by Frank Rhie, MD, MBA
Chief Medical Officer
Published by Atlantic Information Services, Inc.
Reprinted with permission.
The e-health industry continues to revolutionize healthcare in America. Keeping up with the changes and the language of e-health can be challenging. However, as with any industry, once the basic terms are defined, their role and importance can be better understood. Most importantly, with understanding comes the ability to use that knowledge to better communicate and succeed in today's ever-changing e-healthcare marketplace.
access control Limiting the program access only to authorized persons. Methods include user IDs and passwords. Access control may be based on roles, status of a situation (e.g., emergencies), physical location or functions. Policies and procedures for access control are an integral part of the HIPAA regulation. Access control does not necessarily mean authentication of users. It is an important step for any organizations involved in e-health today. (See HIPAA , authentication .)
analog transmission Most of the Internet Web access from homes or outside of offices uses analog transmissions. Under this mode, sounds of varying frequencies and volume are transformed into electric impulses and transferred via regular telephone lines. Analog is available wherever phone lines are available and is important as either the primary communication method or as a back-up for digital transmission, such as when DSL line gets disconnected. (See DSL ).
ADSL Asymmetric Digital Subscriber Line. ADSL transmits slower upstream (from your computer to host computer, up to 1.544 Mbps) but much faster downstream (from host computer to your computer, 1.5 to 8 Mbps) speed. Ideal for Web surfing that requires more downloading than sending information. ADSL Lite is mostly deployed for home high-speed Internet access currently. ADSL Lite has much slower 1 Mbps downstream and up to only 512 Kbps upstream. (See DSL , bps .)
architecture This term is often applied to overall system design, structure and components of software and hardware, its operating system or a network.
ASP Application Service Provider. An ASP hosts applications on servers in ASP data centers to allow users to get connected and use application as if they were located in the client's own site. ASP handles maintenance, upgrades as well as security and back up, disaster recovery plans, etc. This lowers the total cost of ownership (TCO) for clients, while minimizing the risks and costs of keeping highly skilled IT talents. ASPs usually charge per usage or per user basis, like per member per month or per doctor per month.
audit trail A software tracking system to trace the history of who used the computer, when they used it and what information was accessed as well as a history of any actions taken by them to computer files or programs. Audit trail is mandated by HIPAA regulation for patients' medical information. (See HIPAA .)
authentication Methods to confirm the user's identity, preliminarily by user ID and password but may require other technologies like biometrics (electronic capture and analysis of patterns of finger printing, retinal scans or voice recognition) and/or PKI. (See PKI .)
bandwidth A measure of the information-carrying capacity of a communication channel. The bandwidth corresponds to the difference between the lowest and the highest frequency signal that can be carried by a channel. Broadband refers to any system able to deliver multiple channels and/or services to users utilizing very high capacity data transfer medium. Coaxial cable television, fiber-optic cables and satellites are examples, delivering multimedia contents at a high speed to customers.
bps Bits per second. A measurement of how much data can be transmitted across the medium or channel. Bit is the smallest piece of computerized information, a binary digit, representing on (1) or off (0). Kbps is thousand bps and Mbps is one million bps. Current dial-up analog modems transmit 33.6 to 56 Kbps and T1 line transmits 1.54 Mbps. (See analog transmission , T1 .)
browser A software program that reads and displays HTML documents. Browsers allow users to access World Wide Web (www) regardless of platform or operating system of the client computers. Common commercial browsers include Internet Explorer (Microsoft) and Navigator (Netscape). Some applications use proprietary browsers to enhance certain functions and user experiences particular to their programs. (See HTML , www , operating system )
certificate authority An independent organization that guarantees the identity of the person in encrypted electronic communication. CA acts like a virtual notary public, verifies the identity of the user and stores the user's public and private encryption keys and issues a license called a "Digital Certificate" as a seal of authenticity to a recipient. The American Medical Association (AMA) and many state medical societies as well as Intel and VeriSign are active in this field. Digital certificates can be carried in a smart card or stored in one's computer as a software program. (See digital certificate , digital signature , smart card .)
