Healthcare Informatics - The Latest Word 2001 A Glossary of Healthcare Technology Terms (2001)

From the Publishers of Healthcare Informatics
Health Care Financing Administration (HCFA): The
The
branch of the U.S. Department of Health and Human
Services that administers Medicare and the federal por-
tion of Medicaid (http://www.hcfa.gov). Health Infor-
mation and Application Working Group (HIAWG): NOW As
part of the U.S. Information Infrastructure Task an Force,
Latest
this group makes federal recommendations
National Information Infrastructure can be used to
benefit healthcare and encourages cooperation among
healthcare application designers. Health Insurance
Association of America (HIAA): The primary advoca-
on how the
e-book!
Word
cy association for the health insurance industry (http:
//www.hiaa.org). Its nearly 300 members include major
medical, long-term care, dental, disability and supple-
mental insurers. Health Insurance Portability and
2001
Accountability Act of 1996 (HIPAA): A complex law
that protects a person’s credit for previous healthcare
insurance to cover preexisting conditions when chang-
ing health plans and institutes new mandates concern-
ing electronic healthcare transactions and data. The
law’s Administrative Simplification section mandates
national standards for many of healthcare’s processes
(http://www.hcfa.gov/HIPAA /HIPAAHM.htm). See
A Glossary
the of Healthcare
transactions Information
and code Technologyinsurance
sets rule.Health Terms
purchasing cooperative (HIPC): An evolving method
of insurance rate-setting and purchasing. In most cases
a HIPC will consider all people within a certain region
▲ Most comprehensive
for the purpose of determining insuranceinrates. Using
IT industry
this risk pool, the cooperative then gives equal pur-
chasing power to both ▲ More
largethan
and680
small
definitions
companies.Health maintenance organization (HMO): A
health plan that offers▲aAcronyms
range offor
services to its
more than 80members
for a prepaid premium. associations
Members pay and aorganizations
fixed rate and
usually must use the participating physicians and facili-
ties to qualify for coverage unless an outside referral is
▲ Cross-referencing
approved. HMOs use various approaches to gather their
providers, including the staff model HMO, group model
HMO, independent practice association and network
model HMO. Health plan: A person’s specific health
benefits package or the organization that provides such
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Copyright © 2001 Healthcare Informatics

The Latest Word
2001
A Glossary of Healthcare Information
©
Technology Terms
Compiled and edited by Pamela Tabar
and the editors of Healthcare Informatics
Welcome to “The Latest Word 2001: A Glossary of Health-

care Information Technology Terms” from the publishers of
Healthcare Informatics magazine. A publication of The
McGraw-Hill Companies, Healthcare Informatics is the lead-
ing monthly trade magazine covering healthcare information
technology. For back issues or for more information, includ-
ing details on the annual Expo & Conference, go to
http://www.healthcare-informatics.com.
This, the fourth edition of The Latest Word, contains more
than 680 definitions to help you sort out the technologies and
terminologies being used in healthcare IT today, with pertinent
emphasis on security, privacy and emerging e-business models.
To ensure that glossary definitions are accurate and that con-
texts are truly relevant to healthcare, nearly all terms were ver-
ified by examining at least three sources. Cross-references to
terms within definitions are highlighted in blue. Click to go to
the definition.
Also included is an appendix listing acronyms for more than
80 healthcare IT associations and organizations that are not con-
tained in the glossary.
We always welcome your latest word. Email suggestions and
comments to hciletters@mcgraw-hill.com.

Glossary of Healthcare Information
Technology Terms
802.11: The IEEE standard group for wireless local area
networks, whether connecting station-to-station or station-to-
access point. The physical layer covers diffused infrared,
direct sequence spread spectrum and frequency-hopping
spread spectrum transmissions. For security and privacy,
802.11 accommodates the use of Wired Equivalent Privacy
(WEP), a wireless authentication protocol based on ID keys
and bit-encryption.
802.3: The IEEE standard group that forms the basis for
Ethernet networks. The network traffic from workstations
and peripherals is distributed using a Carrier Sense Multiple
Access/Collision Detect (CSMA/CD) access protocol.
AAPCC: Adjusted average per capita cost. The amount of

funding a managed care plan receives from the Health Care
Financing Administration to cover costs. The formula, calcu-
lated by region, allows for 95 percent of fee-for-service rates.
Access control: Procedures, policies and safeguards to keep

unauthorized users from accessing data or systems, and to
keep valid users from accessing or using data in an unautho-
rized way. Proposed HIPAA security regulations require
appointment of a security officer with responsibility for physi-
cal security safeguards, technical security safeguards and
administrative security safeguards.
Accredited Standards Committee (ASC) X12: Established in

1979, this American National Standards Institute (ANSI)
group is the main leader in developing electronic data inter-
change protocols for business transactions. The ASC X12N
standards are the basis for healthcare data exchange under
HIPAA.

ACR-NEMA: American College of Radiology and the National
Equipment Manufacturers Association. Together, these two
groups have determined many of the standards for teleradiol-
ogy, including DICOM.
ActiveX: An object-oriented programming language devel-

oped by Microsoft. Used in Windows, Web sites and
browsers. See Java.
Administrative security safeguards: Policies, procedures and

personnel training to ensure timely and secure access to infor-
mation. The HIPAA-proposed security regulations require
security certification, chain of trust agreements and docu-
mented policies and procedures, including a security risk
analysis, a contingency plan and a sanction policy. See securi-
ty officer. Compare physical security safeguards and technical
security safeguards.
Administrative Simplification: Section 262 of the HIPAA law. In

an effort to streamline the business of healthcare and reduce
costs, this portion of the law mandates the standardization of
various processes, including electronic transactions; coding;
national identifiers for providers, patients and health plans; data
security and patient data privacy protection. As each rule reach-
es final form, healthcare entities will have 24 to 36 months to
comply, depending on the size of the organization. The official
site is http://aspe.os.dhhs.gov/admnsimp. See transactions and
code sets rule.
Admission-discharge-transfer system (ADT): A software sys-

tem healthcare facilities use to track patients from their
arrival to their departure.
ADT: See admission-discharge-transfer system.

