Informatics abbreviations

CTO

Chief Technology Officer - an executive level position focused on scientific and technological issues in an organization

MUMPS

MGH (Massachusetts General Hospital) Utility Multi-Programming System - computer language that has a built-in database designed in 1966 for the healthcare industry.

CI

Confidence Interval - possible range of results which includes the true value 95% of the time

ABCP

"As Built Critical Path" - analyzes the causes and impacts of changes between the planned schedule and the eventual schedule as implemented. The critical path method creates a model for a project based the list of activities for the project; time to complete each activity, dependencies between the activities. Activities, which are critical, and those, which float, are determined. Critical tasks affect the project timeline. Delay of float tasks does not affect the time line. Crash duration is the shortest possible time a project can be done

NEC

"Not elsewhere classified" - ICD 9 abbreviation to indicate there is no separate specific code to recommend the condition documented. The diagnosis is specific but the coding system is not specific enough. NOS not otherwise specified means the documentation doesn't provide enough information to support a more specific code.

NOS

"Not otherwise specified" - the documentation doesn't provide enough information for a more specific code

SnOUT

"Sensitive tests allow you to rule a condition out" - sensitive tests are good for screening because they minimize false negatives. If a test is sensitive, you can be nearly certain they don't have the disease

SpIN

"Specific tests allow you to rule a condition in" - specific tests are good for confirming because they minimize false positives. If a test is specific you can be nearly certain they have the disease.

ROC

(receiver operator curve) plates true positives (sensitivity) y axis versus false positives (1-specificity) x axis - visual tradeoff between sensitivity and specificity. The inflection point is the optimal threshold for a test. The AUC allows you to distinguish which test tells diseased from normal (high TP, low FP), higher AUC is better.

IMAP

- Internet Message Access Protocol - is a protocol to retrieve email messages from a server. It is now iMAP4 which is similar to POP3 but allows you to search email messages by keyword.

ARP

Address Resolution Protocol - a telecommunications protocol to convert an IP address (numeric label assigned to each device in a computer network) to a physical address such as an Ethernet (or MAC address - an identifier for a network interface usually assigned by the manufacturer of a network interface controller). It translates network layer addresses to link layer addresses

LR +

= probability person with condition having a positive test/Probability person without the condition having a positive test = TPR/FPR = sens/(1-spec)

ARR

Absolute Risk Reduction - absolute difference in event rates

ACO

Accountable Care Organization - a set of health care providers (doctors and hospitals) that work together and accept collective responsibility for the costs and quality of care to a population of patients. The affordable care act allows Medicare to award ACOs for improving quality and saving money (shared savings program)

ASC

Accredited Standards Committee - ASC X12 was chartered by ANSI in 1979 to develop electronic data interchange standards, X12N is a subcommittee of X12 and encourages electronic commerce for health claims

AUC

Area under Curve

AES

Advanced Encryption Standard - an encryption algorithm for storing sensitive but unclassified material from US government agencies likely will become the de facto encryption standard for the private sector. It was established by NIST in 2001. It is a symmetric key algorithm - same key encrypts and decrypts the data.

ADE

Adverse Drug Event - an injury involving medication use. Medication errors are an error in the medication use process. A medication error can cause an adverse drug event.

ACA

Affordable Care Act - 2010 1)Regulation and coverage (eliminates coverage restrictions, high risk pools), 2)Expansion of coverage (individual and employer mandates, Medicaid expansion), 3) Bending the Cost Curve (incentives for low cost care ACO, PCMH, PCORI for research, Independent Payment Advisory Board change Medicare reimbursement if goals aren't met)

AHRQ

Agency for Healthcare Research and Quality - the health services research arm of the US HHS, home to research centers that specialize in QI, patient safety, outcomes search, primary care, a source of funding for health systems research and training

ACR

American College of Radiology - members include radiologists, radiation oncologists, medical physicists, interventional radiologists, nuclear medicine physicians and allied health. They make imaging safe, effective and accessible

ANSI

American National Standards Institute - formed in 1918 from several engineering organizations to coordinate standards, represents the US to the ISO, accredits standards developing agencies, spawned the Accredited Standards Committee

ARRA

American Recovery and Reinvestment Act - 2009 provided $787 billion for jobs, infrastructure and grants and $19 billion for health IT through the HITECH (Health Information Technology Economic and Clinic Health Act). 1) Training for the health IT workforce. 2) University funding for Clinical It education, 3) Regional extension centers to adopt health IT, 4) Leadership - ONC became protected by law and the HIT policy and standards committees were established 5) Incentives for EHR adoption for providers and hospitalists

ASTM

American Society for Testing and Materials - formed in 1898, oldest consensus standards group. Hosts Committee E31 on Health Care informatics, ASTM E1238 is the 1st standard for transfer of clinical data via computers (for labs) now an HL7 standard. Activities include the CCR, security and private standards, EMR vocabulary, medical record portability

ASP

Application Service Provider - application resides on a vendors system and is accessed through a web browser. Custom client software can also access it through APIs. ASPs own the software application, own and operate the servers, information available through the web or a thin client, bills per use or a monthly fee. It delivers a service to a small number of users as opposed to SaaS, which delivers generic software at a scale to many users

ACID

Atomicity, Consistency, Isolation, Durability Mnemonic for database transactions (single operation) 1983 1)Atomicity - a transaction happens or it doesn't. 2)Consistency - a transaction must meet all constraint rules, only valid data will be written to the database. 3)Isolation - a database must sequence simultaneous transactions multiple transactions at the same time must not affect each other. 4)Durability - System must be tolerant to failure (store transactions permanently)

BMI

Biomedical Informatics - the optimal use of information, often aided by technology, to improve individual and public health, health care and biomedical research

BMHI

Biomedical and Health Informatics - infrastructure supporting biomedical informatics initiatives, coordinate availability of these services, and synchronize knowledge across groups.

BAA

Business Associate Agreement - required by HIPAA if business associate has access to PHI, a contract between a company and its associates who will use PHI for billing, administrative, research or QI purposes

CM

Care Management - applies systems, incentives and information to improve medical practice and assist consumers to manage their medical, social and mental health conditions.

CMS

Centers for Medicare & Medicaid Services - an agency within HHS responsible for several key federal health care programs including Medicare, Medicaid, and CHIP

CCIO

Chief Clinical Information Officer - a clinician to act as the chief informatics champion

CMIO

Chief Medical Information Officer - liaison between clinicians and IT, director of clinical IT systems, executive Informatician

CNIO

Chief Nursing Informatics Officer - the senior nurse guiding the implementation and optimizations of HIT systems for an organization

CTSA

Clinical & Translational Science Awards -a federal grant from the Center for Advancing translational sciences, part of the NIH which began in 2006. It was fully implemented in 2012 with 60 grantee institutions. Some areas of focus include drug development, new fields or uses of technology, ensure research is translated successfully into clinical practice and partnerships to speed innovation.

CTS2

Clinical (or Common) Terminology Services 2 - mediates among disparate terminology sources. CTS became an HL7 standard in 2004 and CTS 2 in 2009. CTS is an ANSI standard and provides a standardized set of computing services to query a terminology through standard technology independent interfaces. It defines a minimal set of functional characteristics the terminology resource must possess for use in HL7. The functional characteristics are described as a set of APIs which can be implemented to suit. In CTS2 under the Object Management group, CTS was extended to cover administrative functions, expanded search capability, mapping function, authoring and a conceptual model for terminology.