clearinghouse A service providing connectivity between healthcare providers (physicians, hospitals, etc.) to payers (HMOs, insurers, government entities such as Medicare). Clearinghouses take claims, eligibility requests, claim status checks, etc. from providers in various formats, then translate and reformat them according to the specifications by payers and re-transmit them to their original destination. As a value-added service they may add edit functions to check the validity and completeness of the claims. HIPAA allows providers to use clearinghouses without using standard transaction code sets specified in HIPAA regulations. (See HIPAA .)
client/server A form of distributed computing where a dedicated heavy-duty server computer handles most of the processing tasks while less powerful client computers access and share files, programs and computing prowess. A network located at a customer's site connects servers and clients. Most common client/server systems are either two- or three-tiered architecture. n-tiered (multi-layered) architecture separates even more levels toward distributed computing and business logics allowing different servers can perform different functions making them easier to upgrade and deploy. (See architecture .)
cookie Information about a user (e.g., what Internet sites a user visits, purchases made via the Internet, etc.) is stored as a text file in the user's computer local hard drive. Initially, cookies are passed from a Web server to the user's Web browser. Once accepted, the original Web server can retrieve cookie's data containing passwords, preferences and other visitations by the user on the Web, whenever the user visits the server's page again. Keeping track of the user's behavior on the Web raises concerns about the privacy and confidentiality. One can refuse to accept cookies and erase them at anytime; the only inconvenience is the need to retype user ID and passwords each time and maybe the lack of customization.
CPR Computerized Patient Record or Electronic Medical Record (EMR). CPR is an electronic depository or linked access to patient-centric databases containing patient care information. The goal of many in healthcare today is to replace paper medical records with CPR thus improving the workflow, efficiency and productivity for healthcare providers. Through the Internet, CPR is moving toward combined medical records for physicians as well as for patients.
digital certificate A Digital ID that is issued by a digital certificate authority and serves as an electronic identification document. It includes user information and serial numbers and public key information and expiration dates. (See PKI .)
digital signature An electronic encrypted tag that is added to electronic documents to verify the identity of the signer, allowing the legal status of the communication. Digital signature may use public key infrastructure (PKI), matching the public key to private key of the signer. Recently, legislation was passed to allow electronic signatures to have the equal status as physical signature for banking and e-commerce. Digital signature is also mandated in HIPAA regulation, allowing electronic prescriptions and other document management tasks on-line. (See HIPAA , PKI .)
document imaging Creating a computer file from a paper document. Scanners are devices that record the paper image and change it into an electronic image (tiff or gif files) that can be viewed and transmitted by a computer. Computer images are routed, indexed and filed into appropriate files or programs. These images can be retrieved quickly and sent electronically to anybody via any format, including faxing or attaching to an e-mail message. Faxing into the computers alleviates the need for scanning and provides the same benefits of electronic documents management.
DSL Digital Subscriber Line. DSL is a dedicated broadband networking solution utilizing widely available copper wire telephone lines. DSL connects to public telephone networks and allows multiple forms of data, voice and video transmission over the twisted-pair copper wire on the "last mile" local loop between a network service provider (NSP) central office (CO) and the customer site. The distance between the customer site and CO is the main determinant of the available speed. Cable modem is a shared bandwidth resulting in the fluctuation of speed depending on the number of shared access users.
dumb terminal Rudimentary client computer attached to a host computer to perform data entry and retrieval for viewing. Dumb terminals were prevalent in legacy systems when available local processing power was minimal and expensive. The interest in this model has been resurrected due to the high cost of PC network maintenance. A new twist has been the Net Appliance model that has to be connected to the Internet to process any information.
e-commerce Electronic- or e-commerce has become the umbrella term used to cover any transaction conducted over the Internet. Examples of such transactions include purchasing books, medical supplies, any products and services and transmitting prescriptions and claims.
