Acronyms
| ACO – Accountable Care Organization |
| API – Application Program Interface |
| CA – Certificate Authority |
| CCD – Continuity of Care Document |
| CCDA – Consolidated Clinical Document Architecture |
| CCOW – Clinical Context Object Workshop |
| CCR – Continuity of Care Record |
| CDA – Clinical Document Architecture |
| CDC – Centers for Disease Control and Prevention |
| CDS – Clinical Decision Support |
| CIMI – Clinical Information Modeling Initiative |
| CMS – Centers for Medicare and Medicaid Services |
| CPT – Current Procedural Terminology |
| DNA – Deoxyribonucleic Acid |
| DNS – Domain Name System |
| EDI – Electronic Data Interchange |
| eHI – eHealth Initiative |
| EHR – Electronic Health Record |
| EMR – Electronic Medical Record |
| FHIR – Fast Healthcare Interoperability Resources |
| HDF – HL7 Development Framework |
| HIE – Health Information Exchange |
| HIPAA – Health Insurance Portability and Accountability Act |
| HISP – Health Information Systems Programme |
| HIT or HITech – Health Information Technology |
| HL7 – Health Level-7 |
| HMO – Health Maintenance Organizations |
| HQMF – Health Quality Measure Format |
| HTTP – Hypertext Transfer Protocol |
| ICD – International Classification of Disease |
| IHIE – Indiana Health Information Exchange (pronounced Eye Hi) |
| IMAP – Internet Message Access Protocol |
| IOM – Institute of Medicine |
| JSON – JavaScript Object Notation |
| LDAP – Lightweight Directory Access Protocol |
| LOINC – Logical Observation Identifiers Names and Codes |
| mHealth – Mobile health |
| MDP – Markov Decision Process |
| MIME – Multipurpose Internet Mail Extensions |
| NAM – National Academy of Medicine |
| NDC – National Drug Code |
| NIH – National Institutes of Health |
| OECD – Organisation for Economic Cooperation and Development |
| OID – Object Identifier |
| ONC – Office of the National Coordinator for HIT |
| P4P – Pay for Performance |
| PCP – Primary Care Physician |
| PGP – Physician Group Practice |
| PHI – Protected Health Information |
| PHR – Personal Health Record |
| PKI – Public Key Infrastructure |
| QRDA – Quality Reporting Document Architecture |
| RDF – Resource Description Framework |
| REST – Representational state transfer |
| RIM – Reference Information Model |
| S/MIME – Secure/Multipurpose Internet Mail Extensions |
| SMART – Substitutable Medical Applications,Reusable Technologies |
| SMTP – Simplified Mail Transport Protocol |
| SNOMED – Systemized Nomenclature for Medicine |
| SNOP – Systematized Nomenclature of Pathology |
| XML – Extensible Markup Language |
Vocabulary
| A |
| Accountable Care Organization (ACO): MEDICARE’s outcomes-based contracting approach |
| Acute disease: medical problems that either go away on their own or can be cured with a limited course of treatment |
| Agent-based models: agents represent “actors” in a process and can have a rich set of attributes that allow them to make decisions about how to communicate or interact with each other and their environment |
| American Recovery and Reconstruction Act (ARRA): the Obama administration’s 2009 economic stimulus bill |
| Arden Syntax: an approach to specifying medical knowledge and clinical decision support rules in a form that is independent of any electronic health record (EHR) and thus sharable across hospitals |
| B |
| Bioinformatics: computational modeling of complex intracellular biochemical processes |
| Biosense: the CDC’s electronic surveillance network for disease outbreaks and bioterrorism |
| Blue Button: an ASCII text-based standard for heath information sharing first introduced by the Veteran’s Administration to facilitate access to records stored in VistA by their patients |
| Blue Button +: a newer Blue Button format that provides both human (e.g. text) and machine readable (e.g. XML) formats |
| C |
| Care Coordinator: a professional who engages with and monitors patients between visits to what is often a patient centered medical home model practice |
| Centers for Disease Control and Prevention (CDC): the federal agency focused on disease in the community |
| Centers for Medicare and Medicaid Services (CMS): the component of the Department of Health and Human Services that administers the Medicare and Medicaid programs |
| Centralized architecture: a form of HIE in which data is aggregated and stored centrally in order to provide value-added services |
| Certificate Authority (CA): an entity that digitally signs certificate requests and issues X.509 digital certificates that link a public key to attributes of its owner |
| Chronic disease: medical problems that can’t be cured and for which the goal of treatment is management to avoid long term complications |