Advanced Encryption Standard (AES): A new standard for
private key cryptography, replacing the older Data Encryption
Standard. NIST began seeking industry submissions for the
new standard in 1997, requiring that candidate algorithms use
symmetric key encryption with 128-bit, 192-bit and 256-bit
keys. The Rijndael encryption algorithm was chosen as the
AES in October 2000. For details, see http://csrc.nist.gov
/encryption/aes.
Advanced Mobile Phone Service (AMPS): An 800-MHz ana-

log cellular standard that uses Frequency Division Multiple
Access for transmission.
AFEHCT: See Association for Electronic Health Care Transac-

tions.
AI: See artificial intelligence.
Alpha site: An initial test site for a prototype system or prod-

uct, usually in a controlled setting such as a laboratory. Com-
pare beta site.
Ambulatory care: Services for patients who do not need to

stay in a healthcare facility overnight. Also called outpatient
care.
Ambulatory patient group (APG): Originally developed by

3M Health Information Systems and later modified by HCFA,
this coding hierarchy packages related ambulatory medical
and surgical services together for the purpose of Medicare
reimbursement under the prospective payment system. Its
inpatient sibling is the DRG. See ambulatory payment classifi-
cation.

Ambulatory payment classification (APC): This coding hier-
archy gathers ambulatory procedural and service codes from
HCFA’s Common Procedural Coding System (HCPCS) into
346 groups. These service bundles are the basis for Medicare
reimbursement for both physician and hospital services under
the prospective payment model. APCs are a migratory out-
growth of their predecessors, ambulatory patient groups, and
are similar to inpatient DRGs.
American National Standards Institute (ANSI): The many

committees and accreditation boards of this non-profit organ-
ization (http://www.ansi.org) work to establish acceptance of
electronic data standards. ANSI is the U.S. member of the
International Committee for Standardization (ISO).
American Standard Code for Information Interchange

(ASCII): This coding language translates each character into a
numeric form readable by any computer. This “universal”
language allows otherwise incompatible systems to exchange
information.
Analog transmission: A method of information transfer that

transforms varying frequencies and volumes of sound into
electric impulses. Standard telephones use this, but other com-
munication forms are quickly gaining popularity, such as cel-
lular (radio waves), digital and satellite. Compare digital
transmission.
Ancillary services: Tests, procedures, imaging and support

services provided in a healthcare setting.
ANSI: See American National Standards Institute.

Antivirus software: A program designed to examine a com-
puter’s applications and files for a virus, Trojan horse or
worm code that may have invaded the system. Since antivirus
programs rely on a data set or library of known malicious
programs, the library must be kept current for the software to
detect new or variant invaders. Antivirus software is not an
end-all to protection; if computer users are careless, a new
malicious program can spread itself throughout the world
before programmers can create an antivirus to combat it.
APC: See ambulatory payment classification.
APG: See ambulatory patient group.
API: See application program interface.
Applet: See Java.
Application program interface (API): A set of premade func-

tions used to build programs. APIs ask the operating system or
another application to perform specific tasks. There’s an API for
almost everything, including messaging APIs for email, telepho-
ny APIs for calling systems, Java APIs, and graphics APIs, such
as DirectX.
Application server: Unlike a general file server, this server is

loaded with sophisticated hardware geared toward perform-
ing a few specific application tasks.
Application service provider (ASP): An entity that allows

clients to tap into and use applications held on an off-site
third-party server, usually on a subscription or per-use
basis. Halfway between on-site processing and outsourcing,
this model allows the client to control the processing work-
flow while eliminating the need to purchase and maintain the
application software. See business service provider.

Architecture: This structure term refers to a system’s form
and how its pieces communicate and work together. See
client/server and tiered architecture.
Artificial intelligence (AI): Both a system and a concept, this

refers to the idea of a computer system that can think and
“learn” like a human. A computer with artificial intelligence
could update and increase its knowledge based on previous
problems and results, making itself “smarter.” See expert sys-
tem, symbolic reasoning and Bayesian network.
ASC X12N: Electronic data exchange standards developed by

the ANSI Accredited Standards Committee for the insurance
industry. X12N is the chosen set of standards for the health-
care transactions listed in the transactions and code sets rule.
Implementation guides are available at http://www
.wpc-edi.com.
ASCII: See American Standard Code for Information Inter-

change.
ASP: See application service provider.
Association for Electronic Health Care Transactions

(AFEHCT): A healthcare organization (http://www.afehct.org)
that works to reduce healthcare costs through improved and
pervasive use of electronic data exchange.
Asymmetric key, asymmetric cipher: An encryption key used

in a public key infrastructure, where one key is used to
encrypt and a different key is used to decrypt. Compare
symmetric key.
Asynchronous transfer mode (ATM): A telecommunications

method for relaying images, sound and text simultaneously at
high speeds.
ATM: See asynchronous transfer mode.

Attachment: Any extra information appended to a claim or
electronic message; may include graphics as well as text. See
MIME, S-MIME and claim attachment.
Audit trail: A software tracking system used for data security.

