So many new terms are being used in discussions of health information technology. Here, we help sort out what the terms actually mean.
A process or set of rules to follow in calculations or other problem solving, typically in computing.
Algorithmovigilance refers to scientific methods and activities relating to the evaluation, monitoring, understanding and prevention of adverse effects of algorithms in health care. It is a term coined by physician Peter Embi, president and CEO of the Regenstrief Institute and associate dean for informatics and health services research at the Indiana University School of Medicine.
Artificial intelligence has the potential to help transform medical decision-making and treatment, but its algorithms must be thoroughly tested and continuously monitored to avoid unintended consequences or harms to patients, Embi wrote in a recent commentary in JAMA Network Open.
Algorithmic performance changes as it is deployed with different data, settings, and times, Embi wrote. How algorithms are used also involves human-computer interactions that add another level of variation and complexity that can change an algorithm’s performance or how its outputs are interpreted by different users, he said.
Application Programming Interfaces (APIs)
APIs are systems of tools and resources in an operating system that enable developers to create software applications. So-called “open APIs“ – where specifications are available for outside programmers to build upon – are considered important for the growth of interoperable health information technology and new innovations.
APIs are important in health IT because they allow programmers to access key data from other sources and integrate that data into their own applications. Think of an API as a conduit that allows program creators to “grab“ data sources. A good example of consumer API use is a smartphone weather app, which takes data from other sources and organizes it so you know whether you'll need sunscreen or a snow shovel.
APIs have the potential to improve interoperability and patient access to their own data. APIs can also help create more useful resources on patient care.
Artificial Intelligence (AI)
AI is the ability of a computer or robot controlled by a computer to perform tasks usually done by intelligent beings. Sophisticated machine learning is already being applied to health care and this trend is expected to accelerate in the coming years.
Augmented reality (AR) is an interactive experience of an immersive, simulated real-world environment in which objects that reside in the real world are enhanced by computer-generated information to impact the senses of sight, hearing, touch, or smell. AR requires technology components such as a processor, display, and sensors. AR can be accessed using a smartphone, tablet computer, special headset or other technologies.
This differs slightly from virtual reality. In virtual reality, a user’s perception of reality is based completely on virtual information. But in augmented reality, a user is provided with additional computer-generated information to enhance their perception of reality.
Uses of AR in medicine include: smart glasses that allow surgeons to see high-resolution, 3D representations of their patients’ anatomy (akin to X-ray vision); enhanced viewing of a fetus inside a mother’s womb; and a near-infrared vein finder that films veins under the skin and projects the image onto the skin to help with blood draws or placement of intravenous catheters, etc.
Augmented video analysis
The application of artificial intelligence to video recordings made in hospital patient rooms to help health care staff better understand alarms related to movement in those rooms. This can detect elopement (wandering) or fall risk, missed meals or medication, as well as any equipment tampering by patients or their visitors.
Automatic speech recognition (ASR)
Also known as voice recognition technology, ASR allows a person to converse with computers using normal speech and be reasonably understood and receive a response. That response might be an answer to a question, a correct prompt or by transcribing the user’s speech into readable text in real time.
ASR is made possible through natural language processing (the capability of computers to understand human language) and is used every day in the form of Google's Siri and Amazon's Alexa, for example. ASR is also used in simpler formats called directed dialogue, the best example being automated phone trees for customer service needs of banking, airlines, health care and other sectors.
ASR has a lot of potential in health care. It could be used for remote patient monitoring, for instance, or to conduct pre-appointment information gathering.
Best practice alert (BPA)
A programmed notification in an electronic health record (EHR) that occurs at a specific point in patient charting or documentation. BPAs remind clinicians of best practices they should follow in clinical decision-making. Some BPAs have a “hard stop,” meaning that the clinician must adhere to the alert before closing the patient’s EHR or moving onto the next task.
Big data is a massive volume of data – both structured and unstructured – that is too large to be processed using traditional software and database techniques. Big data is important to health care because huge amounts of data are being generated through electronic health records, wearables, public health departments, clinical studies and other sources. Collectively, this information could be used to improve disease prevention and treatment. Tech companies are developing platforms to harness this data and make it actionable to health care providers and health officials.
