Uniform IT definitions proposed to promote understanding

Washington -- The jumble of terms in health information technology soon could be simplified. The National Alliance for Health Information Technology announced March 24 that it finished proposed definitions for five key HIT terms and will seek public comment on them until April 9.

The alliance, a nonprofit organization serving as a forum for companies and officials to debate emerging HIT issues, started its work in November 2007 for the Office of the National Coordinator for Health Information Technology. The terms are electronic medical record, electronic health record, personal health record, health information exchange and regional health information organization.

The ONC chose the terms because they are the most often confused. Lawmakers have proposed bills that use the terms in different ways, said Karen M. Bell, MD, director of the ONC's Office of HIT Adoption.

After the definitions are finalized, the ONC will officially adopt them and use them in its contract language, said alliance Vice President and Chief Marketing Officer Jane Horowitz, who leads the project. Organizations and companies should follow and operationalize the definitions throughout health care, she said.

One of the most significant developments would be distinguishing EMRs from EHRs. The two are frequently used interchangeably. The alliance proposed identifying an EMR as medical information on an individual patient from a single organization, including affiliated settings. EHRs would be data on a patient aggregated from multiple organizations.

The EMR definition is built upon the notion that a person's medical history is recorded to help a physician address an immediate health condition at a single care setting. EHRs, by contrast, intend to boost health care quality by organizing and enabling the sharing of information across care settings to allow a broad spectrum of clinicians to coordinate care for individual patients. An EMR would be a distinct building block of an individual's EHR, the alliance said.

In addition, the organization defined a personal health record as information managed and controlled by an individual, who would act like a librarian by organizing it and deciding who can "check it out." PHRs would exist separately from EHRs, which would be under the control of a health care entity.

The terms health information exchange and regional health information organization have overlapped, the alliance said. It based its definitions on their root meanings. HIE reflects the technological aspects of sharing data, while RHIO reflects the drive for better health care quality and efficiency within a region.

So the alliance defined HIE as the electronic movement of health-related data across nonaffiliated organizations in a way that protects privacy and security.

It defined a RHIO as a multi-stakeholder governing entity responsible for electronic information exchange within a geographic area. A RHIO must involve data sharing between separate entities in a defined area whose collaboration crosses organizational boundaries. It also must be focused on the greater good of a defined population area, instead of specific disease communities, such as a network exchanging information only on diabetics.

"Now is the time to be heard and provide input on the definitions," Horowitz said. "Final definitions will provide an important reference point for policy evaluation and standards development activities, and they will help explain health IT concepts in language that consumers can readily understand."

The definitions are intended to create an HIT culture based on what people should expect from the technology, Dr. Bell said. For example, patients who know that their physician has health IT capabilities should expect it to improve the quality of medical care, she said.

The latest draft of the definitions is available online . The terms are expected to be finalized and sent to the Dept. of Health and Human Services by the end of spring, Dr. Bell said.

Once the definitions are approved, the national HIT coordinator's office will start a campaign to educate the public and physicians, she added.