Health IT Definitions
Click on "Meaningful Use Regulation for Electronic Health Records" for an exposition on the final Meaningful Use rules straight from the horse's mouth—David Blumenthal, MD, MPP, and Marilyn Tavenner, RN, MHA, at the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid
Widely used but frequently misunderstood, the electronic health record (EHR)—also called an electronic patient record (EPR) or computerized patient record (CPR)—is an evolving concept now commonly defined as a longitudinal collection of shared and comprehensive electronic health information about individual patients. This digital record must be capable of being shared within and across different healthcare settings, via an enterprise-wide, network-connected information system. Such records may include a whole range of information in comprehensive or summary form, including demographics, medical history, medication and allergies, immunization status, laboratory test results and radiology images. Billing information may also be included.
The purpose of an EHR is to create a complete, electronically accessible record of patient encounters that helps automate and streamline healthcare workflow. It also helps reduce medical errors, and promote patient safety and quality through such tools as barcode-enabled medication administration (BCMA) and computerized physician order entry (CPOE) systems, as well as more in-depth tools such as evidence-based clinical decision support, quality management and outcomes reporting. Security of the data—and protection of the patient's right to privacy by controlled access to information on an as-needed basis—is a critical requirement.
Click here to access Wikipedia's definition and citations, as well as a link to a larger version of the screenshot below, which depicts a sample patient record view from the world's most popular EHR, the VistA system developed by the Veteran's Health Administration, and upon which Medsphere's OpenVista is based.
Before disbanding in September of 2009, the National Alliance for Health Information Technology clarified the definition of a variety of commonly misused terms as follows:
Electronic Medical Record—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 healthcare organization.
Electronic Health Record—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 healthcare organization.
Personal Health Record—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—The electronic movement of health-related information among organizations according to nationally recognized standards.
Health Information Organization—An organization that oversees and governs the exchange of health-related information among organizations according to nationally recognized standards.
Regional Health Information Organization—A health information organization that brings together healthcare stakeholders within a defined geographic area and governs health information exchange among them for the purpose of improving health and care in that community.
What is VistA?
VistA is an electronic health record (EHR) programmed by Federal (US) employees working for the Department of Veterans Affairs (previously Veterans Administration) for several decades, since the late 1970s. It's public domain software. It is considered by many to be a national treasure. For a more complete coverage of the question you should read What is VistA Really.
Four flavors of VistA
At the present time, VistA comes in only four flavors:
- FOIA VistA—Click here to download this (unlicensed) public domain
- WorldVista—Click here to download this (GPL type license) software.
- OpenVista—Click here to download this (AGPL type license) software.
- vxVista—This (EPL type license) software is not downloadable.
- Others—da Vinci Vista, VOE Vista and Hui Vista don't exist and/or are not maintained anymore.
VistA's IHS cousin: RPMS
Another public domain EHR, RPMS was programmed by the Indian Health Service beginning in the late 1960s, and thus predates VistA. From the 1960s to the 1980's, it was a different architecture. Since the 1980s, it uses the same architecture as VistA. While RPMS shares a lot of features with VistA, it's much stronger in population-based and outpatient-based electronic health records.
According to the IHS, RPMS is "an easy and integrated way to effectively manage resource and patient information." It is "an integrated solution for the management of clinical, business practice and administrative information in healthcare facilities of various sizes. Flexible hardware configurations, over 50 software applications, and appropriate network communication components combine to provide a comprehensive clinical, financial, and administrative solution. This solution is in use at most health care facilities within the Indian health care delivery system."
Click here to download RPMS.
Definition—Ecosystems vary in size. They can be as small as a puddle or as large as the Earth itself. Any group of living and nonliving things interacting with each other can be considered an ecosystem. Within each ecosystem, there are habitats that may also vary in size. A habitat is the place where a population lives. A population is a group of living organisms of the same kind living in the same place at the same time. All of the populations interact and form a community. The community of living things interacts with the non-living world around it to form the ecosystem. The habitat must supply the needs of organisms, such as food, water, temperature, oxygen, and minerals. If the population's needs are not met, it will move to a better habitat. [While interactive, the] processes of competition, predation, cooperation, and symbiosis occur. [Adapted from a definition provided by Franklin Institute, Resources for Science Learning.]