Unique physical characteristics such as fingerprints, voice recognition or iris scans that can be used for automated recognition of people. This is typically for the purposes of security.
Most commonly associated with digital currency such as Bitcoin, blockchain is a data structure that can be timed-stamped and signed using a private key to prevent tampering. Some view blockchain as an important development in health IT to combat cybersecurity threats and advance the free and secure exchange of health information.
Brain-computer interface (BCI)
BCI is a technology system that collects and interprets brain signals, and transmits them to a connected machine—such as a computer or robotic limb—that outputs the commands. BCIs can be directed at researching, augmenting or repairing human cognitive or sensory-motor functions. There are several types of BCIs, ranging from noninvasive (such as using MRI or electroencephalogram) to invasive (such as when a microelectrode array is implanted in the brain to transmit signals wirelessly or through a transmitter worn at the top of head).
Researchers spoke at Health Journalism 2022 about BCI projects to restore communication, mobility and independence for people with neurologic disease, injury or limb loss. Examples are using BCIs to operate a prosthetic limb, move a computer cursor, type messages, or select music or videos via a computer. Brain-controlled robots that attach a laptop or computer monitor to a base on wheels could enable homebound individuals to virtually visit other locations.
Certified Health IT
Certified health IT includes products, programs or systems that meet standards set by the federal government on their security, privacy, usability and interoperability. The Office of the National Coordinator for Health Information Technology (ONC), a division of the U.S. Health and Human Services Department (HHS), oversees health IT certification. Certified health IT participation is voluntary but providers are required to use certified health IT products and systems to participate in Meaningful Use and other federal electronic health record adoption programs.
A computer program that conducts a conversation via text or auditory program. Chatbots are often used in customer service, and increasingly in health care. Chatbots are also known as virtual assistants or virtual agents.
Clinical decision support (CDS)
Computer programs and tools to assist physicians and other health professionals with care decisions. CDS uses databases of signs and symptoms as well as best practices and current research findings to advise clinicians in care choices, with the goal of improving patient safety and quality, and, therefore, outcomes. Some aspects of CDS have gotten a bad rap, most notably alerts and notifications that are too frequent and create clinician “alert fatigue.”
There is not a one-size-fits-all approach to CDS systems. They can include order sets, drug interactions, care plans and protocols, critiques, alerts and other warnings, predictive analytics and relevant data summaries for patients.
Clinical documentation improvement (CDI)
A specialty that involves creating and administering accurate, timely health care records to ensure improved patient outcomes, data quality and accurate reimbursement. Some health care facilities employ CDI specialists to ensure each patient’s clinical documentation is comprehensive and up to date.
Many hospitals have health IT systems, including electronic health records (EHRs), that are on the premises or client server, meaning that these are maintained by the health system. But increasingly, health care is following other sectors of the economy into the cloud.
A cloud platform provides an on-demand computer system environment for software applications that is administered by a vendor offsite. Ideally, this platform is unified to deliver seamless functionality and more streamlined and efficient processes and data management. A cloud platform means that users don’t need to switch between applications – and systems and passwords – for greater usability. It also means data from various functions can be more easily organized and integrated for analytical purposes.
Cognitive computing is the simulation of human thought process in a computerized model. Cognitive computing is used in artificial intelligence (AI) applications such as robotics and virtual reality. It essentially harnesses big data, cloud computing, pattern recognition and natural language processing to mimic how the human brain processes information.
IBM Watson is probably the most well-known example of cognitive computing (it famously won the game show “Jeopardy“ in 2011). Cognitive computing in health care is expected to take off in the next few years. One example is IBM Watson for Oncology, which was created with Memorial Sloan Kettering Cancer Center in New York to help cancer specialists make more informed treatment decisions. The program analyzes a patient’s personal medical data against huge data troves and expertise to offer evidence-based treatment options to individual patients. Some see promise in cognitive computing as a way to solve entrenched problems in health care, from health disparities to physician burnout.
Comprehensive health record (CHR)
As the thinking and research around the social determinants of health evolves, some powerful people in health care think the terminology around electronic data should too. A CHR could include information about a patient's housing status, transportation access and food security, for instance. It could also bring in data gathered from wearable devices such as heart rate, exercise patterns and sleep.
