EHR Integration Terms

1. EHR Glossary of Terms
INTEGRATION

2. Table of Contents
Table of Contents ......................................................................................................................................................................................................2
Integration Terms......................................................................................................................................................................................................4
Connect / Direct...................................................................................................................................................................................................4
Data Conversion...................................................................................................................................................................................................4
Data Migration.....................................................................................................................................................................................................4
Data Workflows ...................................................................................................................................................................................................4
EDI........................................................................................................................................................................................................................4
Functional Testing................................................................................................................................................................................................4
HIE .......................................................................................................................................................................................................................4
Historical Data .....................................................................................................................................................................................................5
HL7 Analyst - Resource ........................................................................................................................................................................................5
Integrated Testing................................................................................................................................................................................................5
Integration Project Management.........................................................................................................................................................................5
Integration Assessment .......................................................................................................................................................................................5
Integration Conversion Programmer ...................................................................................................................................................................5
Integration Data Architect ...................................................................................................................................................................................5
Integration Testing Coordinator...........................................................................................................................................................................5
Interface ..............................................................................................................................................................................................................6
Interoperability....................................................................................................................................................................................................6
Legacy Support ....................................................................................................................................................................................................6
LOINC...................................................................................................................................................................................................................6
Mapped Record Testing.......................................................................................................................................................................................6
Mapping...............................................................................................................................................................................................................6
Regression Testing ...............................................................................................................................................................................................6
Script Development .............................................................................................................................................................................................6
SNOMED ..............................................................................................................................................................................................................6
Support Contracts................................................................................................................................................................................................6
Test Plan Development........................................................................................................................................................................................7
Testing .................................................................................................................................................................................................................7
Translation...........................................................................................................................................................................................................7
Unit Testing..........................................................................................................................................................................................................7
Interface Messages ...................................................................................................................................................................................................8
ADT ......................................................................................................................................................................................................................8
Charges................................................................................................................................................................................................................8
Device Integration................................................................................................................................................................................................8
MDM....................................................................................................................................................................................................................8
MFN.....................................................................................................................................................................................................................8
2 | EHR Glossary of Terms: Integration
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3. Orders..................................................................................................................................................................................................................8
Results .................................................................................................................................................................................................................8
Transcription........................................................................................................................................................................................................8
Integration Languages ..............................................................................................................................................................................................9
CCD - Continuity of Care Document.....................................................................................................................................................................9
CCDA....................................................................................................................................................................................................................9
Dicom...................................................................................................................................................................................................................9
Flat File ................................................................................................................................................................................................................9
Delimited .............................................................................................................................................................................................................9
HL7.......................................................................................................................................................................................................................9
IHE Profiles.........................................................................................................................................................................................................10
SOAP..................................................................................................................................................................................................................10
X12.....................................................................................................................................................................................................................10
XDS.b..................................................................................................................................................................................................................10
XML....................................................................................................................................................................................................................10
Integration Protocols...............................................................................................................................................................................................11
Async..................................................................................................................................................................................................................11
FTP.....................................................................................................................................................................................................................11
sFTP....................................................................................................................................................................................................................11
SNA ....................................................................................................................................................................................................................11
TCPIP..................................................................................................................................................................................................................11
Integration Engines .................................................................................................................................................................................................12
3 | EHR Glossary of Terms: Integration
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4. 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 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.
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5. 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.
5 | EHR Glossary of Terms: Integration
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6. 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.
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7. 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.
7 | EHR Glossary of Terms: Integration
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8. 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.
8 | EHR Glossary of Terms: Integration
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9. 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.
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10. 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.
10 | EHR Glossary of Terms: Integration
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11. 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.
11 | EHR Glossary of Terms: Integration
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12. Integration Engines
Vendor Engine
Cerner Open Engine
Corepoint Health Corepoint Integration Engine
Dynamic Health IT HL7Connect Interface Engine
Eclipsys eLink
Enovacom Anteres V2
Epic Bridges
eTransX eTransX Interface Engine
Iatric Systems EasyConnect Jaguar HL7 Interface Engine
Infor Cloverleaf Integration Suite
iNTERFACEWARE IGUANA HL7 Interface Engine
InterSystems Ensemble
InterSystems HealthShare
KG Intechgra CIP HL7 Engine
LINKMED® IE LINKMED® Interface Engine
MDI Solutions MD Link HL7 Interface Engine
NextGen Healthcare Mirth Connect
NextGen Healthcare Rosetta Engine
Oracle eGate / JCAPS
Oracle SOA
Orion Health Orion Health Rhapsody Integration Engine
Pilot Fish eiPlatform Integration Engine
Qvera Qvera Interface Engine (Mostly Ambulatory)
Siemens OPENLink
Summit Healthcare Express Connect
Sybase e-Biz Impact
The Shams Group Astro Interface Engine
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