EMR Implementation & HITECH Act Blog

The Acronyms of HITECH: What Do They All Mean? (Part 1)

The effort to create an NHIN and implement electronic medical records/electronic health records (EMR/EHRs) available through RHIOs while still complying with HIPAA has created an alphabet soup of terms, acronyms and initials in various combinations.

To help you sort out what all these terms mean, we have created a short glossary.   This is Part 1 (Part 2 will be published tomorrow).  Because almost everything here seems to be subject to change, this will be a living document of sorts.

AHIC – American Health Information Community

The AHIC was a federal advisory panel created by HHS to make recommendations about the implementation of health information technology.   In November 2008, after making more than 200 recommendations, it was decommissioned and became a private organization called the National eHealth Collaborative.

ARRA – American Recovery and Reinvestment Act (ARRA)

The ARRA is a law approved by the 111th congress and signed into law by President Obama in February 2009.  Also called the economic stimulus bill, ARRA authorized the spending of more than $750 billion to kick-start the U.S. economy.   Part of the ARRA is the HITECH Act, which authorized more than $20 billion in incentives to help the health care industry adopt health information technology and EMR / EHRs.

ASTM

ASTM International (formerly the American Society for Testing and Materials) is an international standard-setting organization based in Pennsylvania.   Over more than 100 years, it has created thousands of standards in industries as diverse as plastics, rubber and metals.

CCD – Continuity of Care Document

CCD is a set of specifications and standards for electronic medical records that was developed by HL7.   The CCD specification takes HL7s Clinical Document Architecture and combines it with elements of ASTM’s CCR specification.

CCD is one of two primary standards for the electronic assembly and transmission of medical records.  The other is CCR.  So far, neither proposed standard has been adopted by CCHIT for use in EMR/EHRs.  Chances are you won’t even know which standard a program uses — the rules mostly operate at the programming level.   For the user entering and sending data, the whole thing will be pretty much invisible.

CCR – Continuity of Care Record

CCR is a set of specifications and standards for electronic medical records jointly designed by the ASTM, medical professionals and health informatics specialists.   The continuity of care record contains the core information needed by doctors to treat their patients: patient information, insurance data, medications, diagnoses and problem lists, allergies, etc.  The CCR is designed to be easily created by a provider after a patient encounter.  The CCR uses the XML data interchange language, so it can easily be read, translated, understood and transmitted by EMR/EHR software.

CCR is one of two primary standards for the electronic assembly and transmission of medical records.  The other is CCD.   So far, neither proposed standard has been adopted by CCHIT for use in EMR/EHRs.   Chances are you won’t even know which standard a program uses — the rules mostly operate at the programming level.   Again, for the user entering and sending data, the whole thing will be pretty much invisible.

CCHIT – Certification Committee for Health Information Technology

The CCHIT is a non-profit organization founded in 2004 for the purpose of advancing the adoption of Electronic Health Records and health information technology.   CCHIT has been designated by the U.S. Government as the organization responsible for certifying EMR/EHR software.   If you want the incentives available from the government to adopt HIT, you’ll have to use CCHIT-certified products.

CDR – Clinical Data Repository

The clinical data repository is a name for the database where all the information about a patient resides.   It includes such information as X-rays, blood test results, medications and care notes – a continuous, ongoing record of a patient’s medical history.

CMS – Centers for Medicare and Medicaid Services

The CMS is the blanket government organization that manages both the Medicare and Medicaid programs.   It is also the organization responsible for disbursing the $20 billion in incentives available for the adoption of HIT.

CPOE – Computerized Physician Order Entry

Every time a provider wants an action to take place, such as giving a patient a medicine, ordering blood samples or changing a diet, he or she writes an order.  In the past, the doctor wrote the order by hand. but paper orders can be lost or improperly transcribed, leading to potential problems.   With a CPOE, the doctor writes orders using a computer. Patient data and decision support tools are right there to help.  One great benefit of CPOE – especially when it come to medicines – is that it eliminates any problems related to poor handwriting.

Decision Support

Decision support systems (DSS) are computerized programs that can help doctors make decisions.  A DSS for prescribing, for example, will generally include a knowledge base of drug interactions.   A doctor puts into the program a list of a patient’s current medicines and a diagnosis.  The decision support system compares that list to its knowledge base and gives the doctor a list of medicines he could prescribe that won’t create an adverse interaction. The DSS helps the doctor and saves him time, but it does not make the decision in the doctor’s place.

EHR/EMR/PHR– Electronic Health Record/Electronic Health Record/Personal Health Record

We put these three together because people often use them interchangeably.  “EMR” stands for Electronic Medical Record, “EHR” stands for Electronic Health Record and “PHR” stands for Personal Health Record.  There seems to be a great deal of controversy over which term means what. The definition seems to vary depending on who is doing the defining – a vendor, a doctor or a consultant.  Well, to add to the confusion, here is what the government says.  The following three definitions were taken from the U.S. Department of Health and Human Services website.

An Electronic Medical Record is  “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.”

An Electronic Health Record is “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.”

A Personal Health Record is “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.

Make of these what you will, because chances are the working definitions will change even more as time goes on.

Encryption

Encryption is the use of a mathematical algorithm (called a cipher) to take unencrypted data (plaintext) and make it an unreadable jumble of characters (ciphertext) to anyone who doesn’t have the unique tool to unencrypt it (the key).   To anyone intercepting an encrypted message, it will look like gibberish.   The key is not a physical key, but rather a string of characters (letters, numbers and symbols) that will tell a computer how to convert the data back into plaintext.

HCPCS – Health Care Common Procedure Coding System

This is a numbering system used by anyone who bills Medicare.   Every product or service Medicare might pay for has an alphanumeric code to be used for billing purposes.   In order to be reimbursed by the government, the doctor must use this billing code system.

There are two primary levels of codes – Level I and Level II.   Level I codes are identical to the CPT codes created by the American Medical Association, and include services rendered by doctors, such as a flu shot (code 90658) or stitching up a 1” cut (code 12002).   Level II codes will cover the gauze bandage (code A6216) or the wipes to clean the wound (A4245).

HHS – Health and Humans Services

Health and Human Services (HHS) is the department of the U.S. government that is responsible for overseeing the implementation of EMR/EHRs under the HITECH Act.  Medicare and Medicaid are part of HHS.

Health Informatics

Health Informatics is the use of computers and information management in a health care setting.   Things that fall under the banner of health informatics include EMRs, medical coding systems, practice management software and medical records management.

Rich Silverman                                                                                                                                                                                                      PCHS Blogging Team

Photo by Tillwe courtesy of FLick’r under a Creative Commons Share-Alike License

Posted by PC Healthstop Blogging Team