The following terms are intended to help increase our community’s vocabulary in this era of converging medical devices and information technologies. In particular, the terms below are ones that most health care IT leaders use to describe and manage their budgets and resources, and/or identify the major organizations that are presently influencing our combined industry. Some of the concepts will be familiar to you, and, hopefully, some will open up new concepts for you to explore during these “quiet” winter months. Much more detailed descriptions are usually readily available online, at sites like Wikipedia and Google, to help you delve deeper when you are ready.
Information Technology Terms
DNS: DOMAIN NAME SERVERS, the worldwide matrix of computer-based directories that are the Yellow Pages of the World Wide Web. Each DNS is regularly resynchronized with the others, and contains the name of every Web site (like amazon.com) and the IP4/IP6 numeric address of that Web site—which is something like that Web site’s phone number.
HCIS: HEALTH CARE INFORMATION SYSTEMS, which is a catch-all phrase for the hardware and software used in all phases of clinical, administrative, and operational systems used in health care. It often carries more of an “information system” emphasis (ie, the role of the system in managing and using information).
HIT: HEALTH CARE INFORMATION TECHNOLOGY, which is a popular variant of HCIS that sometimes bears more of a hardware emphasis.
IPV4: INTERNET PROTOCOL VERSION 4, the “good ‘ole Internet” that we have come to know and love. IP, which stands for Internet Protocol, includes the four-part numeric addressing system and the matching worldwide DNS servers that allow us to find Web sites by name.
IPV6: INTERNET PROTOCOL VERSION 6, the expanded-address-space and higher-speed Internet that is slowly rolling out in 2008. Backward compatibility to IPV4 is intended, but not guaranteed forever. New browsers, like IE 7, have IPV6 built in, but Windows versions earlier than XP SP2 may not be able to load IE 7.
I2: INTERNET 2, a much higher-speed-Internet with its own separate fiber optic backbone under beta testing by universities and government agencies. Designed for virtually seamless televideo communication and to facilitate sharing of extremely large blocks of data like those used for geospatial research. Requires special hardware on both ends, and, for now, technical support on both ends to arrange, make, and manage the connection. I2 is not IPV4 or IPV6 compatible, though under certain circumstances “bridges” or “gateways” can be used to link them together, albeit at slower speeds and with fewer features. I2 is in active use today, but the timetable for any sort of commercial or public rollout is uncertain.
MAC ADDRESS: MEDIA ACCESS CONTROL ADDRESS, the unique serial number within each wired or wireless device on a network that allows messages to be routed to/from it.
MESH NETWORKS: Wireless networks composed of single-or multimodal wireless access systems that use, store, and forward techniques to link wireless devices to arbitrary end points. Ad hoc versions of MESH networks self-configure or adapt to changing wireless link conditions for robust responses to environmental and/or situational challenges.
NGI: NEXT GENERATION INTERNET, an initiative that is a possible contender for a post-I2 era with even higher speeds and robust performance.
See the June 2007 article “SOA What” in the 24×7 archives.
SOA: SERVICE ORIENTED ARCHITECTURE, describing information systems in which the majority of a user’s computing tasks are actually performed by a community of high-speed, perpetually connected, Internet-connected “services.” Google Earth is one SOA example that is often cited. SOA commonly includes a critical aspect called SOA Governance, which is often essential to successfully create or manage SOA projects.
VLAN: VIRTUAL LOCAL AREA NETWORK, which uses software and hardware to divide up the available wireless LAN bandwidth and frequencies. This can allow more reliable and secure communication for many simultaneous users.
VPN: VIRTUAL PRIVATE NETWORK, which is a combination of software—and sometimes hardware—that takes VLANs a step further, ensuring privately encrypted communication between parties. Often managed by trusted third parties who are paid to control the passwords and encryption methods for their customers.
SE: SYSTEM ENGINEERING, the discipline of decomposing and designing complex systems in small, understandable portions.
SoSE: SYSTEM OF SYSTEM ENGINEERING, a new discipline exploring ways to understand, describe, anticipate, and manage the very complicated interactions and interdependencies of systems that are made up of many other systems.
V&V: VERIFICATION AND VALIDATION, verification infers knowing or demonstrating that a system is doing what it was designed to do, while validation infers ensuring that a system does the safe, proper, or correct action(s) in each situation. The distinction may bear clarification: a drug-interaction database with incorrect information may be verified to be printing alerts when prompted, but those alerts must be validated against current internal and external standards of care. The Vs can sometimes be switched, and may be compounded. For example, full medical HCIS design and deployment for life-critical applications should include a validated design, a verified implementation, and a validation of the final, in situ system. The V&V process for life- and mission-critical HCIS should go through preplanned V&V following failures, repairs, enhancements, modification, or updates.
Management, Organization, and Enterprise Terms
BPM: BUSINESS PROCESS MANAGEMENT, which is related to operations research and industrial engineering. BPM requires care and discipline to ensure accurate understanding, decomposition, and analysis of core business processes, and managing each of those processes to ensure that 1) they do not deteriorate, and 2) they are properly adapted to changing environmental demands.