| Clinical Context Object Workshop (CCOW): an HL7 standard for synchronizing and coordinating applications to automatically follow the patient; user (and other) contexts allow the clinical user’s experience to resemble interacting with a single system when the user is using multiple, independent applications from many different systems |
| Clinical Data Repository: a database specifically designed to support ad hoc query and usually populated with data from EHRs and other clinical support systems in a hospital or health system |
| Clinical Decision Support: the provision of evidence-based medical advice to providers, ideally within the context of decision making using their EHR |
| Clinical Document Architecture (CDA): an XML-based markup standard intended to specify the encoding, structure, and semantics of clinical documents |
| Clinical Information Modeling Initiative (CIMI): an independent collaboration of major health providers to improve the interoperability of healthcare information systems through shared and implementable clinical information models |
| CONNECT: ONC supported open source software for managing the centralized model of HIE |
| Consolidated CDA (CCDA): the second revision of HL7’s CDA that attempts to introduce more standardized templates to facilitate information sharing (a mandate of Meaningful Use 2) |
| Context Management Specification (CMS): standards to allow diverse and non-interoperable systems to present data to end users as though it all comes froma single system |
| Continuity of Care Document (CCD): an XML-based patient summary based on the CDA architecture |
| Continuity of Care Record (CCR): an XML-based patient summary format that preceded CDA |
| Controlled studies: random and blind assignment of patients into experimental groups, typically to test the efficacy and cost effectiveness of alternate forms of treatment |
| Current Procedural Terminology (CPT): the American Medical Association’s standard for coding medical procedures |
| D |
| Data Lockers: an HIE tool for central data storage while data sources maintain control of its use |
| Data Segmentation Models: approaches to obtaining patient consent to use specific subsets of their health data |
| Data Segmentation: technologies for dividing health data into logical groups in order to obtain patient consent for sharing of some parts of their health data |
| Data Warehouse: a storage facility for data from multiple sources usually to facilitate access and analysis |
| De-identified Health Information: clinical data from which 18 specified fields are removed to prevent identifying the patient (or which has been deemed by an expert to be sufficiently manipulated to prevent identifying the patient) |
| Decision Trees: directed (no repetition) graphs to model a one-way decision making process |
| Deoxyribonucleic Acid (DNA): the genetic material that is passed down across generations and stores information unique to an individual |
| Discrete Event Simulation: a model in which entities have attributes and can wait in queues for resources |
| Distributed Query Standards: standards to request and receive specified data from diverse and distributed sources |
| Distributed Query: a request for specific data from diverse and distributed sources (e.g. HQMF) |
| Domain Name System (DNS): the naming system for computers, services, or any resource connected to the Internet (or a private network). Among other things, it translates domain names (for example, eBay.com) to the numerical IP addresses needed to locate Internet connected resources |
| E |
| e-Prescribing: the electronic ordering of prescription medications, ideally through an EHR, and the transmission of that order to a connected pharmacy of the patient’s choosing |
| eHealth Exchange: a set of standards, services, and policies that enable secure nationwide, Internet-based HIE using CONNECT or one of the commercial HIE products that support eHealth Exchange |
| eHealth Initiative (eHI): a non-profit whose members seek to improve the quality of healthcare by promoting the use of technology and information |
| EHR certification: a set of technical requirements developed by ONC that, if met, qualify an EHR to be used by an eligible professional to achieve Meaningful Use |
| Electronic Data Interchange (EDI): a format for electronic messaging that utilizes cryptic but compact notation primarily to support computer-to-computer commercial information exchange |
| Electronic Health Record (EHR): a stakeholder-wide electronic record of a patient’s complete health situation |
| Electronic Medical Record (EMR): an electronic record used by a licensed professional care provider |