An audit trail is attached to a file each time it is opened so an
operator can trace who has accessed a file and when.
Authentication: A confirmation of a user’s identity, generally

through user name and password or biometric characteristics.
Compare authorization.
Authorization: A confirmation of a user’s access levels within

a network after successful login and authentication.
B2B: Business-to-business. Electronic commerce or services

exchanged between business entities. Its older kin is electronic
data interchange (EDI), but B2B transactions always have the
Web, and its wider functionalities, in mind.
B2C: Business-to-consumer. Electronic commerce or services

exchanged between business entities and consumer-buyers.
Also called e-tailing, alluding to its retail function.
Back end, front end: The back end is the server or host, and
the front end is the client or user interface, such as a graphical
screen or a Web site. For online architectures, the front end is
what the user sees and interacts with; the back end is the Web
server and its corresponding host computers.
Backbone network: The electronic spine that joins multiple

networks together, including the Internet, most commonly via
T1 lines.

Balanced Budget Act of 1997 (BBA): A five-year federal
budget balancing plan to restructure the Medicare system.
The BBA includes limits on payment growth rates, restruc-
tured reimbursement methods, reductions in update factors
for the prospective payment system and incentives to decrease
the number of medical residents.
Bandwidth: A measurement describing how much informa-

tion can be transmitted at once through a communications
medium such as analog transmission, radio frequency or digi-
tal transmission. When the Internet experiences a “traffic
jam,” it’s usually caused by too many people trying to access
or send data at once—more data than the bandwidth can
handle.
Baseband transmission: Unmodulated signals sent on a sin-

gle channel. Used mainly in local area networks, including
those that use Ethernet and token ring. A baseband transmis-
sion consumes the entire channel unless a multiplexer is used.
Batch: A non-interactive, one-way transmission of data used

for sending information that doesn’t need an immediate
response. Batch files often are scheduled to be sent when the
network or system is less busy, such as after business hours.
Also called batch EDI. Compare real-time EDI.
Baud rate: An older term measuring bandwidth usage, now

more commonly described as bits per second.
Bayesian network: A form of artificial intelligence (named for

Bayes’ Rule) that calculates probability based on a group of
related or influential signs. Once a Bayesian network is taught
the symptoms and probable indicators of a particular disease,
it can assess the probability of that disease based on the fre-
quency or number of signs in a patient.
BBS: See bulletin board service.

Beam splitter: [telemedicine] A device that divides the image
beam of a clinical examining scope so the physician has the
choice of looking at the image on a video monitor or directly
through the scope.
Benchmarking: A performance measurement test, either with-

in the organization (i.e., from year to year) or among organi-
zations. See performance measurements.
Beta site: A place where a new product can be tested by peo-

ple outside the research and development team under real-life
conditions. Often several beta sites are used before a system is
placed on the public market. Compare alpha site.
Bioinformatics: The use of IT to acquire, store, manage and

analyze any type of biological data. Today’s accelerated
progress in genetic research and biotechnology is possible, in
part, because of this combination of biology, powerful algo-
rithm tools and immense databases. See genomics.
Biometrics: Electronic capture and analysis of biological

characteristics, such as fingerprints, facial structure or pat-
terns in the eye. Through advancements in smart cards and
cheaper reader prices, biometrics is catching on as a security
alternative to passwords.
Biotechnology: The application of research and industry tech-

nology to biology for the purpose of creating, manipulating
or enhancing organisms. Biotechnology has flourished thanks
greatly to advancements in bioinformatics.
Bisynchronous communications: Data transmitted between

two synchronized computers. Signals are sent between each
portion of data so the sending computer knows when the
receiving computer is ready for the next data stream. Com-
pare asynchronous transfer mode and streaming.

Bit: Short for binary digit. The smallest piece of computerized
information, corresponding to a circuit that is off (0) or on
(1).
Bit depth: [telemedicine] A description of the number of col-

ors or shades of gray a monitor can display or a scanner can
process. The higher the bit depth, the more color hues can be
supported. Also called gray scale.
Bitmapping: The process of assigning colors or depths to the

pixels of a computerized image. Bitmapping is intrinsic to
raster graphics and is best suited for images that require high
definition and little manipulation. Compare vector graphics.
Bits per second (bps): A description of how much data can

be transmitted across a carrier. A modem might transmit
56,000 bps or a T1 line may carry more than a million bps.
Bitstream: See streaming.
Block grant: A proposed method of administering Medicaid

benefits. Under a block grant system, Medicaid would not be
federally controlled—instead, each state would be given a sin-
gle grant, and the state would have to decide who is eligible
for the benefits and how to divide the funds.
Bluetooth: A wireless networking protocol aimed primarily at

connecting diverse, small form-factor devices over short dis-
tances. The protocol, which uses the 2.45-GHz frequency, can
allow a handheld computer to connect to a nearby desktop
PC, a mobile phone or local area network without using a
wired port or cabling. Championed by the Bluetooth Special
Interest Group (http://www.bluetooth.com) and others, Blue-
tooth could radically enhance personal digital assistants, elec-
tronic prescribing tools and other mobile data systems by
allowing real-time transfer with no need to synch via cable
with a wired system.

Bookmark: This software tool can “memorize” the location
of a favorite or often-used page on the World Wide Web. By
using the drop-down list of saved bookmarks, a user can
return to the page later without retyping its address.
Boolean: A standard language of qualifiers (such as “&” and

“OR”) used to restrict an informational or statistical search
to certain parameters. Boolean characters can be of great help
when searching the Internet. For example, on the Infoseek
search engine, searching for “healthcare agency” produces
more than 4 million matches, or all entries that contain either
“healthcare” or “agency.” But a search for “healthcare &
agency” locates only the matches that contain both words,
significantly limiting the results.
bps: See bits per second.
Bridge: A connector between two networks or between two

parts of the same network. A bridge acts as a “shipping
clerk” by forwarding data between the parts.
Broadband: A transmission method used for high-capacity

data that require very large amounts of bandwidth, such as
video. Broadband is commonly carried by fiber-optic net-
works or coaxial cable and is capable of transmitting more
than one million data bits per second.
Browser: A software program that interprets documents writ-

ten in HTML, the main programming language of the World
Wide Web. A browser, such as Netscape or Microsoft Explor-
er, is required to experience the photos, video and sound ele-
ments on a Web page and assists in quick, easy travel around
the Web.
Bulletin board service (BBS): Users dial this computer access

service via modem to send and receive email, participate in
newsgroups and lists or exchange files. These days, most BBSs
have become Internet service providers.

