EHR Glossary of Terms | Integration

The nomenclature of the healthcare integration world can be somewhat of a puzzle to those outside of the industry. In this post, HCIintegrate Vice Presidents Mark Jackson and Scott Hassler provide a helpful definition guide to some of the terms and phrases you will hear when discussing healthcare IT integration. Click here to download a printer friendly document of these terms to hand out to your team. 

Integration Terms

Connect / Direct
Direct exchange describes the push of health information from a sender to a known receiver, similar to a how an email or fax is pushed from one endpoint to another.

CONNECT is a software stack that implements health exchange specifications. The Direct Project is a project to create transport specifications for directed exchange. The CONNECT roadmap includes support for the Direct specifications, which will allow any organization using CONNECT to implement the Direct specifications.

Data Conversion
Extracting data elements that are pertinent to the functionality and decision-making process of the new EHR solution.

Data Migration            
The process of transferring data between storage types, formats, or computer systems. It is a key consideration for any system implementation, upgrade, or consolidation.

Data Workflows         
A workflow is defined as a series of tasks within an organization to produce a final outcome.  Data workflows are translating those defined series into a diagram that shows what data is used and the origins of that data.

EDI       
Electronic Data Interchange.  This is an electronic communication system that provides standards for exchanging data via any electronic means

Functional Testing   
This is the testing phase that assists in the determination of the Application or Integration module readiness.  This phase determines if the individual interfaces or Application modules are functioning as designed.

HIE       
Health Information Exchange. This is the transmission of healthcare-related data among facilities, health information organizations (HIO) and government agencies according to national standards. HIE is an integral component of the health information technology (HIT) infrastructure under development in the United States and the associated National Health Information Network (NHIN).  To meet requirements, HIE technology must enable reliable and secure transfer of data among diverse systems and also facilitate access and retrieval data. The purpose of HIE development is to improve healthcare delivery and information gathering.

Historical Data            
Also known as Legacy data.  This is the data that is identified as valuable information to be included in the Data conversion and Data Migration processes.

HL7 Analyst - Resource         
An integration resource that is assigned to a project that is familiar with the HL7 interface language format. It is not necessarily required that this person be familiar with a particular Interface engine, but it is important that this resource is knowledgeable in interface communication and data workflows.

Integrated Testing    
This is the testing phase that assists in the determination of the Application or Integration overall readiness.   It will often show the readiness for the pending Go Live event.  This is the most formal of the testing phases and follows defined Integration scripts as a method of testing each step of the business workflows.

Integration Project Management   
This is the Project management level for Integration.  Creating timelines and milestones for each Integration project is important to the overall implementation for the Health System.  The Integration Project Manager or Lead is usually tasked with creating, monitoring and reporting status of the Integration steps and Project Plan.  High Level of detail is required for this resource.

Integration Assessment        
The process of evaluating the Integration pieces of a Health System.  Reviewing Integration structure, hardware, connectivity, Issues, readiness and Disaster Recovery options is all part of this task.  Detailed resources are required for this piece as well, to best design a gap analysis for the Health System's current status.

Integration Conversion Programmer          
This is a resource that has not only Integration experience, but also a programming background.  Data conversions often require custom programming to format or extract data from external systems. 

Integration Data Architect  
This is a resource that requires a high level of detail and knowledge of Integration.  This resource is used to plan for Data Conversions and Data Migrations.  Documentation of existing data workflows and detailed views of data flow throughout the entire Health System.

Integration Testing Coordinator    
This is a resource that requires a high level of detail and knowledge of Integration Testing.  The ability to understand data flow processes and help translate that knowledge into usable Testing scripts for all phases of testing.  The ability to lead testing sessions that can consist of a large number of resources working together in multiple locations throughout the Health System.

Interface          
A point where two systems meet and interact.  Typically this is the transfer of data from one system to another via Point-to-Point or through an Integration engine.

Interoperability
Is the ability of making systems and organizations work together (inter-operate).

Legacy Support           
Support of any and all legacy interfaces that will be replaced with the new EMR implementation. 

LOINC 
Logical Observation Identifiers Names and Codes (LOINC) is a database and universal standard for identifying medical laboratory observations. It was developed and is maintained by the Regenstrief Institute, a US non-profit medical research organization, in 1994.