EDI Electronic Data Interchange. Standardized electronic format for business transactions sent from one computer to another computer system. EDI consists of strings of data in a pre-arranged accepted format by both sending and receiving computer systems. Business-to-Business (B2B) e-commerce is based on EDI acceptance by the industry. Healthcare EDI includes electronic claims submission, electronic remittance notices and electronic eligibility checks, etc. HIPAA mandates standardized EDI transaction sets to be ANSI ASC X-12 code sets developed and authorized by the standard setting entity. (See HIPAA .)
encryption Software coding procedure to prevent hacking or illegal accessing by persons not intended. Encryption converts plain text into a disguised file or message using a mathematical algorithm. Security is enhanced with encryption that increases the complexity of time and processing power to decrypt files and messages. Currently, 128-bit encryption is the highest commercially available encryption algorithm.
extranet Private networks, connected by the Internet, which allow only users who have a valid password or digital certificate to use the system. The Internet, by comparison, allows any user to access without the verification of the identity of the user. (See intranet .)
firewall A security protection system that includes software and hardware and often a router, which is situated between a private network and outside networks. It screens user names, source addresses, destination addresses and all other information that is entering or leaving the private network. The firewall system allows, denies or limits the access to the private network, depending on the system rules.
FTP File Transfer Protocol. FTP is the TCP/IP standard way of transferring files across the Internet and between computers. (See TCP/IP .)
Hi-Ethics Health Internet Ethics. Organized in 1999 by many leading e-healthcare companies that agreed that Internet users deserve high-quality content, responsible advertising and the protection of personal health information. Hi-Ethics is developing a set of ethics principles for health information on the Internet in the areas of content, privacy, advertising and commerce.
HIPAA Health Insurance Portability and Accountability Act of 1996. This law was designed to provide continuing insurance coverage for pre-existing conditions when a person changes employment. In addition, the second part of the law was intended to simplify administrative aspects of electronic healthcare transactions. HIPAA mandates standard transaction code sets to be used by "covered entities"-providers, plans, payers and employers. The intent was to help promote e-commerce by using standard code sets that would simplify EDI transactions. HIPAA also covers important issues such as security, privacy and the confidentiality of a person's identifiable health information via electronic media. Final enactment is set to occur 24 months after the final rules have been published in the Federal Register for two months. Smaller provider groups, with revenues less than $5 million, will have 36 months to comply.
HL-7 Health Level 7. HL-7 is an interface standard for exchanging and transferring health data between computer systems. It is also the name of a non-profit ANSI accredited organization. ANSI (American National Standard Institute) approves all national standards. The ANSI X-12 committee handles healthcare related standards, including claims and remittance, mandated by HIPAA. HL-7 controls demographics and other messaging standards. The newest HL-7 version-3.0-incorporates XML technology. Not released as of the date of this publication. (See HIPAA , XML .)
HON Health on the Net. A Swiss non-profit foundation dealing with ethical conduct of healthcare Web sites. If e-healthcare Web sites subscribe to the HON code of conduct in various areas, they can display the icon of HON on their Web site as a pledge to follow the principles of code of conduct.
HTML Hyper Text Markup Language. The basic, human readable text programming language used to develop Web sites. HTML controls the presentation and appearance of Web pages. HTML documents are identified by the file extension .htm or .html (depending on the operating system used to create them), and are viewed by browsers. (See browser .)
http:// Hyper Text Transfer Protocol. A language protocol used when Web sites and browsers communicate with each other. It indicates that the Web site interprets HTML and uses it as a part of the Web address. When an "s" is added to the URL (https://) it indicates a secure Web site that is protected by firewall and encryption. (See browser , encryption , firewall , HTML , URL .)
infrastructure Includes the physical hardware used to interconnect a computer and its users, and the software used to send, receive and manage the data transmitted.
ISDN Integrated Services Digital Network. ISDN is a widely available digital communication route on existing telephone copper wire with low noise and high digital quality. Speed is about 64 to 128 Kbps. ISDN needs ISDN modem in both ends of switches. It is charged by usage time and needs an external power source to run the modem. (See bps .)
interface An interface enables software to connect one information system to another, to share certain data or outputs, to join systems to perform tasks seamlessly and without double entry of data. Examples include sharing demographic and insurance information by clinical and financial systems to produce a seamless workflow for all functions in a physician's office. The interface engine is software that handles the duty of translating and routing information from one system to another.
Internet The Internet, sometimes called simply "the Net," is a worldwide system of computer networks that allows users to send and receive information from other computers.
intranet Private networks that allow access only by individuals inside of the physical network - or members only - using the look and feel of the Internet. The Internet, by comparison, allows any user to access without the verification of the identity of the user.