CCS

Clinical Coding Specialist - review data from patient's records and assign ICD9 and CPT codes, hospitals use that data to bill insurance or the government

CCOW

Clinical Context Object Workgroup - HL7 standard single sign-on across applications, networks, data that links them to the context of the patient, provider and encounter

CDR

Clinical Data Repository - a database optimized for the storage or viewing of clinical information such as labs and radiology. It stores data sent from interfaces from department systems

CDS

Clinical Decision Support - an electronic tool which reduces the cognitive burden of patient care in an EHR or an electronic system which provides structured guidance on patient specific inputs.

CDA

Clinical Document Architecture - defines the XML structure including data structure and metadata for clinical documents. HL7 has 9 document templates including CCD, 60 section templates. Version 1 is general document specification and version 2 has document types with allowable structures and markup in the Reference Information Model)

CEM

Clinical Element Model - an information model for representing clinical information in electronic health systems. It is intermountain health's strategy for detailed clinical models. It provides a single logical structure for a data element to which all incoming data of that type are normalized. CEMs are written in Constraint Definition Language (CDL) that can be compiled into objects for other programing languages. HL7 version2 and 3 are CEMs that prescribe codes from controlled terminologies. It facilitates interoperability between systems allowing for disparate architecture within those symptoms.

CI

Clinical Informatics - application of information technology to deliver healthcare services

CIO

Clinical Information Officer - ensures clinical adoption and engagement in technology, develop clinical information that supports organizational reform

CIS

Clinical Information System - advanced technologies directly used by clinicians to support healthcare decisions

CQM

Clinical Quality Measure - a mechanism to assess the degree to which a provider delivers appropriate services to a patient in an optimal time frame. They are eMeasures encoded in a health quality measure format (HQMF). CMS has 44 CQMs that demonstrate appropriate use of EHR technology to support clinical practice. The CQM includes the patient population, numerator, denominator, exclusions, and exceptions

CAP

College of American Pathologists - organization of board certified pathologists

CDE

Common Data Elements - a data element, which is common to multiple data, sets across different studies. These can be universal, domain specific (i.e. Parkinson's), required (for an institution or particular type of study), core (expected in particular classes of study). These result from a formal process to identify data elements for inclusion. NIH has CDE initiatives

CISC

Complex Instruction Set Computer - a computer where a single instruction can execute several low level operations or computers designed with a full set of computer instructions to provide needed capabilities in the most efficient way

COSTAR

Computer Stored Ambulatory Record - Mass general 1960s Octo Barnett MUMPS language, outpatient system + administrative and financial needs

CCDSS

Computerized Clinical Decision Support Systems - information systems to improve clinical decision-making. Characteristics of individual patients are matched to a computer database and software algorithms generation patient-specific recommendations

CPOE

Computerized Provider Order Entry (or, Computerized Physician Order Entry) - usually inpatient involves pharmacy/labs/radiology

CCDA

Consolidated - Clinical Document Architecture - commonly used CDA templates were harmonized and consolidated into a single implementation guide in 2012. CDA standardizes the expression of the clinical concepts, templates specify packaging of the concepts, and sets of templates create a clinical document. To meet MU2 compliance, C-CDA and MU2 guidelines must be implemented together because no C-CDA document template meets all the data requirements for transition of care/care coordination

CHI

Consolidated Health Informatics - a collaborative effort to create and adopt health informatics standards to be used by federal departments such as HHS and the VA. It uses standards such as HL7, LOINC, DICOM and SNOWMED. It is one of the office of management and budget's electronic government initiatives. It is a key component of the federal health architecture led by ONC and the NwHIN

CCD

Continuity of Care Document - XML readable document using HL7 CDA (Clinical Document Architecture)

CCR

Continuity of Care Record - XML based on basic health data practioners may want to share from ASTM

CER

Control Event Rate - proportion in the control group who experience a studied event

CRUD

Create, Retrieve, Update, and Delete - features of a database management system. 1) Create = insert, 2)retrieve = read, 3) update = edit and 4) delete the data

CAH

Critical Access Hospitals - hospitals certified to receive cost based reimbursement from Medicare to improve their financial performance and avoid closures. It encourages the development of rural health networks. They must be in rural areas, 35+ mi from another hospital or 15 mi with mountainous or secondary roads.

CPT

Current Procedural Terminology - classification of procedures performed by physicians usually required for reimbursement. Developed by the AMA. It includes the evaluation and management portion.

DDL

Data Definition Language - it is a syntax similar to computer programming languages to define database structures especially database schemas. It is used to create and destroy databases and database objects. It is primarily used by database administrators during the setup and removal of a database project (Create, Use, Alter, Drop). It is a description of the table and structure. It contains metadata and a data dictionary

DES

Data Encryption Standard - a previously dominant algorithm for the encryption of electronic data. It originated at IBM and is an ANSI standard. NIST did not recertify it and is replacing it with Advanced Encryption Standard.

DLP

Data Leakage Protection (or prevention) - system to detect potential data breach transmissions and prevent them by monitoring, detecting and blocking sensitive data while in-use (endpoint), in-motion (network), at-rest (data storage)

DSA

Data Storage Agreement - parties store data for each other

DUA

Data Use Agreement - an agreement required by the HIPAA privacy rule between a covered entity and the person or entity that receives a limited data set. The agreement must state the recipient will use or disclose the information in the limited data set only for specific limited purposes. Also, conditions for use and sharing of data between organizations

DBMS

Database Management System - software system which allows definition, creation, querying, updating and administration of databases

DMAIC

Define, Measure, Analyze, Improve, Control - a data driven improvement cycle for business processes. This is part of the Six-sigma strategy where there is an infrastructure of champions (green, black, yellow belts). Six sigma is from Motorola 1980s and a business strategy of GE in 1995. Six sigma states continual efforts to achieve stable and predictable results, manufacturing and business processes can be measured, strong leadership commitment to make decisions by data

EDR

Emergency Department Referral - IHE has an EDR profile which includes structures to pass data specific for ED referrals such as estimated time of arrival and method of transport

LOINC

Logical Observation Identifiers Names and Codes - Regenstrief laboratory terminology. Lab tests have standard names and codes. Each test has a name, property, time, specimen and method.

Routers

Device which joins 2 networks together

DRG

Diagnosis-related Group - aggregation for ICD-9 codes for research, adopted by HCFA (now CMS) in the 1980s for prospective payment for hospitalization. Numeric weighting represents resource intensity. DRGs arrange into 25 MDCs (Major diagnostic categories)

DIR

Diagnostic Imaging Report - a specialist's interpretation of imaging data. This information can be recorded through the HL7 CDA architecture

DSM

Diagnostic and Statistical Manual of Mental Disorders - standard classification of mental disorders and diagnostic criteria. It is prepared by the American Psychiatric Association

DICOM

Digital Imaging and Communications - developed by the American College of Radiology and national electric manufactures association. It defines how images and data are moved in electronic systems (device -> PACS). It uses SNOWMED for coded fields.