Connected devices/smart devices
Any physical device that is embedded with sensors or network connectivity, enabling that device to “talk“ to other devices.
A cyberattack is an attempt by hackers to gain illegal access to a computer or computer network for the purpose of causing damage or harm. Hospitals, health care systems, and others in the industry are increasingly concerned about the potential of cyberattacks due to the increase in employees working at home as well as an increased use of health care devices that are connected to hospital records systems.
There are several types of cyberattacks. Malware is malicious software such as spyware, ransomware, viruses and worms. These look for vulnerabilities to breach networks, like if a user clicks on a dangerous link or email attachment that then installs risky software. Once installed, malware can block access to component of the network, render certain components inoperable, or secretly transmit data from the hard drive.
Phishing is the practice of sending fraudulent communications, usually through email, that appear to come from a legitimate source. The goal is to steal data like credit card or login information and install malware on a victim’s machine. Man-in-the-middle attacks are when attackers insert themselves into a two-party transaction to filter and steal data. For more information, see https://www.cisco.com/c/en/us/products/security/common-cyberattacks.html.
A term for storage of data information by hospitals, health systems and other organizations.
Deeper dive: Data lakes are distributed storage and processing in mostly cloud-based systems. Data lakes use flat architecture to store data while data warehouses use hierarchical files and folders. Think of data pouring into a lake in unstructured format, stored there, and then only structured or sorted when the information is retrieved.
The responsibilities of collecting, managing, viewing, storing, sharing and otherwise using patient health information. Hospitals, health systems, payers, government entities and others are trusted with data stewardship of patient information.
Deeper dive: Data stewardship includes all aspects of data: creating it, storing it, archiving it, etc. It encompasses knowing what data an organization possesses, understanding where it is located, ensuring it’s accessible and safe, enforcing rules and regulations on how it can be used, and helping the organization make the most of its data for research, patient care, etc.
A subset of Artificial Intelligence (AI) where computer networks are able to learn from data that is unstructured. Deep learning happens when a computer system uses mathematical algorithms to analyze data independently to achieve results.
Deeper dive: Deep learning computer systems look for patterns in the data and learn to recognize these patterns to draw certain conclusions. Deep learning is being studied for practical health care applications, such as interpreting medical imaging scans to detect cancer. Also important are the ethical implications and potential downsides to using machines to conduct analysis traditionally done by humans. Deep learning is an exciting field right now, and holds enormous potential to alter health care diagnosis, treatment and workflows. A Health Journalism 2018 panel explored the implications of deep learning on health care.
Digital health equity
Using digital health tools to help make health care more accessible and affordable for everyone.
Deeper dive: With digital health equity, everyone, regardless of social, economic, demographic or geographic differences, should have equal access to digital health resources and should achieve equal health outcomes through the use of these tools.
The term emerged from a renewed focus on health equity occurring during a time of rapid digital transformation of the health care system, which provides an opportunity to address many core health equity challenges, according to an October 2021 commentary in the Journal of the American Medical Association. Digital health tools to augment in-person care such as telehealth and remote care management have the potential to address structural challenges for marginalized populations, authors wrote, including lowering access barriers of time and distance, and providing tailored communication through appropriate language and literacy.
The practice of creating and perpetuating inequities between already marginalized groups, specifically through the use of digital technologies and content, and the internet.
Deeper dive: The Robert Wood Johnson Foundation defines this as “major network providers systematically excluding low-income neighborhoods from broadband service, deploying only sub-standard, low-speed home internet.” Privacy scholar Chris Gilliard, a professor at Macomb Community College in Michigan, defines this as “the creation and maintenance of tech practices, policies, pedagogies, and investment decisions that enforce class boundaries and discriminate against specific groups.”
The concept can be considered a modern extension of the practice of redlining in housing discrimination, in which red lines were drawn on maps to indicate poor, primarily underserved neighborhoods often due to race or ethnicity deemed unsuitable for loans or further development. The digital divide is seen as one impact of digital redlining.