ISP An Internet Service Provider (ISP) is a business entity that provides customers with connectivity via modems or network solutions to the Internet and the Web. Examples of ISPs include AOL, MSN (Microsoft Network), Mindspring, etc. ISPs charge by usage per hour, per month or flat fees regardless of usage. ISP also can serve as "Portals" but they are two different functions, ISP providing connectivity and portal providing default home page to aggregate access points to the Net.
LAN Local Area Network. A network of computers and peripherals connected by cables or wireless connections in close proximity, usually in the same physical building.
legacy system An older software system based on mainframe computer or older programming languages such as MUMPS. Frequently legacy systems are expensive to maintain and upgrade and have extreme limitations of functions. They do not interface with new technologies well and available pool of support resources is dwindling. However they have proven to work compared to newer technologies without proven track records, making it difficult for some providers and organizations to make trade-off decisions regarding old versus new technologies.
operating system The software program that controls the power and logics of all operations of the computer system. It provides a platform on which to run other applications and dictates how they will interact and share in orderly manner. Microsoft Windows, MacOS for Macintosh and OS-2 for IBM are examples. Network operating systems are the protocols and logics for network operation and examples are NT/2000 for Windows, UNIX and Linux.
PDA Personal Digital Assistant. A handheld computer loaded with personal productivity tools such as a calendar, address book, word processing, and spreadsheet functions. Mobile workers use PDAs and work with central databases either with wireless connections using cellular phones or by synchronizing with the host computer with the cradle. Recent interest in the physician e-health market focused on prescription writing, digital voice dictation or recognition for note taking, and direct access to patient centric database from anywhere at anytime. Palm Pilot and Pocket PC are examples of PDA devices.
plug-and-play A hardware component or peripheral, like a printer, that has built-in initializing capabilities to work with computer operating systems seamlessly and without the hassle of configuration. The operating system recognizes its presence automatically and configures the computer set-up. It also refers to software business systems that will work with other types of software with minimal configuration to enhance the interoperability between multiple vendors' systems.
PKI Public Key Infrastructure. Also called public key cryptography, an applied mathematics of transforming messages into seemingly unintelligible forms and back again. PKI employs an algorithm using two different but mathematically related "keys"-one for creating a digital signature or transforming data into a seemingly unintelligible form, and another key for verifying a digital signature or returning the message to its original form. Computer equipment and software utilizing two such keys are often collectively termed an "asymmetric cryptosystem" and two complementary keys have to match to verify the authenticity of signer. Many people know public keys but only the signer knows the private key.
portal A Web site that purports to be a gateway to the Internet and the Web. Users will click through the portal to get to other sites. Portals will aggregate other sites and services and market their brand heavily to drive traffic. High traffic or clicks-per-thousand (CPM) will impact their revenue model by charging advertisers and sponsors high fees. Over the past few years, healthcare portals have garnered much attention due to the high number of health information seekers who may be directed to other sites via portal strategy. (See WWW .)
router A device that connects to and receives data from outer networks and sends data only to network nodes meant to receive them, rather than sending information to all nodes on the network. It keeps track of network traffic and manages it efficiently. A router may contain firewalls. (See firewall .)
SAN Storage Area Network. A network of storage devices connected to the main computer network via a fiber optic channel hub, usually at the data center. Data can be stored at separate computers for scalable, consolidated and efficient storage.
SDSL Single-Line Digital Subscriber Line. Symmetrical transmission using a single copper-pair wire to achieve up to 1.544 Mbps, full duplex (full bi-directional) speed, like a T1 line. Maximum operating range from CO is 10,000 feet. (See DSL , ADSL , T1 .)
security Security has become one of the hot buttons of concern for consumers, legislators and healthcare professionals. Ensuring that data transmitted-particularly sensitive patient records-is safe and secure is a priority for anyone in e-health today. Physical security refers to protecting access to computers; logical security refers to other software or hardware solutions to protect access to programs.
smart card A portable, plastic card embedded with a microprocessor chip containing health and personal information, which can be written on and updated at the point of care. Smart cards can be issued by health plans with eligibility and benefit information. Provider information systems can update with current health information onto the smart card. It can be read and written on using a smart card reader attached to a computer system, using XML or other common program languages.