DMCA

Digital Millennium Copyright Act - a 1998 US law intended to update copyright law for electronic commerce and content providers. It criminalizes circumvention of electronic and digital copyright protection systems. Internet service providers are exempt from liability.

DNS

Domain name system- it is an internet service which converts host and domain name into IP address i.e. www.example.com becomes 198.105.232.4. The DNS system has its own network. If one DNS server doesn't know how to translate the name it asks another.

DHCP

Dynamic Host Control Protocol - a network protocol which enables a server to automatically assign an IP address to a computer. Computers request IP addresses from a DHCP network server. This occurs instead of a static IP Address which could lead to 2 computers configured with the same IP address. Residential routers receive a unique IP address within their provider network and within a local network DHCP assigns a local IP address to devices connected to a local network

ELINCS

EHR-Lab Interoperability and Connectivity Specification - messaging standard for lab ordering and reporting to EHRs, maintained by HL7

EHR

Electronic Health Record - focuses on the total health of a patient and are designed to reach out beyond the provider's office. They can share information with other health providers such as labs and specialists and contain information from all the clinicians involved in the patient's care. EHR data can be created, managed and consulted by authorized clinicians across more than one health care organization.

EMR

Electronic Medical Record - digital versions of paper charts in a clinician's office. It doesn't travel easily out of the practice.

EH

Eligible Hospital - CMS has eligibility criteria defined by law in order to receive payments for implementing EHR programs. For Medicare it includes hospitals paid by the inpatient prospective payment system, critical access hospitals and Medicare advantage affiliated hospitals. For Medicaid, acute care hospitals with at least 10% Medicaid and children's hospitals. Hospitals can select eligible for both Medicare and Medicaid when the register. If you register for both and apply for Medicaid you can apply for Medicare incentives later.

EP

Eligible Professional - for Medicare MD, DO, DDS, DPM, optometry, chiropractor. For Medicaid, MD, DO, NP, Midwife, DDS, some PAs (rule or federal health center). Cannot be more than 80% inpatient or ER. For Medicaid incentives need at least 30% Medicaid patients, 20% Medicaid and peds or practice at a federal health center or rural health center. If you are eligible for both you have to pick a program

ESB

Enterprise Service Bus - it is a software architecture to implement communication between mutually interacting software applications. It provides communication services for software application via an event drive and standards based messaging engine or bus.

EAV

Entity-Attribute-Value - a method to represent a collection of data in a computer. An entity is described from a narrower set of attributes selected from a larger set of possible attributes. This allows a program to keep a dynamic list of all possible attributes that can grow as needed. Consider a personal address book as it relates to a complete address book. There is usually a table with 3 columns - the entity, an attribute and a value for the attribute. In this data model, one row stores a single fact. If there was a patient who had multiple lab tests on a single day the table would have name, date and a single lab test on each row. A conventional table has one fact per column and new columns continually need added. (<patient XYZ>, 1/5/98 12:00 AM, "Hemoglobin," 12.5 gm/dl) (<patient XYZ>, 1/5/98 12:00 AM, "Potassium," 4.9 Meq/L) It is simple to store data this way but difficult to retrieve a data set.

CEN

European Committee for Standardization - represents the EU to the ISO, covers standards including healthcare (TC 251 committee) in Europe

E/M

Evaluation/management - established by congress in 1995 based on CPT codes established by the AMA. They include reporting levels for non-procedural encounters. The categories define variations in skill, effort and time. There are 7 components to define the E and M code for each case including history, exam, medical decision making, counseling, coordination of care, nature of presenting problem and time.

EVN

Event Type - one of the message segments on Version 2 HL7 messaging

EBM

Evidence-based Medicine - a set of tools and disciplined approach to informing clinical decision making

XPHR

Exchange of Personal Health Record - IHE profile for the content and format of summary information extracted from a PHR for import into an EHR and vice versa. It supports interoperability between PHRs used by patients and EHRs used by providers.

EER

Experimental Event Rate - proportion in experiment group who experience a studied event

XP

Extreme Programming - programming phases are carried out in very small steps. Coding is by a pair of programmers. There are automatic tests to provide concrete goals. Design and architecture comes after coding.

FMEA

Failure Mode and Effects Analysis - devised in 1949 by the military used in aerospace, automotive industry and health care. It can prioritize risk by severity of failure, frequency of failure and detectability. Steps include: 1) create a detailed flow chart of the process, 2) Describe what happens if the process fails at each step, 3) Rate each step by S = severity of harm, O = likelihood of occurrence, D = inability of controls to detect failure each 1 to 5 with 5 the worse or can't detect, 4) calculate Risk Priority Number (RPN) = SxOxD

FERPA

Family Educational Rights and Privacy Act - 1974 it protects the privacy of students personally identifiable information. Schools and school districts maintain student health records and they are protected by FERPA and not by HIPAA. HIPAA may apply to patient records at a university hospital or to health records of non-students at a health clinic.

HCI

Human-Computer Interaction - a discipline concerned with the study, design and implementation of human-centric interactive computer systems.

FHIR

Fast Health Interoperability Resources - it is a next generation standards framework created by HL7. It combines the best features of HL7 version 3 and CDA and leverages web standards with a focus on interoperability. It is built from modular components called resources. It is suitable for mobile phone apps, cloud communication, EHR and server communication.

FMT

Federal Medication Terminologies - federal agencies are organizing a set of terminologies to exchange medication information. It includes UNII, National Drug Codes NDC, Structured Product Labeling SPL, NLM's Rx Norm for clinical drug names, VA NDF-RF, DailyMed for drug labels. FedMed partners are working with ONC to develop a group that can support coordination, development and use of this standard.

FQHC

Federally Qualified Health Centers - receive grants from the public health service act. They qualify for enhanced reimbursement from Medicare and Medicaid and other benefits. They must serve an underserved population, offer sliding scale fees and have an ongoing quality assurance program.

FIN

Foreign Identification Number

FK

Foreign key - it is a column in one table that establishes a link with another table. Each database table has one or more columns designated as a primary key. The value is unique for each record in the database (for example a key number which identifies every employee). Foreign key values do not need to be unique. There can be a department key and multiple employees belong to the same department. The department key in the employee table references a new department table.

FSA

Functional Status Assessments - supports handoff of assessment information between care practioners during transfers of care. It is a profile from IHE. It includes the pain score, pressure sore scale, geriatric depression scale and physical functioning and structural problems. It leverages HL7 CDA ontology.

GEM

General Equivalence Mappings - CMS and the CDC created the national version of GEM to ensure consistency of national data is maintained. It can be used by anyone who wants to convert coded data such as ICD 9 CM to ICD 10 CM. Mapping from ICD 10 CM and PCS back to ICD 9 CM is backward mapping and the reverse is forward mapping.

GIPSE

Geocoded interoperable population summary exchange. It was created by the CDC for electronic exchange of health condition summary data. It will be used by public service agencies for early event detection and monitoring of public health events.

GRDR

Global Rare Diseases Registry - NIH office of rare diseases pilot project to develop a web-based data repository of deidentified patient data aggregated in a standard manner using common data elements and standardized terminology. Global unique identifiers (GUID) could link the patient's data to the biospecimen data set. Common Data elements and informed consent documents are being provided to groups establishing patient registries.