An emerging, rapidly evolving sector of the digital health market that uses data analytics, machine learning and artificial intelligence to help patients with behavior change.
Deeper dive: Digital therapeutics is considered by some to be promising as a complement – or even replacement - to drug and medical device therapeutics in patient care. The idea is for machines to support physicians, nurses, care coordinators, health coaches and physical therapists to practice at the top of their licenses by conducting routine and remote monitoring and coordination of a patient's prescribed treatment. Some in Silicon Valley are betting that digital therapeutics can be just as or more effective than some medicines in treating common conditions. For instance, a digital therapeutic application could help a patient with insomnia develop better sleep habits and behavior modifications instead of relying on sleeping pills.
In September 2017, Pear Therapeutics gained Food and Drug Administration approval for the marketing of its mobile application called Reset to help treat substance abuse disorder. Reset is one of the first FDA-approved digital therapeutic applications. Its approval was based on the results of a 12-week clinical trial of nearly 400 patients.
A digital twin is a virtual representation of an object or system that spans its lifecycle. It is updated from real-time data and uses simulation, machine learning and reasoning to aid in decision-making.
Deeper dive: In health care, digital twins are able to provide a secure environment for testing the impact of changes on the performance of a system. For example, digital twin technology can be used to model an individual’s genomic makeup, physiological characteristics and lifestyle to create personalized medicine. It also can be used to create a replica of a hospital, to study operational strategies, capacities, staffing and care models to determine what actions to take. Virtual models could assist in bed shortages, for example, or spreading of germs or staff or operating room schedules. This can help optimize patient care, cost and performance.
For more information and a video example, see https://www.challenge.org/insights/digital-twin-in-healthcare/.
Medical devices that use electrical impulses to provide therapy such as pain control.
Deeper dive: Tiny electrode devices implanted into the body can alter the typical impulses that travel along the nerves and spinal cord that send messages to the brain. Some uses of the devices include for headaches, abdominal pain and cervical and back pain. Such electrical stimulation therapy has been gaining momentum as some researchers believe that it could prove to be more efficient than medication therapy.
Electronic health record (EHR)
Also known as an electronic medical records (EMR), this is a digital record of a patient’s medical information and health history, often now integrated with doctor’s notes, test results, etc.
Deeper dive: EHRs can include information from inpatient stays, outpatient visits, operations, diagnoses, allergies, radiology images, prescribed medications and immunizations. They are supposed to be instantly available in a secure format to all providers authorized to access it, and increasingly, to patients. EHRs also allow access to evidence-based databases and other tools to help providers make care decisions. Some concerns about EHRs include providers having a large documentation burden, the potential for hacking and privacy breaches, and in some cases, a lack of interoperability of EHR systems, so experts may not be easily able to review information for a patient moving from one hospital to another.
The process of converting information or data into a code, particularly to prevent unauthorized access.
Software, diagnostics or products and services that use technology to support women’s health. This could include mobile applications for tracking fertility or menstrual periods, for example.
An interdisciplinary field of scientific research combining gerontology (the study of aging) with technology. Gerontechnologists create technology to transform the lives of older people. This includes assistive technologies to support independent living and social participation.
Health Information Exchange (HIE)
Health information exchange is the action of sharing relevant health information electronically among trusted clinical partners regardless of physical location. The information sharing can be about a single patient to enhance the care of that patient. Or, the information can be about a group of patients for the purposes of public health tracking and improvement.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a law intended to make it easier for people to keep their health insurance when they change jobs. The law set standards for the electronic exchange of patient information, including protecting the privacy of such records. The U.S. Department of Health and Human Services issued a Privacy Rule to implement that aspect of the law, and its Office of Civil Rights is in charge of enforcing it. Essentially, HIPAA requires covered entities to keep private protected health information, or PHI.
ICD, the International Classification of Diseases, 10th revision, is a set of codes used by providers in clinical settings to classify procedures, diseases, injuries and encounters in health care settings for billing purposes. They determine how much providers get paid for each patient encounter, and they also help track the incidence of conditions (such as cancer and sepsis) at health facilities.
Health informatics is the interdisciplinary study of the design, development, adoption and application of information technology-based innovations in health care services delivery, management and planning.
