The American Recovery and Reinvestment Act

The following acronyms and terminology may be helpful when discussing the Recovery Act and the meaningful use guidelines for electronic health records (EHR).

Relevant Acronyms and Terminology

American Recovery and Reinvestment Act (ARRA): The act was signed into law by President Obama on February 17, 2009. Also known as the Stimulus Bill, this includes the HITECH Act, as well as many non-healthcare-related bills such as the Cash for Clunkers program.
Centers for Medicare and Medicaid Services (CMS): The department in charge of Medicare and Medicaid. It is through this group that the stimulus funds are dispersed.
Continuity of Care Document (CCD:) An interoperability standard that allows EHRs to exchange a document with an HL7-CDA header of patient (clinical and demographic) information. Replaces the CCR.
Continuity of Care Record (CCR): The first widely adopted record that exchanged patient data between EHR systems. The CCR typically included basic patient demographics as well as structured clinical data such as current medications and patient history.
Computerized physician order entry (CPOE): A process of electronic entry of medical practitioner instructions for the treatments of patients. Orders typically include prescriptions (ePrescribe), imaging, discharge, and other medical services.
Critical access hospital (CAH): A rural, Medicare-approved hospital with specific HITECH provisions for meaningful use.
Dictation: A process in which a user records a voice file on a digital or analog recorder, the result of which is a transcribed document. Medical providers use dictation/transcription to keep paper and electronic records of their patient encounters for patient care and legal purposes.
Digital Imaging and Communications in Medicine (DICOM): A standard for handling, storing, printing, and transmitting information in medical imaging.
Document Management (DM): A digital storage system designed to digitize patient records that were once stored on paper charts. Typically includes methods to convert paper to electronic records (such as scanning), as well as methods to manage ongoing documents (such as digital import).
Electronic health record (EHR): Software application that replaces the EMR terminology. The difference between an EMR and an EHR is that the EHR includes patient participation in the creation and management of the patient record. This is often accomplished with a patient portal or other tool for the patient to interact with the record. Often the terms are incorrectly use interchangeably, as the EHR term is replacing the EMR term, yet product names are often changed to avoid the appearance of obsolescence.
Electronic medical record (EMR): Software application that is housed in a hospital or physician practice that is used by physicians to document patient encounters. This is designed to replace paper charts that are common in medical practices. Patients do not generally have input or access to an EMR, unlike an EHR. An EMR can be coupled with other applications such as a patient portal to become a full EHR.
Eligible professional (EP): Terminology used in the HITECH Act to identify the type of medical provider that is eligible to receive stimulus benefits for demonstrating meaningful use of certified EHR technology. An eligible professional is defined as a physician described in the Social Security Act.
ePrescribe (eRx): Electronic prescribing software allows medical providers to place a prescription order to the pharmacy electronically. The software often comes with additional features allowing prescribing providers to compare current medications, allergies, diagnoses, and treatments with the new prescription order, using database information to create medical alerts. Additional features (including security functions) often allow paper printing of prescriptions, digital refills, and reports. At a baseline, the system must include the ability to transmit a prescription order directly to a pharmacy using a secure system.
Final ruling:The governmental process by which a final rule is issued to the federal register and the public for implementation. This has been used to finalize the definition of meaningful use, the temporary certification program, and the 2014 Edition Test Certification.
Health information exchange (HIE): Created by the HITECH Act. Local HIEs allow medical providers to share clinical information by the exchange of data through EHRs to HIEs.
Health Insurance Portability and Accountability Act (HIPAA): Health reform law signed in 1996, which includes provisions for standard transaction sets for the transmission of healthcare data, patient privacy rules, and health IT security requirements. All standards were approved during the Bush Administration and have been further refined by HITECH.
Health information technology (HIT or health IT): Vendor market for any computer hardware or software that is marketed to the healthcare industry. HIT companies are often grouped into hospital or physician products, hardware (devices) or software (applications). Software examples include PM/HIS, EHR, and PACS.
Health Information Technology for Economic and Clinical Health Act (HITECH Act): Portion of the ARRA that creates the stimulus payments for physicians to meaningful use certified EHR technology.