NNT

Number Needed to Treat - number of patients to achieve one favorable outcome = 1/ARR

GIPSE

Grid Interface for Parameter-driven Simulation Environments - grid computing is sharing tasks over multiple computers. The tasks can range from data storage to complex calculations. Networked computers can join together to create a virtual supercomputer. Grid computing is similar to cluster computing as there is no centralized management, they are often in different locations performing a variety of tasks. GIPSE is a toolset to streamline management aspects of the grid for simulation-based research.

GEM

Guideline Elements Model - ASTM standard to represent guidelines in XML (Yale). The XML editor for guideline markup is called the GEM cutter.

HCPCS

HCFA (Healthcare financing administration now CMS) Common Procedure Coding System. it was established in 1978 to provide a standardized coding system for services and specific items in the delivery of healthcare. It is based on the AMA's CPT. It became mandatory through HIPAA in 1996. Level I is the AMA CPT codes, Level II non-physician services such as ambulances and prosthetic devices. Level III are local codes developed by state Medicaid, Medicare contractors and private insurers and was discontinued in 2003

HCFA

Health Care Financing Administration - now CMW

HEDIS

Health Effectiveness Data and Information Set - a set of performance measures published by the National Committee of Quality Assurance. It helps consumers compare health plans and tracks quality of care delivered by health plans.

HELP

Health Evaluation through Logical Processing - early EHR system, Utah Homer Warner

HIM

Health Information Management - the practice of acquiring, analyzing and protecting digital and traditional medical information vital to quality patient care. They plan information systems, develop health policy and identify current and future information needs.

HIS

Health Information System - an information system to process data, information and knowledge in healthcare environments

HITECH

Health Information Technology for Economic and Clinical Health 2009 - a $19 billion stimulus for health IT through the ARRA American Recovery and Reinvestment act. It provided training for the health IT workforce, university funding to introduce health IT, Regional Extension Centers (RECs) for adoption of health IT, state grants for health information exchange and to strengthen Beacon programs, standards harmonization, ONC became protected by law. It also provided billions for incentives for HIT adoption.

HICT

Health Information and Communications Technology - used internationally to signify the importance of communication as well as information.

HIPAA

Health Insurance Portability and Accountability Act (Kennedy Kasselbaum) addresses: Title I make insurance more portable when persons change employers and Title II make the health care system more accountable for costs through administration simplification primarily by use of IT. This includes: 1) Standards for financial transactions and code sets, 2) unique identifiers for patients, providers and employers, 3) Privacy and Security standards for transmission of electronic data,

HL7

Health Level 7 - organization which provides the major messaging standards for health care. This includes the eHR functional standard, CCOW, CDA architecture and Version 1,2,3 message exchange.

HPID

Health Plan Identifier - a 10 digit identifier for all health plans covered by HIPAA

HQMF

Health Quality Measures Format - a standard for representing a health quality measure in an electronic document. NQF joined with HL7 and AHIMA for this. They are referred to as e-measures.

HITSP

Healthcare Information Technology Standards Panel - created from an HHS contract to ANSI from 2005-2010 to promote interoperability by harmonizing health information technology standards. It is sponsored by ANSI. ARRA in 2009 provided for the creation of the HIT policy and standards committees which make recommendations to the National Coordinator for Health IT which replaced it.

HRO

High-reliability Organization - an organization that performs high risk work but without rare catastrophic events.

H&P

History and Physical

IC

Immunization Content - It is an IHE profile which defines standard immunization content for public health immunization systems, EMRs and HIEs who wish to exchange immunization data electronically. The immunization content module provides a record of past immunizations, ones required and details on effectiveness of past immunizations.

ICER

Incremental Cost/Effectiveness Ratio - compares a new to an old intervention. (Cost New - Cost old)/(Effectiveness new - effectiveness old)

IPAB

Independent Payment Advisory Board - a government agency created in 2010 from the Affordable Care Act to achieve savings in Medicare. It reduces Medicare reimbursement if goals are not met.

IR

Information Retrieval - retrieval of information from databases that are predominantly text

ITIL

Information Technology Infrastructure Library - framework for IT service management. It was developed in the UK in the 1980s by the Central Computer and Telecoms agency to save money. Microsoft used ITiL as the basis for the Microsoft Operations Framework (MOF). It defines the organizational structure and skill requirements of an IT area and documents operational management procedures for an IT operation.

IaaS

Infrastructure as a Service - an organization outsources the equipment to provide operations including storage, hardware, servers and networking. The service provider owns the equipment. The client typically pays on a per use basis.

IHE

Integrating the Health Enterprise - nonfederal effort to identify and demonstrate solutions to real-world interoperability problems. It produces technical framework documents. It promotes standards by other standards organizations.

IMO

Intelligent Medical Objects - it is a private company which develops, manages and licenses medical vocabularies founded in 1994. It provides vocabularies and interface terminology for companies building EHRs and maps them to standardized vocabularies. Their Problem and Procedure IT help assign billing codes with the interface reviewing the diagnostic data and orders. It speeds the coding process and decreases rejected claims.

ICD-9-CM

International Classification of Diseases - Clinical Modifications, Ninth Revision - CM is the US clinical modification developed by the CDC. ICD9 CM and ICD10 CM are morbidity codes. ICD PCS was the CMS procedure modification for American health care used for inpatient procedures.

ICD

International Classification of Diseases - originally as a list of causes of death in 1983 for mortality statistics taken over by WHO

IHTSDO

International Health Terminology Standards Development Organization - it is an international standards development organization formed in 2006. In particular it promotes SNOWMED CT. It is based in Denmark and the 19 countries which are members largely finance it.

ISO

International Organization for Standardization - international organization founded in 1949 which certifies international standards and organizes standard making. ANSI is the US representative and the EU votes for Europe. TC215 is health informatics standards.

ITU

International Telecommunication Union - an agency of the UN whose purpose is to coordinate telecommunications throughout the world. It was founded in 1865. It has 3 sectors: radio communication, telecommunications standardization, and telecommunications development.

IDPS

Intrusion Detection and Prevention Systems - network security appliances - network detection systems are passive. They monitor for suspicious network traffic activity and send alerts to the network operating center. IPS are active. They monitor for attacks and send alerts but also take programmed actions to stop the attack such as denying the network traffic or removing the malicious computer from the network

JCAHO

Joint Commission on Accreditation for Healthcare Organizations (now known as The Joint Commission) - Non-profit, which accredits healthcare organizations and programs founded in 1951. It does an on-site survey every 3 years. The results are available on a Quality Check Website. It established national safety goals: reduce MDRO; reduce catheter related blood stream infections and surgical site infections. States require accreditation to receive a license and Medicaid money.

KLM

Keystroke-Level Model - a predictive model of human computer interaction (the other is Hickman-Hyman user response time is a function of the number of possible responses - predicts user response to hierarchical menus). Time to task completion is a sum of keystrokes, pointing, homing, mental thinking and system response. It tells you which functions are amenable to shortcuts and hot keys. The descriptive HCI models are Buxton's 3 states of graphical input (transitions of a mouse) and Guiard's Model of bimanual skill (hands are not used equally)

KDD

Knowledge Discovery in Databases - the process of discovering useful knowledge from a collection of data. It is a widely used data mining technique that involves data selection and preparation, data cleansing, incorporating prior knowledge on data sets, applying algorithms to data sets and interpreting accurate solutions from the results. The goal is to extract high-level knowledge from low-level data.