Information blocking is a practice by a health provider or IT vendor, for example, willingly or knowingly interferes or “blocks" the access, exchange or use of electronic health information.
Internet of Things (IoT)
The internetworking of physical devices, including household appliances, cars and buildings that are embedded with sensors and network connectivity. These devices are also known as “connected devices“ or “smart devices." In health care, the Internet of Things can include implanted medical devices and home monitoring systems, for instance.
Interoperability describes the extent to which systems and devices can exchange data, and interpret that shared data. For systems to be interoperable, they must be able to exchange data and subsequently present that data so it is understood by users.
The science of teaching computers to learn on their own without being programmed to perform specific tasks. Machine learning incorporates artificial intelligence and big data so computers can synthesize information and draw informed conclusions.
The metaverse is a shared virtual environment that people can access through the Internet. It combines aspects of social media, online gaming, augmented and virtual reality, cryptocurrencies and more to allow users to interact virtually but feel more engaged than a typical video meeting. People would be able to try on clothing from stores, for example, or attend concerts with friends in the metaverse just as in person.
Mobile health (mhealth)
This refers to health services supported by mobile devices. The emergence of low-cost smartphones and tablets and the proliferation of health-related apps (over 318,000 to date, according to IQVIA) caused the explosion of the mhealth sector in just the past few years.
Natural language processing (NLP)
Natural language processing is the capability of computers to understand human language. If you've ever gotten into an automated phone tree and heard, “I'm sorry, I didn't get that“ in response to something you said into the phone, then you've come up against the limits of natural language processing. Alexa and Siri are popular consumer voice-activated NLPs on the market today. NLP is being applied to health care with limited success so far but this sector is expected to grow. It could, for instance, reduce clerical duties associated with inputting information into electronic health records.
Net neutrality protects equal treatment of all data that travels over internet networks fairly, with no discrimination and no blocking of any legal material. These networks over which information travels are controlled by internet service providers (ISPs) such as Comcast and Verizon.
Patient progress notes have become long and overwrought due to cut-and-paste functions and expandable templates in electronic health records (EHRs), leading to “note bloat." The effort needed to read and sift through long progress notes in the EHR has been cited as a cause of stress and burnout among clinicians in multiple studies.
OpenNotes is an international movement that advocates for transparent communication in health care and studies the effects of shared notes in patients’ records, otherwise known as open notes.
An umbrella term used to describe the processes involved in correctly identifying a patient and linking that patient’s electronic medical records within and across systems.
A computer database of confidential patient information, usually on a specific disease or condition, used to conduct population health management. Many hospitals have patient registries, also known as disease registries, for depression, hypertension and diabetes, for instance.
Population health management
This is the aggregation of patient data across multiple health IT resources, analyzing that data, and using that data to improve outcomes and better track the health of communities and specific populations. Population health management is mainstream thanks to widespread adoption of electronic health records and using those records to create actionable databases and disease registries, which group patients by disease states such as diabetes, hypertension, HIV/AIDS and depression.
An access point to an online system. The word “portal“ is frequently used by hospitals and insurers as shorthand for their “patient portal“ – a website where patients can access their information, email their physician, check lab results, manage prescriptions and make appointments securely.
A “lure” that entices an unwitting user to grant a thief remote access to proprietary data. For instance, a victim will click on a link in an email from someone they think is a trusted source, opening an access door to their computer. Phishing is a way for criminals to infect a computer with ransomware.
Predictive analytics is the branch of advanced analytics, and is used to make predictions about future events. Predictive analytics applies data mining, statistics, modeling, machine learning and artificial intelligence to analyze available data to make predictions about the future. Predictive analytics can be a tool in population health management to intervene in patient health to improve outcomes.
Prescription drug monitoring program (PDMP)
A state-run electronic database used to track patient prescriptions of controlled substances, especially opioids. Physicians and pharmacists (and sometimes law enforcement) can access information provided in these databases to view patient past history of prescriptions. PDMPs are a promising tool in fighting opioid abuse.
Protected Health Information (PHI)
This term, first mentioned in the Health Insurance Portability and Accountability Act (HIPAA) of 1996, refers to any identifiable information about a person that appears in medical records or conversations among health care staff regarding a patient’s treatment. It may also include billing information or any other information that could be used to identify someone in a company’s health insurance records.