Bus, system bus: The hardware that controls the flow of
commands between the main processor and other components
(memory, peripherals, etc.). Despite a surging increase in main
processor speeds, the maximum possible speed of the system
bus was just 66 MHz until Intel introduced a 100-MHz bus
in early 1998.
Bus topology: A network where all user stations are connect-

ed to one central cable. All messages stop at every station and
are picked up or sent on according to the address on the data
packet. Compare star topology and ring topology.
Business Coalitions on Health: Groups of business owners

(especially self-insured companies), associations and others
that discuss ways to keep healthcare affordable.
Business service provider (BSP): An outsourced agent for

business services, such as supply chain management, customer
relationship management, data management, and industry-tai-
lored processes. Often considered to be a specific type of
application service provider, BSPs tend to focus on services
and applications for e-commerce and other Web-driven busi-
ness.
Byte: Short for binary digit eight, because a byte is eight bits.
C+/C++: C is an established programming language found in

many operating systems, including Unix. As object-oriented
technology gains popularity, C++, a daughter program based
on objects, is quickly becoming a favored programming lan-
guage. See Java.
CA: See certificate authority.

Cable modem: A modem that communicates over television
cable instead of telephone lines. It can allow a continuously
“live” connection to the Internet and transfer rates of about
1.5 Mbps, considerably faster than the 56 Kbps of a current
computer modem or the 128 Kbps of a digital subscriber line.
Call center: A central hub for receiving calls and routing

callers to the appropriate resources. In healthcare, call centers
(staffed, automated, outsourced or in-house) can be used to
offload non-emergency callers, link consumers to educational
messages, or route them to physician scheduling systems. Call
center technology combined with expert systems also can help
attending caregivers make triage decisions for after-hours
calls.
Capitation: [managed care] A payment structure where a

caregiver is paid a set amount per patient in advance, regard-
less of how many procedures are performed later. Opposite of
fee for service.
Care management: This traditional utilization management

approach coordinates care with a focus on the event.
Carrier Sense Multiple Access/Collision Detect

(CSMA/CD): This trafficking protocol, important for Ether-
net networks, allows workstation devices to sense whether the
network is free before they transmit data. If the network is
busy, the device will wait and try later. If two devices send
data simultaneously, the protocol alerts both devices to stop
and try later. See the 802.3 standard.
Carve-in, carve-out: Carve-in programs operate on the health-

care organization’s existing network and usually focus on spe-
cific diseases. Carve-out programs exclude certain services—
usually from an organization’s capitated rate—and tend to
focus on one disease in depth.

Case management: The idea of creating a coordinated, ongo-
ing and personalized strategy for patients who have a variety
of healthcare needs, such as the elderly and those with long-
term illnesses. A primary care physician acts as a case manag-
er, planning specialist referrals and giving a sense of continu-
ity within the separate services delivered. See disease manage-
ment.
Case mix: The collective pool of patients in any health system

or physician office, including data on age, gender and health
status.
Case-based reasoning: A form of artificial intelligence, often

used by expert systems, that bases decision-making on prior
case experience instead of a pre-defined rule set. Each new
problem is compared to all similar cases the system has
encountered.
CCD: See charge coupled device.
CCOW: Formerly known as the Clinical Context Object

Workgroup, this independent, open-membership group of
vendors and users works to form agreements on integration
methods and to develop specifications for interfacing products
from multiple vendors.
CD-RW: Rewritable optical disk, capable of holding at least

750 MB of data. Unlike a read-only disk, a CD-RW disk is an
active storage medium, allowing repeated data additions. A
CD-RW drive is required to read or write, but developers are
working to make CD-RW disks readable from a CD-ROM
drive.
CDMA: See code division multiple access.
CDPD: See cellular digital packet data.

Cell/cell switch: A cell is a tiny, fixed unit of information,
such as a character or word, packaged with routing instruc-
tions to the receiver. A cell switch acts as a travel agent, find-
ing and reserving the route a cell must travel to reach its des-
tination.
Cellular digital packet data (CDPD): A high-capacity data

transmission and routing service for cellular networks.
Central processing unit (CPU): Technically, it’s the hardware

inside a computer that processes the commands. CPU also is
used, somewhat erroneously, as a more general term for the
entire box containing the processor, memory and disk drives
(i.e. “the monitor, the printer and the CPU”).
Centralized computing: An information system where all crit-

ical data and programs are stored on one main computer,
usually a mainframe. Unlike the task-sharing concept of a
client/server system, the central computer retains all the
brains and brawn.
CERT Coordination Center: Headquartered at Carnegie-Mel-

lon University, Pittsburgh, CERT monitors Internet attacks,
security breaches and computer worms, educating the public
with alerts and guidelines. It was created by the U.S.
Defense Advanced Research Projects Agency (DARPA) in
1988 and was formerly known as the Computer Emergency
Response Team.
Certificate authority (CA): An independent licensing agency

that vouches for a person’s identity in encrypted electronic
communication. Acting as a type of electronic notary public,
a CA verifies and stores a sender’s public and private encryp-
tion keys and issues a digital certificate, or “seal of authentici-
ty,” to the recipient. See certification policy.