KM

Knowledge Management - the process of developing and translating knowledge so it is available in the CDS system. It also involves acquiring, evaluating, tracking and maintaining knowledge.

LDAP

Lightweight Directory Access Protocol - it is an internet protocol to access and maintain directory information services over an internet protocol network. It allows anyone to locate organizations, individuals, files, and devices on a network.. A common usage of LDAP is a single sign-on where one password for a user is shared between multiple services.

LR

Likelihood Ratio - how much should we shift suspicion for a particular test. LR+ - how much to increase probability if a test is positive and LR- is how much to decrease probability if a test is negative. LR+ = TPR/FPR = Sens/(1-spec) = prob person with condition has a pos test/prob person without condition has a positive test test and LR- = prob person with condition has a negative test;prob person without condition has a neg test = FNR/TNR

MD

Mean Difference - the difference between two independently averaged values. The arithmetic mean is the average.

MU

Meaningful Use - incentives to offset cost and productivity loss to install EHRs. The EHRs have to be used meaning to influence the quality of care. The goals are to improve health outcomes (individual and population health, disparities), improve patient engagement, improve care coordination, improve efficiency of health care, and ensure privacy and security of health information

MAC

Media Access Control - unique hardware address for network interface cards and for each node in a network

MLM

Medical Logic Modules - represents medical algorithms in clinical information systems. It encodes knowledge in a knowledge base form. It contains sufficient knowledge for a single medical decision. Tasks are sequenced with a series of MLMs.

MeSH

Medical Subject Headings - NLM comprehensive controlled vocabulary to index books and journal articles.

MSH

Message Header - parts of version 2 HL7 messaging with ASCII files

MD5

Message-Digest Algorithm - message digests ensure data integrity. A message digest is another name for a hash. MD5 hash takes 512bit blocks and uses them sequentially to modify a 128 bit matrix. The 128 bits compose the message hash. A hash function is a cryptographic algorithm that takes messages of arbitrary length and puts out fixed length code; the out is called the message digest. SHA secure hash algorithm is also popular.

MIMO

Multiple Inputs, Multiple Outputs - use of multiple antennas at the transmitter and receiver end to improve communication performance. It offers increases in data without additional bandwidth.

NCIt SPL

NCI Thesaurus Structured Product Labeling - NCI and FDA subset of the document markup standard approved by HL7 to exchange product information. UNII is FDA for drug ingredients, RxNorm is NLM for drug names and DailyMed is NLM for drug labels. National drug codes NDC is FDA for identifying drug products through a 3 segment number.

NCQA

National Committee for Quality Assurance - Private not for profit organization founded in 1990 that develops quality measures, accredits and certifies hospitals/health plans/physician organizations. It publishes the Health Effectiveness and Information Set. It allows consumes to compare health plans. It has 6 accreditation programs, 5 certification programs and 5 physician recognition programs including a PCMH Recognition program.

NCPDP

National Council for Prescription Drug Programs - create and promote standards for information exchange for medication and pharmacy services. It is ANSi accredited. The SCRIPT standard facilitates ePrescribing.

NDC

National Drug Code - FDA 11 digit code 3 segment for each pharmaceutical. It includes 1st 5 for manufacturer, next 4 for name/strength/dose, and 2 for packaging

NDF-RT

National Drug File Reference Terminology - specifies the mechanism of action, physiological effect and drug class. It is used with RxNorm from the NLM

NIST

National Institute for Standards and Technology - founded in 1901, now part of the US Department of Commerce (non-regulatory). Their goal is to improve industrial competitiveness by advancing measurements science, standards and technology. It received $610 million from ARRA. It works with ONC to develop testing, test cases and test tools in support of the health IT EHR certification program.

NINDS

National Institute of Neurological Disorders and Stroke

NLM

National Library of Medicine - founded in 1836 on the NIH campus. It is the world's largest biomedical library. It conducts and supports biomedical informatics research and training.

NPSG

National Patient Safety Goals - from the Joint Commission. For 2014, identify patients correctly, improve staff communication, use medicines correctly, use alarms correctly, prevent infection, identify patient safety risks, and prevent mistakes in surgery. NQS (National Quality Strategy) is from HHS and looks at patient safety, engagement care coordination, population and public health, efficiency and clinic outcome effectiveness.

NPI

National Provider Identifier - issued by the National Provider System overseen by HHS. It is a 10 positive unique identification number for covered health care providers. It is a HIPAA administrative simplication standard.

NPS

National Provider System - or NPPES National Plan and Provider Enumeration System. It was developed under CMS contract. It uniquely identifies health care providers and assigns them NPIs. The NPI Enumerator (under contract to Fox Systems) handles paper NPI applications and resolves problems related to NPI.

NQF

National Quality Forum - created in 1999 in response to an advisory comission to promote patient protection and health care quality through measurement and public reporting. It receives public and private funding through agencies like cms and the Robert wood Johnson foundation. It developed 28 medical errors which it calls serious reportable events (SRE) or never errors. Measures are collected in a tool called the Quality Positioning System (QPS). There are 685 different measures and NCQA (HEDIS, PCMH recognition, accrediting hospitals, etch) and PQRS (Medicare) are subsets of NQF.

NQM (NQS)

National Quality Strategy - led by the Agency for Healthcare Research and Quality first published in 2011 on behalf of HHS. It was established as part of the Affordable Care Act. There are 3 aims better care, affordable care and healthy people and communities. There are 6 priorities: reduce harm in care, engage patients, promote effective communication and coordination, effective prevention and treatment of leading causes of mortality, healthy living in communities, new health care delivery models to make more affordable care.

NRIC

National Registration Identity Card - identify document for use in Singapore

EIN

National Standard Employer Identifier - HIPAA required employers have national standard numbers that will identify them on standard transactions. The taxpayer number for employers EIN adopted by the IRS was selected and adopted in 2002.

NPV

Negative predictive value - probability of not having disease if the test is negative = TN/TN+FN

NPV

Net Present Value - difference between present value of cash inflows and outflows. Helps determine if a project is an acceptable investment. It is part of operating budgeting

NAC

Network Access Control - network authentication and dynamic vulnerability scanning and detection when a computer joins a network.

NANDA

North American Nursing Diagnosis Association - nursing knowledge expressed through standardized nursing diagnosis language

NIC

Nursing Interventions Classification - it includes interventions that nurses perform. They are grouped into 30 classes and 7 domains. It is included in the NLM's metathesaurus for a Unified Medical Language. It is also registered in HL7 and mapped into SNOWMED.

NOC

Nursing Outcomes Classification - standardized classification of patient outcomes to evaluate the effect of interventions provided by nurses. There are 490 outcomes grouped into 30 classes and 7 domains. They are rated from 1-5. It is included in NLM's Unified Medical Language and CINAHL and has been approved for use by HL7. It is currently being mapped to SNOWMED.