Mapped Record Testing
This is the phase of testing that incorporates all the tables and lists that are included in the EMR and Ancillary systems.  Testing every possible value that can come out of the Sending system to validate that it will function in the receiving system appropriately.

Mapping
This is a task that is usually takes place during the interface build.  Matching specifications from sending and receiving systems, for Integration purposes. 

Regression Testing  
This type of testing involves executing test scripts that that will validate all application/system functionality after system upgrades have been performed.  The key to this testing is to ensure that the upgrades have not broken existing functionality or introduced new faults.

Script Development 
This task is performed as early as possible during the Integration project.  It is translating the Business workflows and data workflows into readable and usable testing scripts that will be used during the Integration Testing phase.  Usually led and managed by the Testing Coordinator.

SNOMED           
The primary purpose of SNOMED CT is to encode the meanings that are used in health information and to support the effective clinical recording of data with the aim of improving patient care. SNOMED CT provides the core general terminology for electronic health records.

Support Contracts    
Contracts that are established between HCI and Health Systems to support existing Interfaces.  We have numerous contracts available, including custom contracts to handle all needs.

Test Plan Development         
This task is performed early during an integration project.  It is performed by the Integration Project Manager along with the overall Project Manager to make sure the Integration tasks are included in the overall project plan.  This listing of tasks and milestones are monitored and reported on by the Integration Project Manager to keep Leadership and team members aware of progress and issues.

Testing             
Made of multiple phases, it consists of the steps that will determine the readiness of systems. 

Translation   
This task is performed during the Mapping task that will help match existing values and codes from the different systems throughout the Health System.  Each system is built with a standard set of codes and values, but they often do not match.  It is important that this task be handled during the mapping task and is included in any and all specification reviews.

Unit Testing               
This is a phase of testing that includes multiple modules working together in cooperation to determine specific outcomes.  i.e. EMR system working with a Lab system, along with the Interface engine to confirm that data is being passed correctly and in the correct format.  This will confirm that the business workflow for the particular ancillary system will meet the defined requirements.  This is typically the phase of testing that precedes Integration Testing.

Interface Messages

ADT
Admission, Transfer and Discharge interface transactions.  This transactions help populate the Sending and Receiving systems with Patient Demographics and Other valuable patient information that is required for future interface transactions and functions.

Charges
Financial transactions that are sent from Ancillary systems to the Patient Accounting system for Billing purposes.  Sends the information such as quantity and Price for tests that are performed.

Device Integration    
Observation transactions that are sent from monitoring devices to the EMR system to track vitals and other observed patient metrics.

MDM   
The Medical Document Management (MDM) transaction set supports transmission of new or updated documents or information about their status(es).  The trigger events and messages may be divided into two broad categories. One which describes the status of a document only and the other that describes the status and contains the document content itself.

MFN     
Master Table Updates that are sent to keep Sending and receiving systems in sync.

Orders               
Clinical Transactions that are sent from the EMR or ancillary systems that identify specific tests that are ordered by the Physicians for their patients.  These transactions included test names, the physician requesting the tests and the frequency that the test should be performed.

Results              
Clinical Transactions that are sent form the ancillary systems to notify the physicians of the values and results of the tests that were ordered.

Transcription              
Clinical Transactions that are sent from the Ancillary systems that include reports dictated by the physicians based on their observations of the patients or results presented to them by the ancillary system.

Integration Languages

CCD - Continuity of Care Document             
The Continuity of Care Document (CCD) specification is an XML-based markup standard intended to specify the encoding, structure, and semantics of a patient summary clinical document for exchange. The CCD specification is a constraint on the HL7 Clinical Document Architecture (CDA) standard.

CCDA  
The Clinical Document Architecture (CDA) is a markup standard developed by the organization Health Level 7 International (HL7) to define the structure of clinical documents such as discharge summaries and progress notes. These documents can include text, images and other types of multimedia.