Health IT Policy Committee (HITPC): HHS contract group that was pivotal to the initial meaningful use “matrix” that is the baseline for meaningful use requirements delivered in the Final Ruling.
Health IT Standards Committee (HITSC): HHS contract group that was pivotal to the initial meaningful use security and privacy requirements that have been put into the meaningful use final rulings. They continue to propose security and foundational requirements for meaningful use, EHR vendor certification, and interoperability.
Health Level Seven (HL7): A standards organization for the exchange of healthcare data. HL7 standards have been in use for exchanging data between HIT technologies for more than a decade, and are included in HIPAA and other regulations. HL7 messages are commonly exchanged between HIT vendors for data such as patient demographics, insurance, scheduling, labs, and other clinical data points. HL7 also authors the CDA, an architecture the CCD is based upon.
Hospital information system (HIS): Patient registration and management system for hospitals. Typically houses all patient information such as demographics, insurance, appointments/visits, and billing. Similar to a PM system for hospitals.
Interim Final Ruling (IFR): The government process by which a proposed rule is put into place prior to finalization. This is an active rule.The IFT was used for the definition of meaningful use stages 1 and 2.
Interoperability: Communication between EHRs and HIEs.
Laboratory information system (LIS): Software designed to manage the CLIA laboratory requirements as well as any lab analyzers at a lab facility. Usually sold to private practices with a lab facility to manage the data of lab tests.
Master patient index (MPI): A central data system that identifies a unique patient record to be used throughout a community system, such as a hospital and attached clinics. Typically, an MPI is housed within an HIS to assign one specific ID per patient, and then that patient information is shared with all hospital departments and hospital-associated clinics. Prevents duplication of data entry and of patient record storage.
Meaningful use (MU): A process by which an eligible professional demonstrates use of a certified EHR in a meaningful manner, as defined by ONC.
Meaningful use certification (MUC): A term created by the industry to indicate a product that has been certified by an ONC-ATCB for meaningful use.
National Health Information Exchange (NHIN): A central data repository for the exchange of data amongst HIEs and the federal systems such as the Veteran’s Administration system.
National Institute for Standards and Technology (NIST): Government agency in charge of oversight for testing and accreditation organizations. They have been assigned the responsibility of creating testing scripts for EHR vendors to certify against.
Natural language processing (NLP): The ability of computers to understand and make use of human language.
Notice of Proposed Rule Making (NPRM): The governmental process by which a proposed (or draft) rule is officially put to the public forum for public comment prior to being finalized.This was used for both meaningful use and the certification programs.
Office of the National Coordinator for Health Information Technology (ONC): A department within HHS that was created during the Bush Administration to oversee the push toward EHRs. This department is in charge of meaningful use.
ONC-Authorized Testing and Certification Body (ONC-ACTB): An organization approved by ONC to certify EHR vendors.
Patient Portal: An application that allows medical practices and patients to communicate through a secure, online portal.
Physician’s Qualitative Reporting Initiative (PQRI): A CMS program designed to better manage patient care through specific quality reporting. For example, physician practices would be incentivized to report on diabetic patient outcomes, such as their A1C levels. In return for participation, practices would receive a reimbursement bonus of 1–2 percent. This programs was enhanced for meaningful use.
Picture Archiving and Communication Systems (PACS): A health IT system designed to manage, transmit, and store patient medical images, typically of DICOM quality. Most PACS systems also include diagnostic tools such as measurements, inverse image displays, and rotate and zoom functions.
Practice Management (PM): A private practice system designed to manage patient registration, scheduling, and billing aspects of a patient record.
Regional extension center (REC): Created by the HITECH Act. Local area organization that has received federal funding to help underserved populations of physicians adopt technology. Primarily focused on primary care. Lower-adoption specialties choose and train on selected technology.
Stimulus Bill: See ARRA.
Transcription: A process wherein a typist translates a recorded file into an electronic document with text. The output is the equivalent of a word processor file. Medical providers use dictation/transcription to keep paper and electronic records of their patient encounters for patient care and legal purposes.
US Department of Health and Human Services (HHS): This office manages all healthcare departments for the government.

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