A type of malware (malicious software) that attempts to deny access to a user’s own data by encrypting the data with a key that won’t unlock until a ransom is paid. Ransoms usually are paid in an untraceable cryptocurrency format such as Bitcoin. Ransomware attacks are becoming increasingly common against hospitals and other medical practices.
Regional Health Information Organization (RHIO)
A Regional Health Information Organization (RHIO) (pronounced “Rio“) is an entity that provides health information exchange services to participating stakeholders in a geographical region. RHIOs typically do the legwork in terms of meeting capability, security and privacy standards for secure exchange of health information among participants. Stakeholders often include providers, laboratories, payers and public health departments in the region. RHIOs must comply with HIPAA and other privacy laws. RHIOs often provide technical and advisory support services to participants as well. They have had a mixed record of success.
Remote patient monitoring
Remote patient monitoring is the use of technology to monitor the health of patients outside of conventional clinical settings. This type of monitoring most often happens at home, but can also be used in long-term care facilities or similar settings. Data collected on vitals like blood pressure, heart rate or weight can be transmitted to care providers in another location for assessment, recommendations and response, and typically is integrated into patients’ electronic health records.
Smart devices/connected devices
Any physical device that is embedded with sensors of network connectivity, enabling that device to “talk” to other devices.
Incidents where staff at hospitals access someone’s medical records without authorization or being directly involved in the patient’s care. In some cases, health system employees have accessed information such as emails, birth dates, clinical information or Social Security numbers, with the likely intention of selling the information or committing fraud.
Software bill of materials (SBOM)
A list of ingredients that make up software components. This is emerging as a key building block in software security.
Although they are sometimes used interchangeably, the terms telehealth and telemedicine have slightly different meanings. Telehealth is a broad term that refers to the use of telecommunications technology and electronic information to provide remote health-related services. This can include clinical medical care, health education for patients or providers, health administration and public health. Telehealth uses technology such as the internet, video conferencing, streaming video, imaging and other electronic communications.
Telemedicine is a more narrow term that is limited to remote clinical services, such as diagnosing and monitoring patients. Therefore, if a physician uses video conferences to diagnose remote patients and monitor their progress, the physician is engaged in telemedicine. If a city uses streaming video on its website to educate the public about COVID-19, the city is engaged in telehealth but not telemedicine.
Telestroke is a form of telemedicine that allows providers to consult with on-call neurologists in other physical locations to better diagnose and more quickly treat stroke victims. Reducing long-term disability caused by stroke requires quick diagnosis and near immediate treatment, making telestroke a very appealing option.
Unique device identification (UDI)
A unique device identification system established by the U.S. Food and Drug Administration (FDA) to adequately identify medical devices sold in the United States, from manufacturing through distribution to patient use. The system is designed to help health care providers and consumers by enabling faster recalls or discoveries of flawed devices, a better assessment of device performance, improved inventory management and more informed patient treatment.
This is information that is not easily organized and located often in disperse locations. Examples include information collected from physician notes in the electronic health record, and information collected from wearable devices, remote monitoring systems, social media, sensors, patient reports and images such as X-rays.
Virtual reality (VR)
A computer-generated simulation of a three-dimensional image or environment. People can interact with these images using electronic equipment such as a headset or gloves outfitted with sensors.
An aspect of telehealth or telemedicine (insert hyperlink), a virtual visit is a medical appointment that takes place via video between at least two parties (usually patient and physician) in different physical locations.
The terms “wearables,” “wearable technology,” and “wearable devices” refer to electronic technologies that are worn on the body or clothing to perform computing tasks. Generally, wearables are able to store and transmit data such as heart rate, sleep activity, etc. to patients’ care team and electronic health records, where information can be accessed in real time.
The way in which a health care professional interacts with patients remotely during telehealth or virtual visits.
White hat/black hat hacker
A white hat hacker is a computer security specialist who tests the security of computer systems and exposes their vulnerabilities before so-called “black hat” (nefarious) hackers can detect them and gain unauthorized access.
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