Laying the foundation
Like all other industries that have moved to electronic communication and business to business transactions, it starts with standards. The Health Care Information Technology industry was no different. In 2004 the Office of the National Coordinator for Health Information Technology (ONCHIT) was established not only to initiate and promote adoption of electronic health information but to lay the foundation for an infrastructure that would bring success to the on going initiative. From the beginning the most basic of terms needed to be defined and adopted to create a consistent language that would support the whole system including public policies, private development, and outreach and educational initiatives.
The National Alliance for Health Information Technology (NAHIT) was hired by ONCHIT to create key health IT definitions which were released in a report in April of 2008. The Executive Summary of the report tells us why defined terms are needed.
“The ambiguity of meaning created by not having a shared understanding of what these key terms signify becomes an obstacle to progress in health IT adoption when questions about a term’s definition and application complicate important policy expectations or directives, contractual matters, and product features. Differences in how a term is used can cause confusion and misunderstanding about what is being purchased, considered in proposed legislation, or included in current applicable policies and regulations.”
The contract to NAHIT was to reach consensus on definitions for the terms EMR, EHR, PHR, HIE and RHIO. HIO was added to the definitions once it was determined that HIE had a process and an entity meaning.
The definitions, when put into practice, will result in a number of benefits including:
- Health IT concepts expressed in a language that individuals comprehend.
- Standard terms for policy makers to use when drafting and evaluating policies.
- Important reference points for health IT initiatives.
- More effective contracting between health IT vendors and their customers.
The following definitions have been adopted:
Electronic Medical Record (EMR) – 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.
Electronic Health Record (EHR) – 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.
Personal Health Record (PHR) – 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.
Health Information Exchange (HIE) – The electronic movement of health-related information among organizations according to nationally recognized standards. (verb)
Health Information Organization (HIO) – An organization that oversees and governs the exchange of health-related information among organizations according to nationally recognized standards. (noun)
Regional Health Information Organization (RHIO) – A health information organization that brings together health care stakeholders within a defined geographic area and governs health information exchange among them for the purpose of improving health and care in that community.
NAHIT was founded in 2002 by industry leaders from several sectors of the health care industry and had heavy membership from hospital systems and associations, and vendors. Its goal was to build a common ground for the implementation of health information technology, which at the time of closing, they said had happened. HIT moved front and center in efforts to reinvent and reinvigorate our health system. The focus changed from educating, advocating, and building common ground to planning, implementing, and using HIT to improve care, safety and efficiency.
Declaring its mission “accomplished”, the National Alliance for Health Information Technology ceased operation in September 2009.
Glossary of Terms
Computerized Provider Order Entry (CPOE) – A computer application that allows a physician’s orders for diagnostic and treatment services (such as medications, laboratory, and other tests) to be entered electronically instead of being recorded on order sheets or prescription pads. The computer compares the order against standards for dosing, checks for allergies or interactions with other medications, and warns the physician about potential problems.
Consolidated Health Informatics (CHI) Initiative – One of the 24 Presidential eGovernment initiatives with the goal of adopting vocabulary and messaging standards to facilitate communication of clinical information across the federal health enterprise. CHI now falls under FHA.
Decision-Support System (DSS) – Computer tools or applications to assist physicians in clinical decisions by providing evidence-based knowledge in the context of patient specific data. Examples include drug interaction alerts at the time medication is prescribed and reminders for specific guideline-based interventions during the care of patients with chronic disease. Information should be presented in a patient-centric view of individual care and also in a population or aggregate view to support population management and quality improvement.
Electronic Prescribing (eRx) – A type of computer technology whereby physicians use handheld or personal computer devices to review drug and formulary coverage and to transmit prescriptions to a printer or to a local pharmacy. E-prescribing software can be integrated into existing clinical information systems to allow physician access to patient specific information to screen for drug interactions and allergies.
Enterprise Architecture – A strategic resource that aligns business and technology, leverages shared assets, builds internal and external partnerships, and optimizes the value of information technology services.
Federal Health Architecture (FHA) – A collaborative body composed of several federal departments and agencies, including the Department of Health and Human Services (HHS), the Department of Homeland Security (DHS), the Department of Veterans Affairs (VA), the Environmental Protection Agency (EPA), the United States Department of Agriculture (USDA), the Department of Defense (DoD), and the Department of Energy (DOE). FHA provides a framework for linking health business processes to technology solutions and standards and for demonstrating how these solutions achieve improved health performance outcomes.
Health Information Technology (HIT) – The application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making.