Etymology—The term ecosystem was coined in 1930 by Roy Clapham to mean the combined physical and biological components of an environment. British ecologist Arthur Tansley later refined the term, describing it as "The whole system … including not only the organism-complex, but also the whole complex of physical factors forming what we call the environment." Tansley regarded ecosystems not simply as natural units, but as mental isolates. Tansley later defined the spatial extent of ecosystems using the term ecotope.
Usage/General—Companies, organizations and other entities are increasingly using the term ecosystem to describe a collaborative community. For instance, Open eGov: an award winning collaborative software ecosystem, enables government organizations, non-profits and the private sector work together to share the cost of enhanced capabilities. Here's one of the benefits they tout to the ecosystem concept: 'The larger the community that shares the application, the more potential benefits derived by each participant. Improvements to the software may be provided or funded by any organization. All participating organizations benefit from any one’s contributions at no additional cost and with no restrictions."
Usage/Medsphere—Medsphere actively nurtures the Healthcare Open Source Ecosystem, a global community of customers, partners, developers and other online collaborators who drive OpenVista innovation and provide a parallel development and support structure.
The Freedom of Information Act was enacted by Congress in 1966 to give Americans greater access to the federal government records. The Electronic FOIA Amendments of 1996 expanded the scope of the FOIA to encompass electronic records and require the creation of "electronic reading rooms" to make records more easily and widely available to the public. Most recently in December 2005, Executive Order 13392, "Improving Agency Disclosure of Information," reaffirmed that FOIA "has provided an important means through which the public can obtain information regarding the activities of Federal agencies" and required Federal agencies to make their FOIA programs "citizen-centered and results-oriented."
In 2005, HIMSS Analytics launched the EMR Adoption Model (EMRAM) to track adoption of EMR applications within hospitals and health systems. The EMRAM scores hospitals in the HIMSS Analytics™ Database on their progress in completing 8 stages (0-7), with the goal of reaching Stage 7 – the pinnacle of an environment where paper charts are no longer used to deliver patient care. Beginning in 2009, the HIMSS Analytics Stage 7 Award honors those hospitals achieving the highest EMRAM level.
Stage 7 healthcare organizations support the true sharing and use of patient data that ultimately improves process performance, quality of care, and patient safety.
Visit the HIMSS Analytics Web site to learn more about the EMRAM and to see what percentage of U.S. hospitals qualify for each stage in the model.
CPOE is short for "Computerized physician (or provider or prescriber) order entry. The Physician Order Entry Team (POET) at Oregon Health & Science University defines CPOE as "the computer system that allows direct entry of medical orders by the person with the licensure and privileges to do so. Directly entering orders into a computer has the benefit of reducing errors by minimizing the ambiguity of handwritten orders, but a much greater benefit is seen with the combination of CPOE and clinical decision support tools.
A master patient index is a database that maintains a unique index (or identifier) for every patient registered at a healthcare organization. The MPI is used by each registration application (or process) within the HCO to ensure a patient is logically represented only once and with the same set of registration demographic / registration data in all systems and at an organizational level. It can be used as enterprise tool to assure that vital clinical and demographic information can be cross-referenced between different facilities in a healthcare system. An MPI correlates and cross-references patient identifiers and performs a matching function with high accuracy in an unattended mode. An MPI is considered an important resource in a healthcare facility because it is the link tracking patient, person, or member activity within an organization (or enterprise) and across patient care settings.
An enterprise master patient index (EMPI) is a database that contains a unique identifier for every patient in the enterprise. This would include the medical center, outpatient clinics, practice offices and rehabilitation facilities. An EMPI cross references patient identifiers across multiple information systems to uniquely identify each patient, perform global patient searches and matching, consolidate duplicate patient records, create complete views of patient information and share data across multiple facilities and information systems in real time.
