocol used to connect hosts on the Internet or a network. TCP/IP connections are established between clients and servers via sockets. TCP/IP is stream-oriented meaning it deposits bits in one end and they show up at the other end.
Socket is “communication endpoint”
Server = wait for connection
Client = initiate connection
Sequenced, reliable transport
Bi-directional by definition
Sometimes/often used uni-directionally
Synonyms: Transmission Control Protocol/Internet Protocol
See also: SSL
Vendor Enterprise Archive (VEA) – PACS vendors archive solution that stores multi-department images. As in the past, software upgrades and new PACS or storage system changes with a VEA can result in data migration of entire image repository. See the definition courtesy of ACUO Technologies.
See also: PACS
Synonyms: Vendor Enterprise Archive
Vendor Neutral Archive (VNA) – A software solution that acts as a middleware application between one or many clinical workflow applications, formerly known as PACS, and various storage platforms and IT strategies. VNA will support: one or many clinical viewing applications, a standards based environment, storage virtualization strategies, robust business continuity deployments and virtual environments. See the definition courtesy of ACUO Technologies.
See also: PACS
Synonyms: Vendor Neutral Archive
A WSDL is an XML-based document for locating and describing a web service. WSDLs contain the identifying information and configuration data for a web service. An application developer will produce a WSDL to make it easier to configure the user’s application to communicate with their web service. Learn about web services in Corepoint Integration Engine.
See also: Web Services
X12 provides for electronic exchange of business transactions-electronic data interchange (EDI). The American National Standards Institute (ANSI) chartered the Accredited Standards Committee (ASC) X12 to develop uniform standards.
Cross-enterprise Document Media Interchange (XDM) – What itss used for: According to IHE, XDM transfers documents and metadata using CDs, USB memory or email attachments. This profile supports environments with minimal capabilities in terms of using Web Services and generating detailed metadata. This standard is utilized by the Direct Project.
Synonyms: Cross-enterprise Document Media Interchange
Cross-enterprise Document Reliable Interchange (XDR) – What it’s used for: The exchange of health documents between health enterprises using a web-based, point-to-point push network communication, permitting direct interchange between EHRs, PHRs and other systems without the need for a document repository.
Synonyms: Cross-enterprise Document Reliable Interchange
Cross-enterprise Document Sharing for Imaging – What it’s used for: The sharing of images, diagnostic reports and related information through a commonregistry.
Synonyms: Cross-enterprise Document Sharing for Imaging
Cross-enterprise Document Sharing What it’s used for: The sharing of documents between any health care enterprise, ranging from a private physician office to a clinic to an acute care in-patient facility, through a common registry. Medical documents can be stored, registered, found and accessed.
Hospital A has a document to store. Hospital A creates a description and metadata for the document and submits it to the HIE Repository.
The HIE Repository accepts the document with metadata. It stores the document and forwards the metadata to the HIE Registry.
The HIE Registry receives a query from Hospital B and identifies the document as a match based on the metadata.
Hospital B retrieves the document from the HIE Repository.
Synonyms: Cross-enterprise Document Sharing