The following terms are used by the Office of the National Coordinator for Health IT (ONC) (Glossary | HealthIT.gov).
Application Programming Interface (API) – A set of tools, definitions, and protocols for building and integrating application software. It lets a product or service communicate with other products and services without needing to know how they’re implemented.
Auth 2.0 — a simple authorization framework that enables a third-party application to obtain access to an HTTP service.
CMS – The Centers for Medicare & Medicaid Services – The Centers for Medicare & Medicaid Services, CMS, is part of the Department of Health and Human Services (HHS). CMS provides health coverage to more than 100 million people through Medicare, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplace. The CMS seeks to strengthen and modernize the Nation’s health care system, to provide access to high quality care and improved health at lower costs.
CMS funds most state Medicaid information technology (IT) development at a ninety percent federal match, to the tune of over $4 billion per year. The Centers for Medicare & Medicaid Services (CMS) is responsible for implementing laws passed by Congress related to Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program. To implement these programs, CMS issues various forms of guidance to explain how laws will be implemented and what states and others need to do to comply. In addition to regulations, CMS issues sub-regulatory guidance to address policy issues as well as operational updates and technical clarifications of existing guidance.
The majority of the Health Information Exchange (HIE) funding for the Territory is coming from CMS. Mandates, guidelines and certification processes are are part of the funding process.
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 Clinical Document Architecture (C‐CDA) – A document standard for the transmission of structured summary data between providers, and between providers and patients. Transmitted data supports care transitions, referrals, and care coordination.
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 Health Record – An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care.
EHRs are a vital part of health IT and can:
- Contain a patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results
- Allow access to evidence-based tools that providers can use to make decisions about a patient’s care o
- Automate and streamline provider workflow
- Fast Healthcare Interoperability Resources (FHIR®) Standard – An interface specification that specifies the content of the data exchanged between healthcare applications, and how the exchange is implemented and managed. The data exchanged includes clinical data as well as healthcare‐related administrative, public health, and research data.
Electronic Medical Records – Electronic medical records (EMRs) are digital versions of the paper charts in clinician offices, clinics, and hospitals. EMRs contain notes and information collected by and for the clinicians in that office, clinic, or hospital and are mostly used by providers for diagnosis and treatment. EMRs are more valuable than paper records because they enable providers to track data over time, identify patients for preventive visits and screenings, monitor patients, and improve health care quality.
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.
Fast Healthcare Interoperability Resource (FHIR) — FHIR is a specification for exchanging clinical and administrative healthcare data exchange published by HL7®. The standard is based on REST and OAuth. The healthcare community is adopting this next generation exchange framework to advance interoperability.
Electronic health records (EHRs) represent patient data in different ways (e.g., medications, encounters) and FHIR provides a means for representing and sharing information among clinicians and organizations in a standard way regardless of the ways local EHRs represent or store the data. FHIR combines the best features of previous standards into a common specification, while being flexible enough to meet needs of a wide variety of use cases within the healthcare ecosystem. FHIR focuses on implementation and uses the latest web technologies to aid rapid adoption.
Health Information Exchange (HIE) – Both the act of moving health data electronically between organizations and an organization that facilitates information exchange. HIEs may be statewide, regional, metropolitan, or organization‐specific and may be privately owned or publicly funded.
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.
Information Blocking – The Cures Act defines the term ‘information blocking’ as a practice that:
(A) Is likely to interfere with, prevent, or materially discourage access, exchange, or use of electronic health information; and
(B) (i) If conducted by a health information technology developer, exchange, or network, such developer, exchange, or network knows, or should know, that such practice is likely to interfere with, prevent, or materially discourage the access, exchange, or use of electronic health information; or
(ii) if conducted by a healthcare provider, such provider knows that such practice is unreasonable and is likely to interfere with, prevent, or materially discourage access, exchange, or use of electronic health information.
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.
Health Level 7 (HL7) v2 messaging — a commonly used data interchange standard. This standard includes messaging specifications for patient administration, orders, results, scheduling, claims management, document management, and many others.
Health Quality Measure Format (HQMF) — a standards-based representation of quality measures as electronic documents
HEART (Health Relationship Trust) — a set of profiles that enables patients to control how, when, and with whom their clinical data is shared.
Integrating the Healthcare Enterprise (IHE) — IHE’s work is organized into profiles that define how systems should cooperate.
