Terminology and Definitions

The following terminology and definitions may be helpful when discussing Electronic Health Records (EHR), specifically in regards to the Recovery Act (ARRA).

Summary of Acronyms

Terminology and Definitions

• ARRA - The American Recovery and Reinvestment Act. Signed into law on February 17th, 2009 by President Obama. Also known as the Stimulus bill, this includes the HITECH Act, as well as many non-healthcare related bills such as the famous Cash for Clunkers auto program.


• CAH - Critical Access Hospital - A Rural, Medicare approved hospital with specific HITECH provisions for meaningful use.


• CCD - Continuity of Care Document - Replacement of the CCR, an interoperability standard that allows EHRs to exchange a document with an HL7-CDA header of patient (clinical and demographic) information. The CCR could be a CDA header and a lab result, or an entire patient record.


• CCR - Continuity of Care Record - the first widely adopted record that exchanged patient data between EHR systems. Typically included basic patient demographics, as well as structure clinical data such as current medications and patient history.


• CMS - The Centers for Medicare and Medicaid Services - The department in charge of Medicare and Medicaid. It is through this group that the stimulus funds will be dispersed.


• CPOE - Computerized Physician Order Entry - A process of electronic entry of medical practitioner instructions for the treatment of patients. Orders typically include prescription orders (ePrescribe), imaging, discharge, and other medical services.


• DICOM - Digital Imaging and Communications in Medicine - a standard for handling, storing, printing, and transmitting information in medical imaging.


• 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.


• DM - Document Management System - 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 on-going documents (such as digital import).


• EHR - Electronic Health Record - Software application that replaces the EMR terminology. Typically, the difference between and EMR and an EHR is that the EHR also 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 used interchangeably, as the EHR term is replacing the EMR term, yet product names are often changed to avoid the appearance of obsolescence.


• EMR - Electronic Medical Record - Typically, this is a software application that is housed in a hospital or private physician, individual or group practice that is used by physicians to document patient encounters. This is designed to replace the paper charts that are common in medical practices. Typically, patients do not have input or access to an EMR, unlike an EHR. Can be coupled with other applications such as a patient portal, to become a full EHR.


• EP - Eligible Professional - 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 as described in the Social Security Act.


• ePrescribe / ePrescribing - Electronic Prescribing Software that 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 often allow paper printing of the prescription, digital refills, reports, and security functions. 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 and the temporary certification program, and will replace all NPRMs and IFRs.


• HHS - The U.S. Department of Health and Human Services. This office manages all healthcare departments for the government.


• HIE - Health Information Exchange. Created by HITECH Act. Local HIEs will allow medical providers to share clinical information to better treat their patients, by the exchange of data through EHRs to HIE.


• HIPAA - Health Insurance Portability and Accountability Act - Health reform law signed in 1996, included 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.


• HIS - Hospital Information System - 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.


• HIT - Health Information Technology - Also abbreviated as Health IT, this is the 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 are PM/HIS, EHR, LIS and PACS.


• HITECH Act - The Health Information Technology for Economic and Clinical Health Act. Portion of ARRA that creates the stimulus payments for physicians to meaningfully use certified EHR technology.


• HITPC - Health IT Policy Committee - HHS contract group that was pivotal to the initial Meaningful Use "Matrix" that was the baseline for the Meaningful Use requirements that were delivered in the Final Ruling.


• HITSC - Health IT Standards Committee - HHS contract group that was pivotal to the initial Meaningful Use Security and Privacy requirements that have been put into place in the Meaningful Use Final Ruling. They continue to propose Security and Foundational requirements for Meaningful Use, EHR Vendor Certification, and Interoperability (communication between EHRs and to HIEs).


• HITSP - Healthcare Information Technology Standards Panel - Several of the recommended technologies that were part of the meaningful use security and infrastructural standards for data exchange were based on the HITSP standards. Most EHR vendors view HITSP standards as the way of the future, instead preferring to use HL7 standards for interoperability.


• HL7 - Health Level Seven - 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.


• IFR - Interim Final Ruling - The governmental process by which a proposed rule is put into place prior to finalization. This is an active rule. The IFR was used for the definition of Meaningful Use (12/30/09, updated 1/13/10), and then replaced with a Final Ruling 7/13/10.


• LIS - Laboratory Information System - Software designed to manage the CLIA laboratory requirements as well as any lab analyzers at a lab facility. Typically sold to private practices with a lab facility to manage the data of lab tests.


• Meaningful Use - a process by which a eligible provider demonstrates use of a certified EHR in a meaningful manner, as defined by ONC. The meaningful use criteria was finalized on July 13th, 2010, and released publicly on the federal register.


• MPI - Master Patient Index - 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 a MPI is housed within a HIS to assign one specific ID per patient, and then that patient information is shared to all hospital departments and hospital associated clinics. Prevents duplication of data entry and duplication of patient record storage.


• MUC - Meaningful Use Certification - A term created by the industry to indicate a product that has been certified by an ONC-ATCB for meaningful use. ONC-ATCBs can have additional certification levels, such as CCHIT's comprehensive certification, but they must have a MUC program as well.


• NHIN - National Health Information Exchange - A central data repository for the exchange of patient data amongst HIEs and the federal systems such as the Veteran's Administration system.


• NIST - The National Institute for Standards and Technology - 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.


• NPRM - Notice of Proposed Rule Making - The governmental process by which a proposed (or draft) rule is officially put into the public forum for public comment prior to being finalized. This was used for the CMS incentives (1/13/10), permanent certification program (3/10/10), and temporary certification program (3/10/10 - later replaced by a Final Ruling 6/18/10).


• ONC - The Office of the National Coordinator for Health IT. A department within HHS that was created during the Bush administration to oversee the push towards EHRs. They were put in charge of Meaningful Use.


• ONC-ATCB - ONC-Authorized Testing and Certification Body. They will certify EHR vendors such as ChartLogic to become certified EHR technology, as defined by ARRA.


• PACS - Picture Archiving and Communication Systems - A Health IT system designed to manage, transmit, and store patient medical images, typically of DICOM quality. Patient images are often radiology, MRI, CT, or ultrasound. This replaces having the film copies of the images. Most PACS systems also include diagnostic tools such as measurements, inverse image displays, and rotate and zoom functions.


• PM - Practice Management System - A private practice system, designed to manage the patient registration, scheduling, and billing aspects of a patient record.


• PQRI - Physician's Qualitative Reporting Initiative - 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%. This program has been enhanced for 2011, and its infrastructure will be used for the Meaningful Use reports.


• REC - Regional Extension Center. Created by HITECH Act. Local area organization that has received federal funding to help underserved populations of physicians adopt technology. Primarily focused on Primary Care and 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. Typically the output is the equivalent to 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.