SQL Structured Query Language. A standard command language that interacts and performs tasks with relational databases. SQL is also the name of a Microsoft database product.
SSL Secure Socket Layer. Encryption protocol (40-bit or 128-bit algorithm) to create a secure transmission connection between a user and a host Web site and enables e-commerce or health care transactions. URL sites starting with https:// may signify that it is safe to submit credit cards or health information. (See encryption , URL .)
T1 Transmission lines that can transmit 1.54 Mbps of data. A T3 line contains 28 T1 lines transmitting 45 times faster than a single T1 line. (See bps .)
TCP/IP Transmission Control Protocol/Internet Protocol. TCP/IP is the de facto international standard governing the rule of exchanging packets of information among networks including the Internet. Packets are information broken up into small fixed size pieces for fast transmission over the network with the coded destination address. Packets are reassembled at the other end as instructed.
telecommunications Telecommunications can be likened to the nervous system and arteries of e-health. Most e-health communication today is conducted via telephone, DSL or cable lines. Telecommunication both enables and limits e-health. For example, wireless communication of data is still not prevalent and is the next step for e-health. (See DSL .)
thin client A stripped-down computing device with much lower processing power than a full-blown smart PC. It is designed to work with a host server computer in a client/server computing model. It costs less to acquire and maintain. More recently, this term has been used to describe a computer that works with a Web browser via the Internet with little local computing power. (See browser , client/server .)
URL Uniform Resource Locator. Unique Web page address. Features of the URL denote the origins of Web sites by using extensions like .com (commercial sites), .gov (government sites), and .edu (educational institutions). Countries outside the U.S. add a two-character country code.
VPN An access-controlled extranet that uses public Internet infrastructure and costs less than a private wired dedicated network. Tunneling software helps to configure VPN for controlled access by outside individuals. Bandwidth may have to be shared with other VPN users resulting in peak hour fluctuation of speed. It is preferred to the open Internet when transactions have to be secure and protected from outsiders, like healthcare organizations or corporations. (See bandwidth , extranet , infrastructure .)
WAN Wide Area Network. WAN connects computers over a distance or larger geographical area, not directly connected by LAN, using digital technology. The Internet is the largest WAN, and holds many smaller WANs together. (See LAN .)
WAP Wireless Application Protocol. An emerging standard to allow cellular/wireless devices to access the Internet. Interoperability to access the Internet via smart phones (WAP phones), palm devices and pocket-PC are enhanced by this standard.
Web-based and Web-enabled Web-based software is native to Internet architecture and based on either Web sites or n-tiered (multi-layer design) architecture deployed over the Internet. It is flexible and can take advantage of new Internet developments. Web-enabled software tends to be a front-end browser graphical user interface allowing the access to the little changed back-end legacy system. It is less flexible and cannot incorporate new advances in Internet technologies. But it will save time and effort by not migrating to a new Web-based system, allowing the customer to buy time before the eventual migration. (See architecture , browser , interface , legacy system .)
workflow automation This type of software can automate workflow and re-engineer business processes to achieve productivity gain and improved customer services. Workflow is an established business process describing how the tasks are done, by whom, in what order and how quickly. By automating workflow with technology, business processes can be re-engineered.
World Wide Web WWW connects Internet resources and users employing HyperText Transfer Protocol. Most Internet addresses (URLs) begin with www.
XML eXtensible Markup Language. A new version of markup language developed by World Wide Web Consortium (W3C). XML mainly deals with data elements and uses HTML for display. XML is being promoted as an EDI tool optimized for Internet-based transactions.
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Most of the common terms used in e-health today can be categorized into one or two of several key categories to better help explain them:
- digital signature
- document imaging
- dumb terminal
- legacy system
- operating system
- smart card
- thin client
- Web-based and Web-enabled
- workflow automation
- World Wide Web
- access control
- audit trail
- certificate authority
- digital certificate
- digital signature
- analog transmission
(949) 789-0500 • www.alteer.com Alteer Corporation is a California-based e-health company providing comprehensive web-based ASP solutions for physicians' offices. Contact Frank Rhie at firstname.lastname@example.org .
Atlantic Information Services, Inc.
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