| Extensible Markup Language (XML): a set of rules for encoding machine and human readable documents via tags and the language used to design CDA templates |
| F |
| Fast Health Interoperable Resources (FHIR): an HL7 initiative that seeks to use modern web standards and technologies to simplify and expedite real world interoperability solutions |
| Federated Architecture: an HIE architecture in which sensitive health data remains stored in the source systems |
| G |
| Gatekeeper: a provider (usually a primary care physician in an HMO) with overall responsibility for a patient’s care and who controls access to specialist physicians |
| H |
| Health Informatics (HIT): the set of tools needed to facilitate electronic |
| Health Information Exchange (HIE): the sharing of digital health information by the various stakeholders involved, including the patient |
| Health Information Systems Programme (HISP): a component of Direct that provides a provider directory, secure e-mail addresses, and public-key infrastructure (PKI) |
| Health Insurance Portability and Accountability Act of 1996 (HIPAA): legislation intended to secure health insurance for employees changing jobs and simplify administration with electronic transactions. It also defines the rules concerning patient privacy and security for PHI. |
| Health Level-7 (HL7): a not-for-pro.t global organization to establish standards for interoperability |
| Health Maintenance Organizations (HMOs): an organization that provides managed healthcare on a prepaid basis. Employers with 25 or more employees must cover federally certified HMO options if they offer traditional healthcare options. |
| Health Quality Measure Format (HQMF): an XML-based standard for specifying a query for a health quality metric |
| Health System: a network of providers that are affiliated for the more integrated delivery of care |
| HL7 Development Framework (HDF): the framework used by HL7 to produce specifications for data, messaging process, and other standards |
| hQuery: an ONC-funded, open source effort to develop a generalized set of distributed queries across diverse EHRs for such purposes as clinical research. It is now part of the more comprehensive Query Health Project initiated by ONC |
| Hybrid architecture: an HIE architecture that combines centralized and federated data storage |
| Hypertext Transfer Protocol (HTTP): a query-response protocol used to transfer information between web browsers and connected servers. HTTPS is the secure version |
| I |
| i2b2 (Informatics for Integrating Biology and the Bedside): a scalable query framework for exploration of clinical and genomic data for research to design targeted therapies for individual patients with diseases having genetic origins |
| Internet Message Access Protocol (IMAP): a newer (than POP) two-way email standard that provides more functionality |
| International Classification of Disease (ICD): the World Health Organization’s almost universally used standard codes for diagnoses. The current version is ICD-10, but ICD-9 is used in most US institutions. The conversion date is October 1, 2014 |
| Interoperability: the ability of diverse information systems to seamlessly share data and coordinate on tasks involving multiple systems |
| L |
| Lightweight Directory Access Protocol (LDAP): a protocol for accessing (including searching) and maintaining distributed directory information services (such as an e-mail directory) over an IP network |
| Logical Observation Identifiers Names and Codes (LOINC): the Regenstrief Institute’s standard for laboratory and clinical observations |
| M |
| Markov Decision Process (MDP):a series of probability-driven decision trees where the output of each is the input to the next |
| Markov Models: decision trees that use recursion (events can repeat), represent time and may, optionally, have memory of past events/decisions |
| Meaningful Use: a set of usage requirements defined in three stages by ONC under which eligible professionals are paid for adopting a certified EHR. The three stages are often referred to as MU1, MU2, and MU3 |
| Medicare: the federally operated program to provide healthcare services to US citizens over the age of 65 |
| Multipurpose Internet Mail Extensions (MIME): the Internet standard for the format of e-mail attachments used in Direct. S/MIME is the secure version |
| N |
| National Drug Code (NDC): the Food and Drug Administration’s numbering system for all medications commercially available in the United States |
| O |