OOP

Object-Oriented Programming

ORM

Object-Relational Mapping - it is a programming technique for converting data between incompatible systems in objected oriented programming languages

OODBMS

Object-oriented Database Management System - information is represented by objects instead of table oriented. There is more support for other types of data such as graphics, images and videos. They are usually integrated into the programming language. They have a many to many relationship. Epic EHR uses Intersystems Cache which is an OODBMS.

OBX

Observation - carries key results reporting information in report messages which transmits it back to the requesting system

OBR

Observation Request - HL7 messaging v. 2 transmits information about an exam, diagnostic study or observation. It should be used in orders where a request is made for a given set of observations.

OR

Odds Ratio - ratio of the odds of the outcome in the treatment group to the odds of outcome in the control group. Odds is the number of people with events/number of people without events. OR = 1 no difference due to treatment. OR<1 = treatment benefit. OR>1 more likely to have disease in the treatment group. It differs from relative risk which is the ratio of the event rate in the experiment group to the event rate in the control group.

OCR

Office of Civil Rights - it protects from discrimination in certain healthcare and social service programs. It enforces the HIPAA Privacy rule (protects the privacy of PHI), HIPAA security rule (sets national standards for security of electronic protected PHI) and the HIPAA breach notification rule. It also protects confidentiality of the Patient Safety Rule which protects identifiable information from being used to analyze patient safety events and improve patient safety.

ONC

Office of the National Coordinator for Healthcare IT - Established in 2004 and mandated in 2009 by the HITECH act. It oversees national activities to promote health IT and health information exchange. It established certification criteria for EHRs and established HIE standards.

OSI

Open Systems Interconnect - it is a reference model for how messages should be transmitted between any two points in a telecommunication network or how information from an application in one networked computer passed to an application on another networked computer. It guides product implementers so their products will work with other products. The reference model defines seven layers of functions that take place at each end of communication. Mnemonic - All people seem to need data processing = Application, presentation, session, transport, network, data link, physical.

OECD

Organization for Economic Cooperation and Development - an international organization of 34 countries formed in 1961 to stimulate economic progress and world trade. It publishes Health at a Glance which provides comparable data on different aspects of health systems in OECD countries. They develop statistics of healthcare performance and countries benchmark their policies against high performing health systems

OEID

Other Entity Identifier - needs to be identified in standard transactions, not eligible for NPI or HPID, not an individual

PID

Patient Identifier - HL7 messaging patient identifier HL7 messaging

PPOC

Patient Plan of Care - IHE profile based on data elements from the nursing process. It defines the implementation of an HL7 CDA document to represent data elements needed for care planning

PPACA

Patient Protection and Affordable Care Act

PROMIS

Patient Reported Outcome Measurement System - NIH Tool to measure health outcomes from the patient perspective. The measures can be used as primary or secondary endpoints in clinical studies on the effectiveness of treatment.

PCORI

Patient-Centered Outcomes Research Institute - created by the Affordable Care Act in 2010 to investigate the relative effectiveness of medical treatments. It is funded by the PCORI Trust Fund authorized by the ACA from a general fund of the treasury and fee on Medicare and insurance plans for each person covered the plan.

PCIDSS

Payment Card Industry Data Security Standard - it is an information security standard for organizations that handle cardholder information. It was created to reduce credit card fraud. It is not required by US Law.

PAN

Personal Area Network - a collection of networked devices that does not have a centralized network system. Generally one device is the main hub and all connected devices connect to it. Bluetooth and Wi-Fi have an effective broadcast network of 30 feet. Two of the pieces could be as far as 60 ft. apart. They can be constructed with cable (USB, Firewire) or be wireless (Bluetooth, infrared, Wi-Fi)

PIER

Physician's Information and Education Resource - electronic medical resource from the American College of Physicians. It provides evidence based guidelines and can integrate into EMRs

PACS

Picture Archiving and Communication System - provides storage, access and transmission of electronic images and reports via the DICOM format. PACS consists of the imaging equipment, secured network, workstations to interpret and review images and archives to store and retrieve the images.

PDCA

Plan, Do, Check, Act - used for continuous improvement versus the PDSA when the improvement scenario is more straightforward versus PDSA for complex scenarios which require more reflection. Check implies how does the state of the system compare what you were expecting. Study implies what can we learn from the state of the system as compared to what we were expecting. PDCA emerged in 1950 from a lecture given by Deming in which he described his interpretation of the continuous improvement cycle proposed by Shewhart in 1939. In 1986 Deming amended his description of PDCA to reflect on the meaning of the metric you are checking and PDSA emerged.

PDSA

Plan, Do, Study, Act - Deming 1970s, small repeated cycles to select targets, improve on a small scale, implement widely and measure outcome

PaaS

Platform as a Service - delivering operating systems and associated services over the internet. It is sometimes called cloudware.

PPP

Point to point protocol - direct connection between 2 nodes in layer 2 data link layer. It is a method to connect a computer to the Internet and is part of the data link layer.

PEST

Political, Economic, Socio-cultural, Technological (Analysis) - political, economic, sociocultural and technology factors - analysis of external factors which is beneficial when conducting research to begin a new project. It is different that SWOT because it is directly aimed at external macro environmental factors that may affect your business or identify new directions for your business.

PICO

Population, Intervention or Variable of Interest, Comparison, Outcomes - how to ask a clinical question using EBM techniques

PICOTS

Population, Intervention or Variable of Interest, Comparison, Outcomes, Type of study, Setting study would take place

PPV

Positive Predictive Value - probability of disease in patients with a positive test = TP/TP+FP

PK

Primary Key - It is a unique identifier for a database record. It is a column in a relational database table which has a unique identifier

P&L

Profit & Loss - it lists the income and expenses of a business over a period of time. It will tell a bank if your business is profitable or not. It is part of an operating budget. The operating budget also includes the cash flow statement (flow of cash in and out of a business over a period of time) and a balance sheet (snapshot of a firms financial resources and obligations in a single point in time)

PERT

Program (or Project) Evaluation and Review Technique - it is a project management technique to schedule, organize and coordinate tasks within a project. A project is illustrated with nodes for events or milestones and vectors representing tasks. It clearly illustrates task dependencies. Tasks that must be completed in sequence are dependent or serial tasks. Tasks that can be done simultaneously are parallel or concurrent tasks. The PERT chat can be more difficult to interpret than the GANTT chart. It analyzes what tasks are involved to complete a project, how much time for each task and the minimal time to complete the whole project.

PMBOK

Project Management Body of Knowledge - it is a project management guide which is an ANSI standard produced by the Project Management Institute

PHI

Protected Health Information - individual identifiable health information

QI

Quality Improvement - formal approach to the analysis of performance and systemic efforts to improve it

QPS

Quality Positioning System - the national quality forum (NQF) collects and standardizes quality measures in the quality positioning system

QALY

Quality-adjusted Life Year - a measure of disease burden which includes both the quantity and quality of life. Each year of perfect health has a value of 1 and death has a value of 0. Life years which are not in perfect health are assigned a value between 0 and 1. QALY = (quality of life fraction)x(quantity of life)

QED

Query for Existing Data- IHE profile which supports dynamic web services style queries for clinical data

QMR

Quick Medical Reference - followed the University of Pittsburgh Internist 1 from the 1970s where users entered in clinical findings and the system procedure a diagnosis. It utilized scoring and heuristics for knowledge modeling. It weighed the positive and negative findings by evoking strength, frequency and severity. QMR was a commercial standard along product which did not succeed. It was integrated with Vanderbilt's EHR.