BPR: BUSINESS PROCESS REENGINEERING, builds upon BPM methods and data to identify opportunities for significant or profitable process redesign and/or automation. E-businesses that allow users to fill in their own online order forms and shipping and payment data are an excellent example. Those businesses make capital investments in technology that yield many multiples in savings and revenue growth by eliminating substantial labor, inventory, and error costs while simultaneously accelerating product-delivery and payment cycles.
CPM: CRITICAL PATH METHOD, a well-proven project-planning and tracking method that links each project task to preceding and following tasks. CPM strives to keep an eye on the tasks that represent the longest path to the end of a project, and to help warn when that critical path may threaten to become longer and, potentially, more expensive.
EVM: EARNED VALUE METHOD, which is the US Government’s preferred method for accurately reporting the progress and risks inherent in IT projects. There is no single EVM system, but contractors are responsible for accurately disclosing data about the proportion of a system completed, the portion that remains to be done, the velocity of system-development progress, and the financial resources consumed to date. EVM attempts to instill more accuracy in reporting because it discloses proportional progress and financial investment.
NPV: NET PRESENT VALUE, a fairly simple financial analysis tool that uses compound interest, time value of money, and opportunity cost analysis to help compare business alternatives or decisions in today’s dollars.
PERT: PROGRAM EVALUATION AND REVIEW TECHNIQUE, is a project-management technique that seeks to identify and track all of the significant discrete elements and resources needed to accomplish each task.
PM: PROJECT MANAGEMENT, includes at least these following SDLC categories: waterfall or cascade; spiral, agile, or flexible; and extreme.
SAAS: SOFTWARE AS A SERVICE, an emerging business model in which software is rented or leased to users on a per-use basis, rather than purchasing a full license. Often closely related to SOA. Proponents advocate these advantages: the user pays only for needed resources on an as-needed basis; the user is freed from installation, customization, and maintenance costs and headaches; and the vendor and user are freed from many common distribution costs.
SDLC: SYSTEM (OR SOFTWARE) DEVELOPMENT LIFE CYCLE, is the process of developing information systems through investigation, analysis, design, implementation, and maintenance. It also is known as information systems development or application development and is a systems approach to problem solving made up of several phases, each comprised of multiple steps.
TCO: TOTAL COST OF OWNERSHIP, helps interpret, anticipate, and manage the complex life-cycle costs of information technologies. Factors such as hardware and software system capital costs, license fees, upgrades and repairs, staff training, insurance, electricity, cooling, and disposal costs all combine to make the cost of owning and using computers many times the original purchase price, especially over many years of ownership. Proper TCO analyses should use NPV to ensure that future years’ expenses are accurately analyzed in terms of today’s real dollar cost.
V-MODEL: An SE and SoSE term used to describe acquisition and iterative system design and development models that use incremental V&V to reduce risks and optimize outcomes.
Clinical Records Terms
EHR: ELECTRONIC HEALTH RECORD, the general concept for a person’s lifelong set of all clinical data.
EMR: ELECTRONIC MEDICAL RECORD, the general concept for a single physician’s or practice’s patient records for each patient for whom they provide care. Often the record is not lifelong.
PHR: PERSONAL HEALTH RECORD, which attempts to provide patients/families with comprehensive, lifelong clinical data in a consistent electronic form so that they can choose to save, share, or update the data with relevant personal health notations.
HIT Agency and Organizational Acronyms
AHIC: AMERICAN HEALTHCARE INFORMATION COMMUNITY, a leadership group for ONCHIT; (www.hhs.gov/healthit/ahic).
IHE: INTEGRATING THE HEALTHCARE ENTERPRISE (www.IHE.net).
CCHIT: Certification Commission for Healthcare Information Technology (www.CCHIT.org).
HIE: HEALTHCARE INFORMATION EXCHANGE, a generic general and more contemporary term for RHIO.
HITSP: HEALTHCARE INFORMATION TECHNOLOGY STANDARDS PANEL (www.ANSI.org/hitsp).
NHIN: NATIONAL HEALTHCARE INFORMATION NETWORK, the primary deliverable from ONCHIT to enable EHRs for US citizens by 2014.
ONCHIT: OFFICE OF THE NATIONAL COORDINATOR OF HEALTHCARE INFORMATION TECHNOLOGY, within Health and Human Services (www.hhs.gov/healthit).
MD PNP: MEDICAL DEVICE PLUG AND PLAY.
RHIO: REGIONAL HEALTHCARE INFORMATION ORGANIZATION, which is a generic term for emerging agencies that will help hospitals and physicians exchange patient data.
Elliot B. Sloane, PhD, Villanova University; is cochair of the HIMSS/RSNA/ACC IHE Strategic Planning Committee; and cochair of the ACCE/HIMSS IHE patient care device domain.
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