Commonly implemented profiles include:
ATNA — audit trail and node authentication: basic security and audit logging
XCA — cross-community access: query and retrieve patient records held by other communities
XCPD — cross-community patient discovery locates patient records in other communities and resolves different patient identifiers
XDR — cross-community interchange: point-to-point sharing of electronic documents
XDS — cross community document sharing discovery and sharing of electronic documents
PDQ — patient demographics query: consult a central patient information server to look up patient identity based on demographics
PIX — queries for patient identity cross references among different sites .
Interoperability – The Cures Act defines interoperability, with respect to health information technology, as such health information technology that:
1) Enables the secure exchange of electronic health information with, and use of electronic health information from, other health information technology without special effort on the part of the user.
2) Allows for complete access, exchange, and use of all electronically accessible health information for authorized use under applicable State or Federal law; and
3) Does not constitute information blocking as defined in section 3022(a).
Logical Observation Identifiers Names and Codes (LOINC) – A common language (set of identifiers, names, and codes) for identifying health measurements, observations, and documents159
Medical Device – An instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease.160
(ONC) – Office of the National Coordinator for Health Information Technology. The Office of the National Coordinator for Health Information Technology (ONC) is at the forefront of the administration’s health IT efforts and is a resource to the entire health system to support the adoption of health information technology and the promotion of nationwide, standards-based health information exchange to improve health care. ONC is organizationally located within the Office of the Secretary for the U.S. Department of Health and Human Services (HHS).
ONC is the principal federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. The position of National Coordinator was created in 2004, through an Executive Order, and legislatively mandated in the Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009.
Through its work, ONC remains focused on two strategic objectives:
- Advancing the development and use of health IT capabilities; and
- Establishing expectations for data sharing
Patient Unified Lookup for Emergencies (PULSE) – The PULSE™ initiative is an effort to create national resilience through access to health information during disasters, including public health emergencies. PULSE provides a process for states and localities to grant response personnel (e.g., epidemiologists, emergency medical services, and healthcare volunteers) secure access to vital health information during disasters, ensuring patients can continue to receive care when and where they need it.
Personal Health Records – Personal health records (PHRs) contain the same types of information as EHRs—diagnoses, medications, immunizations, family medical histories, and provider contact information—but are designed to be set up, accessed, and managed by patients. Patients can use PHRs to maintain and manage their health information in a private, secure, and confidential environment. PHRs can include information from a variety of sources including clinicians, home monitoring devices, and patients themselves.
Quality Reporting Document Architecture (QRDA) — a standard for communicating healthcare quality measures
Telehealth – The use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health, and health administration. Technologies include: videoconferencing, the internet, store-and forward imaging, streaming media, and terrestrial and wireless communications.
Telehealth is different from telemedicine because it refers to a broader scope of remote healthcare services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.
Trusted Exchange Framework (TEF) – A set of principles and minimum required terms and conditions for trusted exchange as required by the Cures Act.
Trusted Exchange Framework and Common Agreement (TEFCA) – TEFCA’s goal is to provide a single HIE “on-ramp” that will allow clinicians, hospitals, and other healthcare stakeholders to join any health information network (HIN) and then immediately link and participate in nationwide health information exchange. It provides value by supporting exchange of health information across stakeholders, consistent with applicable law. It will advance the following opportunities:
- Providers’ ability to get the data they need to provide the best care possible for patients.
- People will have easier access to their complete health history in one place.
- Health plans and providers will face fewer burdens when sharing information to support care coordination, case management, and health plan operations.
- Public health departments will have more nimble access to the information they need, while providers that currently expend tremendous resources connecting to numerous single-purpose public health reporting channels or report through non-digital means will have simpler connectivity.
TEFCA Principles & Components
- (1) Standardization
- (2) Openness and Transparency
- (3) Cooperation and Non-Discrimination
- (4) Privacy, Security, and Safety
- (5) Access
- (6) Equity
- (7) Public Health.
TEFCA – Supports consumer’s access to their health information. Ultimately, TEFCA is about people. When TEFCA is implemented, it will be easier for individuals to ask for and see their health information on their smartphones or via their portals. TEFCA will provide the infrastructure to more readily enable individuals to access their information, from every connected provider and health plan, in one place.
Qualified Health Information Networks (QHINs) – are networks that agree to the common terms and conditions of exchange with each other (as specified in the Common Agreement) and to the functional and technical requirements for exchange (as specified in the QHIN Technical Framework or QTF). Each QHIN will voluntarily enter into a contractual agreement with the RCE by signing the Common Agreement, which describes the rules for the network-of-networks. QHINs will be the central connection points within the TEFCA ecosystem. They will route queries, responses and messages among entities and individuals sharing information. TEFCA creates “Qualified Health Information Networks” (QHINs) to help support a defined technique for HIE inter-connectivity, as well as a new administrative body called the Recognized Coordinating Entity (RCE).
