Glossary

The following definitions are quoted from a variety of sources, as indicated:

Health Information Technology (HIT): Information processing using both computer hardware and software for the entry, storage, retrieval, sharing, and use of health care information.*(1)

Legislation and Implementation Responsibilities

Health Information Technology for Economic and Clinical Health (HITECH) Act (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.*(2)

Health Insurance Portability and Accountability Act (HIPAA): 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 healthcare system by encouraging the widespread use of electronic data interchange in the U.S. healthcare system. (2)

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. (2)

Electronic Health Records and Use in Quality Improvement

Although EMR and EHR are often used interchangeably, several sources suggest a distinction:

Electronic Medical Record (EMR): An electronic replacement of paper charts, an electronic medical record (EMR) is the record of patient health information generated by encounters at one particular provider. This is the physician's own electronic record of his or her patient's medical care. When a physician purchases software he or she is purchasing an EMR system.*(3)

Electronic Health Record (EHR): A record of a patient’s long-term and aggregate health information generated by one or more encounters in any care delivery setting. Stemming from the interoperability of multiple providers, the electronic health record (EHR) is distinct from the clinical systems that will directly support caregivers treating patients. Rather, the EHR connects the various clinical systems and providers. Included in this information are patient demographics, progress notes, problems, medications, past medical history, immunizations, laboratory data and radiology reports. (3)

Computerized Physician Order Entry (CPOE): A computerized system that allows a physician's orders for services such as medications, laboratory tests and other tests to be entered electronically instead of being recorded on order sheets or prescription pads. This allows for the order to be compared against standards for dosing and to be checked for any patient allergies or interactions with other medications, or other potential problems if the order is filled. (1)

Personal Health Record (PHR): An electronic record of health-related information on an individual that can be drawn from multiple sources while being managed, shared, and controlled by the individual. *(4)

Interoperability: The ability of different information technology systems and software applications to communicate, to exchange data accurately, effectively, and consistently, and to use the information that has been exchanged. (1)

Meaningful Use: A term associated with The American Recovery and Reinvestment Act of 2009 (ARRA) that authorizes the Centers for Medicare & Medicaid Services (CMS) to provide reimbursement incentives for medical professionals and hospitals that become compliant in the use of certified electronic health record (EHR) technology. To be compliant with meaningful use requirements, providers and hospitals will need to be able to use EHRs to: chart changes in vital signs; maintain up-to-date lists of active medication, allergies, and current and active diagnoses; provide patients with electronic copies of health information, office visit summaries, and hospital discharge summaries; implement clinical decision support; order medication and check for drug-drug / drug-allergy interactions; report clinical quality measures; extract patient demographic information; and demonstrate capability to exchange clinical information among providers.

Providers and hospitals must also choose to comply with several objectives among the following: incorporating clinical lab test results into EHRs; checking drug formularies; sending reminders to patients for preventive/follow-up care; ensuring consistency of patient medication regimens during transitions in care (medication reconciliation); providing summary care records for transition of care or referral; generating lists of patients by specific conditions to use for QI, reduction of disparities, research, or outreach; identifying patient-specific education resources; and demonstrating capability to submit electronic data to immunization registries and syndromic surveillance data to public health agencies.

Professionals and hospitals that meet these objectives of “meaningful use” according to measures set in the meaningful use Final Rule will begin receiving incentive payments in 2011. By 2015, providers are expected to have adopted and be actively utilizing a certified EHR in compliance with the "meaningful use" definition or be subject to financial penalties under Medicare.*(2)(5)

Regional Extension Center (REC): Part of the Health Information Technology for Economic and Clinical Health (HITECH) Act's Health Information Technology Extension Program, 60 Regional Extension Centers (RECs) in the United States will support and serve health care providers to help them quickly become adept and meaningful users of electronic health records (EHRs). RECs will: provide training and support services to assist doctors and other providers in adopting EHRs; offer information and guidance to help with EHR implementation; and give technical assistance as needed. The goal of the program is to provide outreach and support services to at least 100,000 priority primary care providers within two years.*(6)

Health Information Technology Research Center (HITRC): As part of the Health Information Technology for Economic and Clinical Health (HITECH) Act’s Health Information Technology Extension Program, the Health Information Technology Research Center (HITRC) will gather information on effective practices and help Regional Extension Centers work with one another and with relevant stakeholders to identify and share best practices in electronic health record adoption, meaningful use, and provider support.*(6)

Health Information Exchange

Health Information Exchange (HIE): 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, efficient, and patient-centered care. (2)

Nationwide Health Information Network (NHIN): The Nationwide Health Information Network (NHIN) is one of the major initiatives of the Office of the National Coordinator of Health Information Technology (ONC). 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 Health Information Technology for Economic and Clinical Health (HITECH) Act. *(2)(7)

Regional Health Information Organization (RHIO): A Regional Health Information Organization (RHIO) is a multi-stakeholder organization, operating in a specific geographical area, that enables the exchange and use of health information, in a secure manner, for the purpose of promoting the improvement of health quality, safety and efficiency. Officials from the U.S. Department of Health and Human Services see RHIOs as the building blocks for the Nationwide Health Information Network (NHIN). When complete, the NHIN will provide universal secure access to electronic health records.*(1)

(1) Glossary on Health Information Technology, A Reporter’s Toolkit: Health Information Technology, Alliance for Health Reform, 2007.

(2) Healthcare Interoperability Glossary, Corepoint Health, accessed December 20, 2010.

(3) Electronic Medical Record vs. Electronic Health Record, Texas Medical Association, 2010.

(4) Report to the Office of the National Coordinator for Health Information Technology on Defining Key Health Information Technology Terms, The National Alliance for Health Information Technology, 2008.

(5) Part II: Department of Health and Human Services, Centers for Medicare & Medicaid Services 42 CFR Parts 412, 413, 422 et al. Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule, Federal Register, 2010. 44567-44570.

(6) Health Information Technology Extension Program, The Office of the National Coordinator for Health Information Technology, 2010.

(7) Nationwide Health Information Network: Overview, The Office of the National Coordinator for Health Information Technology, 2010.