RCT

Randomized Controlled Trial - it is a scientific experiment in which the study subjects are eligible are randomly allocated to receive the treatment or the control (no treatment or previously tested treatment). It is the gold standard for a clinical trial.

RED

Re-Engineered Discharge - Boston University researchers developed a set of activities and materials to improve the discharge process. The RED was effective in reducing readmissions and post-discharge hospitalizations. It is a set of 12 actions to undertake during and after a hospital stay to ensure a smooth transition at discharge. AHRQ contracted with BU to develop the toolkit.

RSS

Real Simple Syndication, Rich Site Summary - it is bibliographic knowledge based content. They are feeds mostly new content, short summaries of web content. It contains mostly metadata about journal articles or typical library resources.

ROC Curve

Receiver operating characteristic Curve - Receiver Operator Characteristic (ROC) - Visual representation of the tradeoff between sensitivity and specificity. Graph of sensitivity versus 1-specificity (TP rate versus FP rate). The inflection point is the optimal threshold for a test with a variety of results

RISC

Reduced Instruction Set Computer - a computer designed with frequently used instructions to get more work done in a shorter time period for most applications or a microprocessor designed to perform a smaller number of computer instructions so it can operate at a higher speed

RIM

Reference Information Model - uses an object oriented approach to define health care interactions with 5 classes (entity, role, participation, act and act relationship). HL7 Version 3 based on the RIM and it is in XML.

RHIA

Registered Health Information Administrator - an expert in managing health information and medical records, administering computer information systems and using medical terminologies. They need to have a HIM bachelor's degree and take a test from AHIMA. The RHIA has a higher level of expertise and receives administrative training.

RHIT

Registered Health Information Technician - they manage and analyze health care data. They ensure the quality of the medical records. It is a 2 year degree for jobs in coding, reimbursement, risk management and utilization management.

RDBMS

Relational Database Management System - it stores data in the form of related tables. A single database can be spread across multiple tables as opposed to flat-file databases where the database is self-contained in a single table.

RR

Relative Risk = EER/CER - risk of the event in the exposed over risk of the event in the unexposed. It compares the risk of disease or death in two groups.

ROI

Release of Information - the process of logging, verifying and tracking and PHI request, retrieving the health information, authenticating the requestor, and packaging and mailing the documents with an invoice.

RCG

Request for Clinical Guidance - it is an IHE profile to obtain decision support prior to ordering medications, tests, immunizations, etc. It supports integration of clinical decision support into health IT systems.

RFI

Request for Information - request during project planning when buyer cannot clearly identify requirements or specifications

RFP

Request for Proposal - document organization posts to elicit bids from potential vendors for a service or product.

RFQ

Request for Quotation - when the requirements are clear cut and the price is the main factor for selecting a bidder

RHC

Rural Health Care or clinic - a clinic located in a rural (as defined by the census bureau) and medical underserved area that has a separate reimbursement structure than standard Medicare and Medicaid.

SNOMED CT

SNOMED Clinical Terms - SNOWMED merged with the English clinical terms project in 2000 to become SNOWMED CT. IHTSO owns it as of 2007 and the US paid for us to use it for free.

SHA

Secure Hash Algorithm - A hash function is a cryptographic algorithm that takes messages of arbitrary length and puts out fixed length code; the out is called the message digest. SHA secure hash algorithm uses a 160 bit hash value. There is SHA 0,1,2,3. SHA was designed by the NSA. MD5 is also common.

SSH

Secure Shell - it is a cryptographic network protocol for secure data communication, remote command line login and remote command execution. It uses public key cryptography to authenticate the remote computer and user if necessary. It is typically used to log into a remote machine and execute commands.

SLA

Service Level Agreement - contractual rather than legal for performance. It is a contract between a service provider and a customer. It details the nature, quality and scope of the service to be provided.

SDLC

Software Development Life Cycle. It is a framework to define tasks performed at each step in the software development process. It is a detailed plan to develop, maintain and replace specific software. The phases include planning (scope, requirements), implementation (code), testing (verification - did you build the software correctly and validation did you build the software the customer wanted), documentation, deploying and maintaining.

SaaS

Software as a Service - software is licensed on a subscription basis and is centrally hosted. It is also known as on-demand software. It extends the Application Service Provider model which hosts specialized business applications. SaaS unlike ASP develop and manage their own software. SaaS unlike the initial ASP is predominantly delivered through a web browser unlike ASP which requires an application to be downloaded.

SMART

Specific, Measurable, Attainable, Relevant, and Time-bound - characteristics of goals of workflow engineering. They are attributed to Peter Drucker's management by objectives concept. The 1st use was in 1981 in a paper by George Doran

SMD

Standardized Mean Difference - it is a summary statistic in meta-analysis when the studies all assess the same outcome but measure it in a variety of ways. It is necessary to standardize the results to a uniform scale prior to combining. The SMD is the size of the intervention effect in each study relative to the variability observed in that study

S&I

Standards & Interoperability - the framework is the mechanism by which ONC will manage the implementation of specification and harmonize existing health IT standards to promote interoperability. It is not developing new standards.

SDO

Standards development organization - an organization whose activities are to develop, revise, interpret or produce technical standards. Most standards are voluntary but some become mandatory legal requirements.

SCHIP

State Children's Health Insurance Program - it provides health coverage to children in families too high for Medicaid but too low for private insurance. CHIP provides matching federal funds to states to provide this coverage. It is administered by the states but jointly funded by the federal government and the states. States can do Medicaid expansion, a separate CHIP or combination.

SIM

Strategic Information Management - how an organization should collect, use, manage and share its information to improve its competitive advance. It is important to categorize and prioritize key information according to strategic importance, offer access and make best use of the information and protect the information.

SWOT

Strengths, Weaknesses, Opportunities, Threats - identify internal advantages and disadvantages which could benefit or hinder the outcome of a planned project. Opportunities are current external trends and threats are external movements which could cause a problem. It can also identify external factors which can make a different to the success or failure of a project

SME

Subject Matter Expert - authority in a particular area or subject

SOAP

Subjective, Objective, Assessment, and Plan

SMArt

Substitutable Medical Apps, reusable technologies - substitutability is the capability of a system to replace one application with another of similar functionality without being technically expert. The goals of the platform architecture project is to develop a user interface for medical apps based on shared basic components and create a set of services to capture, store, retrieve and analyze data scalable to the national level respectful of patient policy. It is lead by Harvard medical school with several partners. It was 1st described in a 2009 NEJM medical perspectives article. There is also a smart apps challenge sponsored by the ONC. $15 million was award for the project through the Strategic Health IT Advanced Research Project (SHARP).

SNOMED

Systematized Nomenclature of Medicine - comprehensive controlled vocabulary originally developed by the American college of pathology. Richest vocabulary for clinical observations and findings.

VMR

Virtual Medical Record - it is an HL7 simplified standardized electronic health record data model to support CDS systems. It will leverage existing data models within the HL7 community and identify the subset of data which is directly relevant to CDS.