The Clinical Document Architecture is based on XML, the Extensible Markup Language. Meanwhile, to represent health concepts, the CDA uses HL7’s Reference Information Model, which aims to put data in a clinical or administrative context and to express how pieces of data are connected, and coding systems such as Systematized Nomenclature of Medicine -- Clinical Terms (SNOMED CT) and Logical Observation Identifiers Names and Codes (LOINC).

Dicom
Digital Imaging and Communications in Medicine (DICOM) is a standard for handling, storing, printing, and transmitting information in medical imaging. It includes a file format definition and a network communications protocol.

Flat File            
The data format that is sent with specific lengths and locations.  Data transaction size is not determined on the amount of data sent by the system.

Delimited        
The data format that is sent with a specific delimiter for each field.  Typical delimiters include Commas or Pipes that separate the data fields.  These transactions are various lengths.

HL7
Health Level 7.  HL7 is an international community of healthcare subject matter experts and information scientists collaborating to create standards for the exchange, management and integration of electronic healthcare information.
HL7, which is an abbreviation of Health Level Seven, is a standard for exchanging information between medical applications. This standard defines a format for the transmission of health-related information. Information sent using the HL7 standard is sent as a collection of one or more messages, each of which transmits one record or item of health-related information. Examples of HL7 messages include patient records, laboratory records and billing information.

IHE Profiles   
IHE Profiles organize and leverage the integration capabilities that can be achieved by coordinated implementation of communication standards, such as DICOM, HL7 W3C and security standards. They provide precise definitions of how standards can be implemented to meet specific clinical needs.

SOAP   
SOAP (Simple Object Access Protocol) is a way for a program running in one kind of operating system (such as Windows 2000) to communicate with a program in the same or another kind of an operating system (such as Linux) by using the World Wide Web's Hypertext Transfer Protocol (HTTP)and its Extensible Markup Language (XML) as the mechanisms for information exchange.

X12      
Standards defining the structure, format, and content of business transactions conducted through Electronic Data Interchange (EDI). ANSI X12 is produced by the committee ASC X12, supported by the Data Interchange Standards Association, Inc.

XDS.b
The IHE XDS.b Integration Profile is the basis for IHE work in the area of security (see XUA Supplement) and Cross Community communication (see XCA Supplement).   Cross-Enterprise Document Sharing. Focused on providing a standards-based specification for managing the sharing of documents between any healthcare enterprise, ranging from a private physician office to a clinic to an acute care in-patient facility and personal health record systems. This is managed through federated document repositories and a document registry to create a longitudinal record of information about a patient within a given clinical affinity domain. These are distinct entities with separate responsibilities:

A Document Repository is responsible for storing documents in a transparent, secure, reliable and persistent manner and responding to document retrieval requests.

A Document Registry is responsible for storing information about those documents so that the documents of interest for the care of a patient may be easily found, selected and retrieved irrespective of the repository where they are actually stored.

Documents are provided by one or more Document Sources

They are then accessed by one or more Document Consumers

XML     
Extensible Markup Language (XML) is a markup language that defines a set of rules for encoding documents in a format that is both human-readable and machine-readable. It is defined in the XML 1.0 Specification produced by the W3C, and several other related specifications, all free open standards.

Integration Protocols

Async  
At the higher data link layer of communication, asynchrony is synonym of statistical multiplexing, such as in packet mode. The information transmission may or may not start immediately as requested by sender, the additional delay being caused by medium congestion.

FTP      
The File Transfer Protocol (FTP) is a standard network protocol used to transfer computer files from one host to another host over a TCP-based network, such as the Internet. FTP is built on a client-server architecture and uses separate control and data connections between the client and the server.

sFTP    
The SSH File Transfer Protocol or SFTP is a network protocol that provides file transfer and manipulation functionality over any reliable data stream. In WISE-FTP it is used with the SSH-2 protocol to provide secure file transfer, but is intended to be usable with other protocols as well.

SNA      
Systems Network Architecture (SNA) is IBM's proprietary networking architecture, created in 1974. It is a complete protocol stack for interconnecting computers and their resources.

TCPIP 
Transmission Control Protocol/Internet Protocol (TCP/IP) is the suite of communications protocols used to connect hosts on the Internet.  Typically the most used protocol to connect interfaces via IP Address and Port Number.

Integration Engines