Group issues final definitions for health IT terminology

Industry experts hope a uniform vocabulary will encourage technology adoption by ending confusion over contracts and legislation.

By Dave Hansen — Posted June 16, 2008

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EHR, EMR, PHR -- what's the difference? Any physician pondering the purchase of health information technology could well ask that question. Now a national organization working for the government has come up with the answer.

The National Alliance for Health Information Technology, a nonprofit organization focused on how health IT can improve outcomes, on May 20 announced uniform definitions for electronic health record, electronic medical record, personal health record, health information exchange and regional health information organization. It also invented a new term: health information organization, a body overseeing the transmission of electronic information.

These terms are the building blocks of the health IT infrastructure necessary for doctors, hospitals and others to use and to confidentially share patient-focused electronic health information, the alliance states in the April 28 report presenting its final definitions. But the terms meant different things to different people. For example, NAHIT found 63 definitions of electronic health record in use in the medical community.

The lack of common definitions caused confusion about the products doctors and others were purchasing, as well as about health IT contracts, legislation and regulation, the report states.

The ambiguity created an obstacle to health IT adoption and hindered its potential to improve health care quality and lower costs.

A uniform set of definitions will simplify health IT contracting and give legislators and regulators standard terms to use, NAHIT states.

The U.S. Office of the National Coordinator for Health Information Technology hired the alliance to handle the project. NAHIT will send the definitions to the American Health Information Community, a federal advisory board, in early June. If accepted, the definitions will become the language used by the Dept. of Health and Human Services, said Jane Horowitz, NAHIT's vice president and chief marketing officer. The medical community will begin adopting the terms as HHS starts using them and incorporates them into contracts, she said.

The standard definitions will speed health IT adoption, predicted Mark Leavitt, MD, PhD, chair of the Certification Commission for Health Information Technology. "Once people understand what they are buying and investing in, it makes it safer."

Promoting interoperability

The terms aim to foster health information technology interoperability, said Horowitz, who led the project. NAHIT focused on this issue because the public comments it received in March on the proposed definitions made it clear the health care community wants interoperability, she said.

Doctors should verify the interoperability of a system with the Certification Commission for Healthcare Information Technology, said Donald Mon, PhD, vice president of practice leadership at the American Health Information Management Assn., a professional society that aims to advance best practices and standards for health information management. The certification commission is the sole organization recognized by the federal government to certify interoperability, Dr. Leavitt said.

Physicians who have health IT might be concerned that their systems will be obsolete if they aren't interoperable, Dr. Leavitt said. CCHIT-certified systems are compatible and probably will stay that way, he said.

"Most people want their products to keep up with the latest standards, so you can expect an update to your software if you buy a certified product," Dr. Leavitt said. "If you don't, you're on your own." About 200 vendors are marketing electronic record systems, and more than 100 are certified, he noted.

NAHIT made several critical distinctions when writing the definitions.

The terms EMR and EHR were frequently interchanged in the health care community. Now EMR refers to a single record within a group, while an EHR is a record shared between health care organizations.

The alliance also found that the term health information exchange has two meanings in the medical community: transmitting information and governing its exchange. To clarify, NAHIT created the term health information organization for oversight bodies.

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What's the word?

Standard definitions by the National Alliance for Health Information Technology:

Electronic medical record: Information on a patient that can be created, gathered, managed and consulted by authorized clinicians and staff in one health care organization.

Electronic health record: Information on a patient that conforms to nationally recognized interoperability standards. It can be created, managed and consulted by authorized clinicians and staff across more than one group.

Personal health record: Information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources. It is controlled by the patient.

Health information exchange: Electronic movement of health information among organizations according to nationally recognized standards.

Health information organization: A body that oversees and governs the exchange of health information among organizations according to nationally recognized standards.

Regional health information organization: A body that brings together health care stakeholders within a defined geographic area and governs health information exchange among them to improve health and care.

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Health IT confusion

In a literature review, the National Alliance for Health Information Technology found that the medical community used multiple definitions for common health IT terms.

Health IT term Definitions
Electronic health record 63
Personal health record 36
Electronic medical record 26
Health information exchange 20
Regional health information organization 18

Source: National Alliance for Health Information Technology

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External links

National Alliance for Health Information Technology (link)

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