| Office of the National Coordinator for Health Information Technology (ONC): the agency created in 2004 within the Department of Health and Human Services to promote the deployment of HIT in the United States |
| Organisation for Economic Cooperation and Development (OECD): a 34 member group of advanced countries that seeks to improve global economic development through a stronger, cleaner, fairer world |
| P |
| Patient Portal: a secure website that gives patients access to personal health information. Data typically include: recent provider visits, hospital discharge summaries, and clinical information such as medications and lab results. More advanced portals provide functions like e-mail to the provider, appointment scheduling, and prescription renewal requests |
| Pay for Performance (P4P): an approach to pay for healthcare that rewards physician performance against certain defined quality metrics |
| Personal Health Record (PHR): typically a web page where health data and information related to their care is maintained by the patient |
| PopMedNet: a technology for reporting population level data from diverse and distributed sources |
| Primary Care Physician (PCP): the generalist in a patient’s care team who assumes overall responsibility for all their health issues and often the gatekeeper who must generate referrals to specialists |
| Privacy Consent Models: approaches to obtaining patient consent for sharing clinical data |
| Privacy: assuring that clinical data is only shared according to patient specified preferences |
| Private Key: the protected (known only to its owner) part of the special pair of numbers used to encrypt documents using PKI |
| Process mining: inferring overall processes from discrete data collected from/about events that are part of the process |
| Protected Health Information (PHI): any health or health-related information that can be related back to a specific patient. PHI is subject to HIPAA regulations |
| Provider: health professionals, including physicians, nurse practitioners, physicians’ assistants, that are engaged in direct patient care |
| Public Key Infrastructure (PKI): a widely used system for protection of documents, messages, and other data that rests on a pair of public and private keys to allow for a variety of use cases |
| Public Key: the public part of the special pair of numbers used to encrypt documents using PKI |
| Q |
| Quality Reporting Document Architecture (QRDA): an XML standard for reporting quality metrics usually in response to an HQMF query |
| Query Health Project: ONC’s workgroup to identify the standards and services for distributed population health queries to certified EHRs and other patient data sources, such as HIEs |
| R |
| Reference Information Model (RIM): a pictorial representation of the HL7 clinical data (domains) that illustrates the life cycle of an HL7 message or groups of related messages |
| Registration Authority (RA): an entity that collects information for the purpose of verifying the identity of an individual or organization and produces a certificate request |
| Rescue Care: high technology care of patients with acute life threatening diseases or conditions |
| Resource Description Framework (RDF): a framework for representing information on the Web using uniform resource identifiers (URIs) to name the relationship between things as well as the two ends of the link |
| RESTful Web Services (REST): a software architecture providing interoperability between computer systems on the Internet |
| S |
| Security: limiting access to data to only those who are authorized to access it |
| Semantics: the meaning of words or expressions |
| Simplified Mail Transport Protocol (SMTP): the Internet standard for e-mail used by Direct. The secure version is S/SMTP |
| SMART on FHIR: a technology layer that defines a way for health apps to connect to EHR systems with appropriate security guarantees |
| Syntactics: the structure of words or expressions |
| Systemized Nomenclature for Medicine (SNOMED): a comprehensive, hierarchical healthcare terminology system |
| T |
| Telemedicine: the use of telecommunications-based technologies to deliver remote medical care, monitor patients, or provide other healthcare services |
| Trust: assuring that data is being shared with the person or entity with whom it is supposedly being shared |
| Uniform Resource Identifier (URI): a string of characters used to identify a resource |
| w |
| Web Services: software that makes itself available over the internet via an open standard such as XML |
| X |
| X.509 Digital Certificate: the technical name for an electronic document issued by a CA that uses a digital signature to bind a public key with an identity based on information from an RA |