Certification: [security] Verification that a computer network
and all appended systems fulfill security and data availability
requirements, attested to by either a third-party or by in-
house documentation of compliance based on a pre-deter-
mined list of requirements. Such certification is part of the
HIPAA proposed security regulations and is envisioned to
become part of the accreditation process.
Certification policy: A statement that outlines the business

liabilities that a certificate authority agrees to be bound to
when issuing a digital certificate, and what liabilities are the
responsibility of the certificate applicant.
Chain of trust agreement: A legal contract between two busi-

ness partners, promising to maintain confidentiality and
integrity of the health data they exchange. The proposed
HIPAA security regulations require covered health entities to
use such a contract with non-covered partners that handle
protected health information.
CHAMPVA: Civilian Health and Medical Program of the

Department of Veterans Affairs. A cost-sharing health plan
for the dependents of qualifying disabled veterans.
Channel service unit/data service unit (CSU/DSU):

[telemedicine] This device acts as connector between a data
transmission system and the communications line. The
CSU/DSU provides the linking protocols, enhances the signals
and ends the transmission when the data are transferred.
Charge coupled device (CCD): [telemedicine] In a camera or

scanner, it’s the semiconducting device containing the photo-
sensitive cells. Since each pixel, or dot, of an image requires a
cell, the more CCDs in a scanner, the higher the resolution of
the image.

Charge master, charge description list: An electronic list of
a provider facility’s services and supplies, their billing codes
and the associated charges. The charge master must be kept
updated to the latest codes and government billing regulations
for health claims, often via a grouper.
Children’s Online Privacy Protection Act of 1998 (COPPA):

Enforced by the Federal Trade Commission, this law, effective
April 2000, regulates the Web-based collection and use of per-
sonal information gathered from or about children under age
13. Health organizations or other entities that offer pediatric-
centric Web sites or family medical record services most likely
fall under this law, which requires a posted disclosure policy
on information collection mechanisms (including cookies),
parental consent prior to information-gathering and parental
review of information collected. The rule also forbids tempt-
ing children to provide personal information in exchange for
any sort of prize.
CHIN: See community health information network.
Claim: A bill for healthcare service. A provider sends the

claim to the patient’s insurance or health plan, which may
review the claim for validity before paying the benefits.
Claim attachment: Supporting documentation, usually clini-

cal or administrative, used to justify charges in a healthcare
claim. National standards for electronic claim attachments
under HIPAA are forthcoming.
Clearinghouse: A service that takes claims and other electronic

data from providers, verifies the information and forwards the
proper forms to the payors. More than a transfer station, a
clearinghouse acts as a fact-checker and data format translator.

Clickstream, clickstream tracking: Although sometimes used
to describe the user patterns on the Internet as a whole, the
clickstream most often represents the traffic patterns on a sin-
gle Web site. Studying clickstreams is big business in Web mar-
keting and e-commerce: By tracking which pages a visitor goes
to first, last or most frequently, marketers and designers can
create site pages that engage consumers without taxing their
patience. Tracking a user’s exit is equally useful—especially if a
user leaves the site without completing a requested download
or transaction.
Client/server: A network system where a dedicated computer

(server) handles some of the processing tasks while multiple
smaller computers (clients) complete other processes by tapping
into the server’s shared files and programs. See distributed
computing.
Clinical Context Object Workgroup: See CCOW.
Clinical decision support: See decision support system.
Clinical laboratory information management system

(CLIMS): A management system that receives all information
for ordered lab procedures, delivers the results to caregivers
and stores the data for future reference.
Closed panel: See staff model HMO.
Coaxial cable: An electrical cable with an extra layer of con-

ductive material surrounding the core. The current standard
for cable television, coaxial cable can carry more data than
standard telephone wire but less than fiber-optic networks.
COB: See coordination of benefits.

Code Division Multiple Access (CDMA): A wireless commu-
nication method that uses digital spread-spectrum technology
rather than Time Division Multiple Access (TDMA). Each
transmission is identified by a unique code, allowing multiple
calls to use the same frequency spread. Voice and data can be
transmitted simultaneously during the same call. Mobile
CDMA units tend to use less battery power than TDMA units
but may have poorer sound quality.
Code on Dental Procedures and Nomenclature: See Current

Dental Terminology.
CODEC: See coder/decoder.
Coder/decoder (CODEC): Uses hardware and/or software to

translate analog transmissions into digital transmissions and
compresses the signals. A CODEC is an efficient way to trans-
mit video, since it allows the images to be sent using a lower
bandwidth, but another CODEC is needed on the receiving
end to decompress the signals.
Coinsurance: The portion of a covered claim that a patient

must pay.
COLD: See computer output to laser disk.
COM: See Component Object Model.
Commission: A type of finder’s fee set by insurance brokers

or agents for selling health plans. The commission fee is built
into the premiums paid by the insured group.
Common Object Request Broker Architecture (CORBA): A

framework for communications with object-oriented technol-
ogy developed by the Object Management Group. CORBA
uses Object Request Brokers as traffic conductors to funnel
requests across multiple platforms. Compare Component
Object Model.

Community health information network (CHIN): Providers
and payors within a specific area who are networked to
exchange medical and administrative information, eliminating
redundant data collection and reducing paperwork.
Community-based healthcare: See population health manage-

ment.
Component Object Model (COM): Microsoft’s framework for

object-oriented programming and the basis for ActiveX.
Objects created using COM can be accessed by any other
COM-compliant application. Compare Common Object
Request Broker Architecture.
Computer output to laser disk (COLD): A technology used to

store data on laser-written disks, allowing users to read, dis-
tribute and archive the information.
Computer telephony integration (CTI): The technological

joining of a telephone switch and a computer. CTI can per-
form call routing to free up staff and can keep activity logs to
assist in assuring information delivery. Compare interactive
voice response.
Computer-based patient record (CPR): Also called electronic

medical record or patient health record. Much more than a
computerized medical chart, a CPR acts as a “personal health
library” providing access to all resources on a patient’s health
history and insurance information. A CPR is a linking system
rather than an independent database and is more a process
than a product. An integrated CPR will link to separate
sources detailing medical history and images, laboratory
results and drug allergies. Several organizations are focused
on creating standards for CPRs, including common coding
terminology, clinical decision support, patient confidentiality
and secure data transfers.

