April 14, 2008

Looking for Definition — The NAHIT Outlines Five Key HIT Terms
By Tracy Meadowcroft
For The Record
Vol. 20 No.8 P. 6

To-may-to, to-mah-to. Po-tay-to, po-tah-to.

Fred Astaire and Ginger Rogers may have talked about calling the whole thing off when they sang those now-famous lyrics back in the 1930s, but that isn’t the case today for some members of the HIT world.

With the advent of certain electronic technology in the healthcare field, as well as organizations devoted to making the sharing of health information easier, another kind of po-tay-to, po-tah-to problem was bound to crop up. That’s because one facility’s electronic medical record (EMR) may be another’s electronic health record (EHR)—and there is a difference.

Recently, the Office of the National Coordinator (ONC) enlisted the National Alliance for Health Information Technology to craft standardized definitions for five key HIT terms: EMR, EHR, personal health record (PHR), health information exchange (HIE), and regional health information organization (RHIO). The hope is to facilitate further adoption of electronic technology and establish information sharing groups designed to improve the quality of healthcare, as well as ensure their success and prevent any further confusion.

According to Jane Horowitz, the alliance’s vice president and chief marketing officer, the need for more standardized definitions for these terms came about “because everything we’ve been working on for the past couple years [in the healthcare industry] has been about sharing information, and a lot of these terms have been used inconsistently in contracts, regulations, and potential legislation. You’ll find a very different definition of EHR when you look at some of the healthcare IT bills that have sat on the floor of the Senate than the definition that may appear in the Stark rules. It really is about getting some consistency of language and understanding of how these terms are used and what are their conventions of use.”

But just how many definitions for these HIT terms are currently being used? In the interim draft report of the alliance’s work “Defining Key Health IT Terms,” it is noted from the research done by the organization’s two workgroups involved in creating the standardized definitions that the following number of unique definitions were found: 63 for EHR, 36 for PHR, 26 for EMR, 20 for HIE, and 18 for RHIO. These numbers were the result of a comprehensive search of all the organizations that would have reason to use a definition for one or more of these terms, according to Horowitz.

“That gives you a sense of the issue, especially when you’re trying to work with vendors and contracts,” she explains. “So having the right language is the start of forming good policy and good contracts. But also, these terms are generally defined in a way that you and I as consumers of healthcare wouldn’t understand.”

The alliance began working on this project with the ONC in September 2007, holding the first workgroup meeting on November 30, 2007. There are two workgroups involved in the process, with the Network group devoted to definitions for HIE and RHIO and the Records group dealing with EMR, EHR, and PHR. The workgroups consist of many HIT stakeholders, including providers, vendors, and members of the legal profession, especially those with experience concerning medical records.

In January 2008, a public forum was held in Washington, D.C., to discuss the workgroups’ progress to that point. “We weren’t that far along in the process, but we sensed we were going in the right direction by the comments we received [during the forum],” says Horowitz.

“They’re more than just a concise, two-sentence definition that you would find in the dictionary,” she adds of the definitions. “They’re closer to the way you would define something in an encyclopedia. There’s background information that leads you to the definition, and then we have worked our way through what are the distinguishing characteristics because part of the assignment was not just to define those terms but also [to find out] where they differ from each other and where they relate.”

The initial versions of the standardized definitions centered on the current ones that appeared to be most common. “We didn’t want to start with a clean slate,” says Horowitz. “We wanted to start with what’s out there and then tear that apart and build it up. We want to align with where the efforts are going, and we just want to make sure we can create a distinction among those terms.”

After the public forum, the workgroups examined the questions that were posed to further refine their research. “By answering those questions, it really helped us flesh out some of the work we were doing, question some of the directions we were heading, and determine if we had a good, solid basis to make those recommendations,” Horowitz explains.

An online comment period occurred after the public forum and before the draft report was presented for discussion during the recent HIMSS conference in Orlando, Fla. There were two sessions about the report held during the conference—one centering on the definitions for EMR, EHR, and PHR and the other for HIE and RHIO.

By the time the conference had commenced, Horowitz says, “We were pretty far along in the work that we were doing and said at that point, all we would be doing was moving words around on the page. So we had to get public comment to make sure that we had explained interoperability correctly, that we had explained what we meant by this term and that term. Also, where were some of the potential ambiguities, or what was something that could be perceived as emotionally charged? We wanted to understand where those barriers would be to the adoption and endorsement of the work that we were doing.”

Horowitz says that like before, the questions posed by the HIMSS audience mirrored many of those during the workgroup sessions. “So the thinking was quite parallel,” she says, “and it really does tell you that yes, in fact, there is a misunderstanding of what [certain] terms are.”

A third draft of the report was due for public comment by mid-March, with the final report due to the ONC by April 28. The American Health Information Community will have the final approval of the definitions.

“I think it really comes down to three points,” says Horowitz of the need for these standardized HIT definitions. “First, because it’s really about sharing information and the coordination of care” among healthcare professionals, especially when dealing with chronic illnesses such as diabetes. “Second, when you provide individuals with that kind of electronic access to their providers … they can take greater responsibility for their health,” she says. “And that is really key, and that is where we’re really heading. And third, when there’s broad and deep aggregation of health data, you can provide that information to analyze trends.”

Updates to the definitions will occur as technology and information sharing organizations (hopefully) flourish, with comprehensive reviews done before any changes are made final, according to Horowitz.

And if all goes well with the creation of these standardized definitions, no matter whether a member of the healthcare community says po-tay-to or po-tah-to, it will sound the same to everyone.

— Tracy Meadowcroft is the production editor at For The Record.

Draft Definitions
The following is a portion of the draft definitions for the five HIT terms as found in the interim draft report of “Defining Key Health IT Terms” made available at the HIMSS conference:

Electronic medical record: A computer-accessible resource of medical and administrative information available on an individual collected from and accessible by providers involved in the individual’s care within a single care setting.

Electronic health record: A computer-accessible, interoperable resource of clinical and administrative information pertinent to the health of an individual. Information is drawn from multiple clinical and administrative sources and is used primarily by a broad spectrum of clinical personnel involved in the individual’s care, enabling them to deliver and coordinate care and promote wellness.

Personal health record: A computer-accessible, interoperable resource of pertinent health information on an individual. Individuals manage and determine the rights to the access, use, and control of the information. The information originates from multiple sources and is used by individuals and their authorized clinical and wellness professionals to help guide and make health decisions.

Health information exchange: The electronic movement of any and all health-related data according to an agreed-upon set of interoperability standards, processes, and activities across nonaffiliated organizations in a manner that protects the privacy and security of that data and the entity that organizes and takes responsibility for the process.

Regional health information organization: A multistakeholder governance entity that convenes nonaffiliated health and healthcare-related providers and the beneficiaries they serve for the purpose of improving healthcare for the communities in which it operates. It takes responsibility for the processes that enable the electronic exchange of interoperable heath information within a defined contiguous geographic area.

For more information, visit http://definitions.nahit.org.