TMR

The Medical Record - Duke 1970s began in the outpatient OB clinic Ed Hammond and William Stead

VPN

Virtual Private Network - an authenticated encrypted limited communication from an external computer or network to an internal network

TCO

Total Cost of Ownership - it is a financial estimate to help owners determine the direct and indirect costs of a product or system. It includes the total cost of acquisition and the operating costs. A TCO analysis is used to gauge the viability of a capital investment.

TCP/IP

Transmission Control Protocol/Internet Protocol - set of communication protocols used by the internet and similar networks. It provides end-to-end connectivity and specifies how the data should be formatted, routed and received.

TNR

True Negative Rate (= Specificity) - proportion of patients without disorder who have a negative test = TN/TN+FP

TPR

True Positive Rate (= Sensitivity) - proportion of patients with disorder who have a positive test = TP/TP+FN

UCUM

Unified Code for Units of Measure - it is a code system which includes all units of measure used in international science, engineering and business. The purpose is to facilitate unambiguous communication of the quantities and their units electronically. It is typically used for electronic data interchange (EDI) protocols. It is heavily based on ISO 2955-1983, ANSI X3-50-1986 and HL7 extensions called ISO+. These standards have some severe defects.

UMLS

Unified Medical Language System - it is a comprehensive controlled vocabulary which is a project of the NLM. It contains a metathesaurus (terms and codes from many standard vocabularies including CPT, ICD10, LOINC, SNOWMED CT, RxNorm and MeSH), semantic network (generic relationships between concepts) and a lexicon (natural language processing tools). The semantic network and lexicon tools produce the Metathesaurus. It integrates and distributes key terminology, classification and coding standards to promote more interoperable biomedical information systems and services. The UMLS can be accessed through a web browser, web service APIs or local installation. The MetamorphoSys tool in the local installation allows you to customize the UMLS and then can be downloaded into your own database system.

UML

Unified Modeling Language - standard tools to describe databases, software and business processes. It is an ISO/IEC general purpose modeling language in software engineering and is managed by the Object Management group. It includes graphic notation techniques to visualize database schema, software components, programming language, actors, activities and business processes.

URL

Uniform resource locator - it is the global address of documents and resources on the world wide web. An example is http://www.pcwebopedia.com/index.html

UPS

Uninterruptible Power Supply - it offers backup short-term emergency power when the main power source fails. It uses batteries which provide nearly instant power but only lasts a few minutes as opposed to a standby or backup generator. It is used to protect hardware such as computers, data centers and telecommunication equipment which power disruption could cause serious data disputation.

UNII

Unique Ingredient Identifier - it is an alphanumeric identifier based on the substance's structure and/or descriptive information used for drugs, biologics, foods and devices. It is used in the FDA structured product labeling. It is found in UMLS, NDF-RF and is used to generate RxNorm. It is managed by the FDA and US Pharmacopeia.

UMD

Universal Medical Device - UMD Nomenclature System is a standard international nomenclature and computer coding system for medical devices. It facilitates identifying, storing, retrieving and communicating data about medical devices. It is incorporated into the NLM Unified Medical Language System. It is maintained by the ECRI institute. The FDA has a Unique Device Identifier to assign a unique number to medical devices in the US.

UPIN

Universal Physician Identifier Number - for doctors that treat Medicare patients

UDP

User Datagram Protocol - reliable delivery of packets of data used for streaming media usually. It is fasting than TCP (transmission control protocol) but no flow control or error connection. It is used in the transport layer in the 7 layer model of communication across a network as part of the Open Systems Initiative

VistA

Veterans Health Information Systems and Technology Architecture

WMD

Weighted Mean Difference- unlike the arithmetic mean some data points contribute more than others. If the weights are equal it is the arithmetic mean.

WPA

Wi-Fi Protected Access - WPA and WPA2 are security protocols developed by the Wi-Fi alliance to secure wireless computer networks in response to weaknesses in WEP. A flaw in a feature added to Wi-Fi called Wi-Fi protected Setup allows WPA and WPA2 to be bypassed. WPA2 replaced WPA and includes a new AES encryption mode with strong security. Wi-Fi devices since 2006 include both. Both WPAs are vulnerable to password cracking.

WEP

Wired Equivalent Privacy - it is a security algorithm for IEEE 802.11 wireless networks. It provides data confidentiality comparable to a traditional wired network. In 2003, it was superseded by WPA (Wi-fi Protected Access)

WLAN

Wireless Local Area Network - a LAN is a wireless computer network that connects computers in a limited area such as a home or school. Typically the connected devices share the resources of a single processor or server in a small geographic area. The server has applications and data storage shared by multiple users. Wi-Fi wireless radio connection is used to build the LAN in WLAN.

WBS

Work Breakdown Structure - it is a deliverable oriented decomposition a project into smaller components. It provides guidance on schedule development and a framework for cost estimates. The 100% rule states that the WBS should capture 100% of the work as defined by the project scope and the deliverables. Mutually exclusive - there is no overlap between different elements of a WBS. 80 hour rule - no single activity at the lowest level of detail should take more than 80 hours of effort. The hierarchy is coded by decimal points in the WBS coding scheme.

WHO

World Health Organization - it is the coordinating authority for health within the UN. It provides leadership on global health, shapes health research, sets standards, and provides technical support to countries assessing health trends.

HMAC

a keyed Hash-based Message Authentication Code - a message authentication code is a short piece of information to authenticate a message which guarantees integrity and authentication. Hashes guarantee integrity only. Message authentication codes combine a shared secret key with the message. HMAC uses a hash function over a message and key.

XML

eXtensible Mark-Up Language - a set of rules for encoding documents to make it machine readable and human readable.

FTP

file transfer protocol - the protocol for exchanging files over the internet. It uses the Internet's TCP/IP protocols to exchange data transfer. It is commonly used to download a file from a server using the internet or to upload.

HTML

hypertext markup language - converts text documents to an Internet compatible format. Hypertext is structured text that uses logical links (hyperlinks) between nodes containing text

IP

internet protocol assigns IP addresses to network devices. An IP address is an identifier on a computer or device on a TCP/IP network which uniquely identifies the device.

POP

post office protocol - a protocol to retrieve email from a mail server. POP3 which is the newest can be used with or without SMTP.

LR -

probability person with condition having a negative test/ Probability person without the condition having a negative test = FNR/TNR = 1- sens/spec

SSL

secure socket layer - a protocol to transmit private documents via the internet. It is a cryptographic system. Netscape navigator and IE support SSL. Many web sites use the protocol to obtain confidential user information. URLs that require an SSL connection start with https

SMTP

simple mail transport protocol for sending email messages between servers. The messages can be retrieved with an e-mail client using POP or IMAP. SMTP is also used to send messages from mail client to a mail server.

TLS

transport layer security - guarantees privacy and data integrity between client/server applications. The TLS handshake protocol allows authentication between the server and client and negotiation of an encryption algorithm and keys prior to transmitting or receiving data. Layer 4 in the Open Systems Interconnection initiative 7 layer model for network communication. It provides reliable transmission of segments of data through the Transmission control protocol or faster streaming through user data protocol