Consumer informatics: Any computer-based information
available to the general public, including electronic databases,
CD-ROMs and the World Wide Web. See patient education.
Context-based access control: A security access protocol

that verifies valid users by restricting a user name to a specific
context. For example, a user may be granted access only from
a certain floor or department, or granted access during daily
business hours but not at night. Compare role-based access
control and user-based access control.
Contingency plan: A formal plan detailing what to do if

something goes wrong, usually accompanied by documenta-
tion that proves an effort to be prepared. The HIPAA-pro-
posed security regulations require a computer security contin-
gency plan that includes identification of mission-critical data
and applications, data backup, disaster recovery, routine test-
ing procedures and alternate business operations during an
emergency or disaster.
Continuous speech recognition: A vocal-to-digital translation

system with heightened capabilities; unlike standard speech
recognition systems, it can interpret words spoken in a natu-
ral cadence and within several contexts.
Convergence: The melding of once-disparate technologies

into a single user modality, such as multipurpose fax/printers,
Internet telephony, smart phones, cable modems and voice
over IP.
Cookie: A piece of information passed from a Web server to

the user’s Web browser. If the browser accepts the cookie, its
data, accessible only by the server/ domain that sent it, is
stored on the user’s hard drive and retrieved automatically
whenever the server’s page is visited. Used to store passwords,
ordering information, preferences and bookmarks. Some
cookies expire the same day; others last several years. See
intelligent agent.

Coordination of benefits (COB): When a patient carries more
than one type of health insurance, insurers and health plans
use this verification system to make sure the same claim is not
paid twice.
Co-payment: The flat fee that a patient pays, usually at the

time of service.
CORBA: See Common Object Request Broker Architecture.
CORBAmed: A healthcare task force that recommends stan-

dards for object-oriented communication in the healthcare
industry.
Cost shifting: A leveling method where one patient group is

charged more to make up for another group’s underpayment
or inability to pay.
Cost per click: A rate model for Web site advertising, where
the advertiser’s charges are based on the number of users who
click on the ad.
CPR: See computer-based patient record.
CPT code: See Current Procedural Terminology.
CPU: See central processing unit.
Credentialing: The examination of a healthcare professional’s

credentials, practice history and medical certification or
license.
CSMA/CD: See Carrier Sense Multiple Access/Collision

Detect.
CSU/DSU: See channel service unit/data service unit.
CTI: See computer telephony integration.

Current Dental Terminology (CDT): Procedural, evaluation
and orthodontic codes for the dental industry developed by
the American Dental Association. The transactions and code
sets rule has mandated CDT as the national code set for den-
tal procedures. Also referred to as the Code on Dental Proce-
dures and Nomenclature.
Current Procedural Terminology (CPT): A procedure identifi-

cation system that serves as the basis for healthcare billing.
CPT coding assigns a five-digit code to each service or proce-
dure provided by a physician. It simplifies billing and is a way
to protect a patient’s medical privacy. See HCPCS.
Customer relationship management (CRM): The act of pro-

viding services, information and support that will enhance the
satisfaction and loyalty of customer-patients, including more
efficient service delivery, health risk assessments, group-specif-
ic or patient-specific service marketing and Web-based com-
munication avenues. Often combined with enterprise resource
planning, data mining and Web-enabled communications,
CRM is taking a greater role in the business strategy for com-
petitive advantage.
Daisy chaining: Connecting several peripheral devices or com-

puters, one to another, via a SCSI interface. As the number of
external devices used with even a basic desktop computer
increases, daisy chaining can eliminate the port-switching
problem. Also important for laptops and other mobile devices
that may have only one physical port. See universal serial bus.
Data: Pieces of information or commands.
Data Encryption Standard (DES): A private key cryptography

system based on a 56-bit key, with 72 quadrillion possibilities.
“Triple DES” uses three consecutive 56-bit keys. DES has
been the encryption protocol for the U.S. government for
decades, but it is slated for replacement by the Advanced
Encryption Standard (AES).

Data entry: The transcription of information from the original
source into a machine-readable form. Although keyboard entry
is the most familiar, other fast-growing methods include scan-
ners, speech recognition and automatic device-to-system tech-
nology.
Data integrity: The assurance that a data element is in its

original or authorized updated state. As more healthcare
information is being exchanged electronically, software tools
such as digital signatures and audit trails can help verify that
integrity has been preserved as information moves among
users.
Data Interchange Standards Association (DISA): This

organization (http://www.disa.org), created by ANSI, seeks to
proliferate national and international standards for electronic
commerce. DISA participates in the international EDIFACT
organization and is a leading source for education on current
e-commerce topics as well as the ASC X12 standards.
Data mart: A well organized, user-centered, searchable data-

base system. A data mart picks up where a data warehouse
stops—by organizing the information according to the user’s
needs (usually by specific subjects), with ease of use in mind.
Data mining: The comparison and study of large databases in

order to discover new data relationships. Mining a clinical
database may produce new insights on outcomes, alternate
treatments or effects of treatment according to race or gender.
Data repository: A database acting as an information storage

facility. Although often used synonymously with data ware-
house, a pure repository does not have the analysis or query-
ing functionality of a warehouse.
Data warehouse: This vast database stores information like a

data repository but goes a step further, allowing users to
access data to perform research-oriented analyses.