Never events are defined as 28 inexcusable health care occurrences. The list, compiled by the National Quality Forum (NQF), defines never events as "adverse events that are serious, largely preventable, and of concern to both the public and health care providers for the purpose of public accountability."
Several states have passed laws, with associated remuneration or punishment, that require hospitals to disclose never events. A Leapfrog Group study found that about half of all hospitals waive fees for never events; the hospitals that do waive fees are far more likely to have perfect scores on the Leapfrog Safe Practices Score survey.
As defined by the NQF and commonly agreed upon by health care providers, the 28 never events are:
- Artificial insemination with the wrong donor sperm or donor egg
- Unintended retention of a foreign object in a patient after surgery or other procedure
- Patient death or serious disability associated with patient elopement (disappearance)
- Patient death or serious disability associated with a medication error (e.g., errors involving the wrong drug, wrong dose, wrong patient, wrong time, wrong rate, wrong preparation or wrong route of administration)
- Patient death or serious disability associated with a hemolytic reaction due to the administration of ABO/HLA-incompatible blood or blood products
- Patient death or serious disability associated with an electric shock or elective cardioversion while being cared for in a healthcare facility
- Patient death or serious disability associated with a fall while being cared for in a healthcare facility
- Surgery performed on the wrong body part
- Surgery performed on the wrong patient
- Wrong surgical procedure performed on a patient
- Intraoperative or immediately post-operative death in an ASA Class I patient
- Patient death or serious disability associated with the use of contaminated drugs, devices, or biologics provided by the healthcare facility
- Patient death or serious disability associated with the use or function of a device in patient care, in which the device is used or functions other than as intended
- Patient death or serious disability associated with intravascular air embolism that occurs while being cared for in a healthcare facility
- Infant discharged to the wrong person
- Patient suicide, or attempted suicide resulting in serious disability, while being cared for in a healthcare facility
- Maternal death or serious disability associated with labor or delivery in a low-risk pregnancy while being cared for in a health care facility
- Patient death or serious disability associated with hypoglycemia, the onset of which occurs while the patient is being cared for in a healthcare facility
- Death or serious disability (kernicterus) associated with failure to identify and treat hyperbilirubinemia in neonates
- Stage 3 or 4 pressure ulcers acquired after admission to a healthcare facility
- Patient death or serious disability due to spinal manipulative therapy
- Any incident in which a line designated for oxygen or other gas to be delivered to a patient contains the wrong gas or is contaminated by toxic substances
- Patient death or serious disability associated with a burn incurred from any source while being cared for in a healthcare facility
- Patient death or serious disability associated with the use of restraints or bed rails while being cared for in a healthcare facility
- Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed healthcare provider
- Abduction of a patient of any age
- Sexual assault on a patient within or on the grounds of the healthcare facility
- Death or significant injury of a patient or staff member resulting from a physical assault (i.e., battery) that occurs within or on the grounds of the healthcare facility
According to the Agency for Healthcare Research and Quality, "the health care safety net consists of a wide variety of providers delivering care to low-income and other vulnerable populations, including the uninsured and those covered by Medicaid. Many of these providers have either a legal mandate or an explicit policy to provide services regardless of a patient's ability to pay."
Per AHRQ, "Major safety net providers include public hospitals and community health centers as well as teaching and community hospitals, private physicians, and other providers who deliver a substantial amount of care to these populations."
Attributed to Dartmouth Medical School's Elliot Fisher, MD, Accountable Care Organizations or ACOs, share three essential characteristics:
- The ability to provide, and manage with patients, the continuum of care across different institutional settings, including at least ambulatory and inpatient hospital care and possibly post acute care
- The capability of prospectively planning budgets and resource needs
- Sufficient size to support comprehensive, valid, and reliable performance measurement
For more on ACOs, click on the "Guide to Accountable Care Organizations, and Their Role in the Senate’s Health Reform Bill" by Jordan T. Cohen, a March 11, 2010, Health Reform Watch blog of Seton Hall University School of Law's Health Law's Policy Program.