There are currently no established QHINS yet. Only the RCE can designate a QHIN under TEFCA. The RCE has not yet designated any QHINs. It will begin doing so in 2022, after the Common Agreement Version 1 Final and QHIN Technical Framework Version 1 Final are finalized.
U.S. Core Data for Interoperability (USCDI) – A common set of data classes that are required for nationwide, interoperable health data exchange. The first version of the United States Core Data for Interoperability (USCDI v1) is adopted as a standard in the ONC Cures Act Final Rule. The USCDI sets a foundation for broader sharing of electronic health information to support patient care. The USCDI will be expanded over time. The USCDI Version 1 is available at https://www.healthit.gov/uscdi .
Usability – The extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use
(RCE) – Recognized Coordinating Entity
Validated Healthcare Directory Implementation Guide – an HL7 FHIR based implementation guide and architectural considerations for attesting to, validating, and exchanging validated data as well as a RESTful FHIR API for accessing data from that directory.
The Sequoia Project, Inc., – Under a Cooperative Agreement with the Office of the National Coordinator (ONC) for Health Information Technology, the RCE will:
- Work with ONC to develop, update, implement, and maintain the Common Agreement and Qualified Health Information Network (QHIN) Technical Framework;
- Engage with stakeholders to obtain feedback;
- Designate and monitor QHINs for compliance with the Common Agreement; and
- Develop and maintain the governing approach to maintain and update Common Agreement, including sustainability.
For OHIT Website as contain hyperlinks
Health IT Standards to Watch
The 21st Century Cures Act, passed in 2016, calls for the development of a trusted exchange framework and a common agreement (TEFCA). The Trusted Exchange Framework is a set of non-binding but foundational principles for health information exchange, and the Common Agreement is a contract that advances those principles. The Common Agreement establishes the technical infrastructure model and governing approach for different health information networks and their users to securely share clinical information with each other – all under commonly agreed-to rules-of-the-road.
The Common Agreement supports multiple exchange purposes critical to improving health care and has the potential to benefit a wide variety of health care entities. This flexible structure allows stakeholders—such as health information networks, ambulatory practices, hospitals, health centers, federal government agencies, public health agencies, and payers—to benefit from TEFCA through improved access to health information. Individuals will also be able to benefit from TEFCA and seek access to their health information through entities that offer individual access services.
Consolidated-Clinical Document Architecture (C-CDA) — C-CDA is a framework for creating clinical documents that contain both human-readable text and machine-readable XML
Direct — is a standard for sending health information securely over the internet.
Fast Healthcare Interoperability Resource (FHIR) — FHIR is a specification for exchanging clinical and administrative health care data. The standard is based on REST and OAuth.
Validated Healthcare Directory Implementation Guide – an HL7 FHIR based implementation guide and architectural considerations for attesting to, validating, and exchanging validated data as well as a RESTful FHIR API for accessing data from that directory.
Integrating the Healthcare Enterprise (IHE) — IHE’s work is organized into profiles that define how systems should cooperate. Commonly-implemented profiles include:
- ATNA — audit trail and node authentication: basic security and audit logging
- XCA — cross-community access: query and retrieve patient records held by other communities
- XCPD — cross-community patient discovery: locates patient records in other communities and resolves different patient identifiers
- XDR — cross-community interchange: point-to-point sharing of electronic documents
- XDS — cross community document sharing: discovery and sharing of electronic documents
- PDQ — patient demographics query: consult a central patient information server to look up patient identity based on demographics
- PIX — queries for patient identity cross references among different sites
Health Level 7 (HL7) v2 messaging — a commonly used data interchange standard. This standard includes messaging specifications for patient administration, orders, results, scheduling, claims management, document management, and many others.
Quality Reporting Document Architecture (QRDA) — a standard for communicating health care quality measures
Health Quality Measure Format (HQMF) — a standards-based representation of quality measures as electronic documents
OAuth 2.0 — a simple authorization framework that enables a third-party application to obtain access to an HTTP service.
HEART (Health Relationship Trust) — a set of profiles that enables patients to control how, when, and with whom their clinical data is shared.
OpenID Connect — a simple identity layer designed to work with Oauth 2.0.