Database: An aggregation of records or other data that is
updatable. Databases manage and archive large amounts of
information. See relational database.
Decision support system: Software that taps into database

resources to assist users in making decisions on care options.
A clinical decision support system gives physicians structured
(rules-based) information on diagnoses and treatments.
Defense Advanced Research Projects Agency (DARPA): The

main research and development arm of the Department of
Defense. It supports the development of high-risk, high-cost
technology within the government and private industry. An
earlier version of this agency created ARPANET, a four-site
network that eventually grew into today’s Internet.
Defined contribution: An emerging health insurance benefits

model where employers provide a fixed contribution toward
the health insurance of the employee’s choice, instead of offer-
ing all employees a preselected health plan.
Demand management: Easing the demand for direct health-

care services by delivering information to patients and care-
givers, often through call centers, disease hotlines, consumer
health education Web sites or physician-centric resources.
Demand management empowers both patients and providers
and may include aspects of disease management. See triage.
DHTML: Dynamic HyperText Markup Language. More a

markup concept than a specific language, DHTML is HTML
that’s “alive.” DHTML extensions can give a Web site the
ability to react to a user’s actions and change its own page
content, even after the page has been downloaded, without
communicating with the Web server. Currently, DHTML is
only accepted by newer browsers (such as Netscape 4.0 or
MS IE 4.0 or higher). See World Wide Web Consortium.

DICOM: [telemedicine] Digital Imaging and Communications
in Medicine. A standard developed by ACR-NEMA to define
the connectivity and communication protocols of medical
imaging devices.
Digital certificate: Also called a digital ID. An official elec-

tronic identity document based on public key infrastructure
and obtained through a certificate authority. Includes the
user’s name and registered serial number as well as the user’s
public key and its expiration date. Most certificates conform
to the International Telecommunication Union’s X.509 stan-
dard, but not all are compatible across all Web browsers. See
digital signature.
Digital dictation: A technology similar to a transcriptionist’s

tape recorder, only better. Since the voice files are saved in
computerized (digital) form, they can be played back at any
speed without distortion. Future developments in continuous
speech recognition eventually may make digital dictation sys-
tems obsolete.
Digital linear tape (DLT): An archiving and backup storage

medium that uses half-inch tape. One cartridge can store 20
to 40 GB. With transfer rates of 2.5 to 5 MB per second, DLT
is an efficient choice for medical images and other graphic-
intensive data.
Digital service unit: See channel service unit/data service unit.
Digital signature: A type of electronic signature that adds an

encrypted digital tag to an electronic message or file to verify
the identity of the sender and that the file has not been
changed since it was sent. The HIPAA-proposed security regu-
lations require that digital signatures must provide user
authentication, data integrity and non-repudiation. Digital
signatures do not encrypt the files to which they are append-
ed; if confidentiality of data is an issue, others forms of
encryption should be added. See digital certificate.

Digital subscriber line (DSL): A new digital phone connection
used as an alternative to the limited speed of analog telephone
lines. More than five times faster than an ISDN, a DSL skips
the analog-digital-analog conversions and sends data directly
in digital format. Signal splitting also will allow simultaneous
voice and data communication on the same line.
Digital transmission: Voice, image or text data transformed

and transmitted as combinations of zeros and ones (bits), and
then transcribed back into the original medium by the recipi-
ent. Digital transmission is faster and less susceptible to noise
interference than analog transmission.
Digital versatile disk (DVD): Also called digital video disk.

An optical disk capable of storing more than 4 GB of audiovi-
sual data on a single side, or about 17 GB on a quad-sided
disk. Current marketing is targeted at full-length movies, but
DVD’s high MPEG compression standard and immense stor-
age capacity may have a significant impact on telemedicine.
Direct Sequence Spread Spectrum (DSSS): A wireless

spread-spectrum method that breaks each transmission into
pieces, scatters them across the designated spectrum and
reconstructs the pieces at the receiving end. Since each piece is
marked with data chipping codes destined for a specific
receiver, pieces for multiple calls can travel on the same fre-
quency without interfering with each other. Compare
Frequency-hopping Spread Spectrum.
Direct-attached storage: A storage device or repository con-

nected to a single computer. Commonly used where database
or mail applications require direct connectivity or where file
sharing and multiple access to stored data are not issues.
Compare network-attached storage and storage area network.

Directory service: Acts as a postal sorter for network com-
munications by looking up the electronic destination and
routing the data the fastest way. The service can detect an
incorrect address before transmission and notify the sender
rather than clogging the network with a misdirected package.
DISA: See Data Interchange Standards Association.
Disaster recovery: The restoration of data and business

processes lost or damaged through a physical event (fire,
flood, power outage), a system failure or an attack from a
computer Trojan horse, virus or worm. The HIPAA-proposed
security regulations require documented disaster recovery
preparations, including regular data backups and a contin-
gency plan.
Disease management: The development of an integrated

treatment plan for patients with long-term illnesses or recur-
ring conditions instead of viewing each physician visit as a
separate event.
Disenrollment: The act of terminating the membership of a

person or group in a health plan.
Diskless workstation: See dumb terminal.
Distributed computing: A system where tasks are divided

among several computers rather than having all processes origi-
nating from one central computer. Client/server systems are one
type of distributed computing. Compare centralized computing.
DME: See durable medical equipment.
Document imaging: Using a scanning device and software to

translate a paper document into a computer file. The file then
can be sent to recipients on a network or the World Wide
Web, much like having a fax machine connected to the Inter-
net.

DRG: Diagnosis related group. Patient study groups classified
by age, gender, health condition and predicted treatment
needs. A formula is calculated based on the particular DRG
to determine how much money providers will be given to
cover future procedures and services—primarily for inpatient
care.
Drug price review (DPR): A monthly report that lists the

average wholesale prices of prescription drugs.
Drug utilization review (DUR): A study of drug prescriptions

to evaluate a medication’s uses and cost-effectiveness. Can be
used to analyze practitioners’ treatment choices, suggest drug
alternatives or update an organization’s formulary.
DSSS: See Direct Sequence Spread Spectrum.
Due diligence: A legal term describing a thorough effort to

intercept potential problems before they occur, such as
preparing for Y2K or monitoring for fraudulent claims. In IT,
the process includes documented evidence that information
systems are regularly assessed, updated and monitored for
data integrity and security. Due diligence will be intrinsically
involved in the privacy and security regulations under HIPAA,
via audit trails, user authentication and access controls.
Dumb terminal: A keyboard and screen used to input data to

and receive data from a host computer. So named because it
cannot process anything without the assistance of the main
computer.
Duplexing: Running two file servers or identical drives at the

same time, so a backup system is already running if the pri-
mary system fails. Compare mirroring.
DUR: See drug utilization review.

Durable medical equipment (DME): Equipment needed daily
by disabled or chronically ill patients for a medical or health
maintenance purpose, including artificial limbs, wheelchairs,
monitoring devices and medical equipment used in the home.
In many circumstances, Medicare or state agencies will pro-
vide reimbursements for most DME, provided it is medically
necessary.
DVD: See digital versatile disk.
Dynamic signature: A combination of electronic signature

and biometrics technology. It authenticates the user by analyz-
ing the signature itself and the way in which it was signed,
comparing it to an individualized baseline set of biometric
attributes, such as pen stroke speed, pen pressure and the
order of strokes.
E1: The European equivalent of the T1 transmission carrier.

The lines range from E1 (32 channels with 64 Kbps each and
data rates of about 2 million bits per second) to E5 (8192
channels with rates of about 565 million bits per second).
E-care: An umbrella term referring to the automation of all

aspects of the care delivery process across administrative, clin-
ical and departmental boundaries throughout the healthcare
system. The beneficiary of the convergence of multiple tech-
nologies, such as object-oriented technology, and adaptive
applications that leverage the Web to link disparate systems
and enable automated, real-time responses to inquiries, clini-
cal alerts, etc. Can incorporate disease management, work-
flow automation and supply chain management.
E-commerce, e-business: An overarching term for service,

sales, and collaborative business conducted over the Internet,
either B2C or B2B. Some define e-commerce as a monetary
transaction segment of e-business, but in most cases, the
terms are synonymous. See e-health.

E-health: Both a concept and a business strategy, e-health
empowers users by bringing health information, products and
services online. Portals and niche sites can include everything
from consumer health content, health plan descriptions and
insurance quotes to ask-a-doctor messaging. Some sites, such
as online pharmacies, cross over into e-commerce.
E-tailing: See B2C.
EAI: See enterprisewide application integration.
EDI: See electronic data interchange.
EDIFACT: An acronym for Electronic Data Interchange For

Administration, Commerce and Transport. Developed by the
United Nations, these standards work toward universal, inter-
national conventions for electronic data interchange.
EHNAC: See the Electronic Healthcare Network Accreditation

Commission.
Electroluminescent display (EL): A flat-panel technology that

uses a phosphorescent film pressed between two wired plates.
The advantages of an extremely thin screen and very fast dis-
play rates are countered by high power consumption and ini-
tial expense.
Electronic data interchange (EDI): A standard transmission

format for business information sent from one computer to
another using strings of data. EDI also can accommodate
encryption. See batch and real-time EDI.
Electronic funds transfer (EFT): Financial transactions or

data exchanged between computers, or “electronic banking.”

Electronic Healthcare Network Accreditation Commission
(EHNAC): EHNAC began as a network technical advisory sub-
group within the Workgroup for Electronic Data Interchange
and now is an independent accreditation body that establishes
minimum criteria for healthcare data exchange, transactions,
and networking architecture. The organization (http://www
.ehnac.org) plans to offer accreditation for future HIPAA secu-
rity requirements.
Electronic mail: See email.
Electronic media: For healthcare, what matters is the HIPAA

definition of electronic media, which includes information
passed over the Internet, an extranet, leased lines, dial-up
lines, or virtual private networks and information moved to
magnetic tape, floppy disk, CD-ROM or optical disk.
Electronic medical record: See computer-based patient

record.
Electronic Provider-Partner Interface (ePPI): An emerging

technology that enables an “e-dimension” to care delivery by
using electronic tools to connect providers with patients, sup-
ply partners, payors and others. The current focus is on con-
necting patients and physicians with personalized health and
disease management information, appointment scheduling
and prescription refill tools.
Electronic signature: An attribute that verifies the sender of a

message or file and proves that the file has not been changed
since it was signed. A electronic signature system can use a
variety of methods to authenticate the sender, including digi-
tal signature encryption, biometrics or passwords. Compare
digital certificate.
Eligibility: The ability to be part of a healthcare plan, includ-

ing a definition of the specific benefits for which a member
qualifies and the time frame of coverage.

Email: A communiqué, with or without attachments, sent
from one computer user to another. Some systems still deliver
email at set intervals, but most deliver messages within a few
minutes of sending. Email has evolved considerably from its
BBS roots, and most types of email can accommodate down-
loadable image files as well as attachments.
Employee contribution: The portion of health plan premiums

paid by an employee (often debited from wages) to the com-
pany’s contracted payor. See employer mandate. Compare
defined contribution.
Employer mandate: For companies that provide health insur-

ance for their employees, this stipulation forces the company
to pay for at least part of the insurance premium for each
employee.
Encryption: Coding attached to data with the intent to keep

the information secure from anyone but the addressee.
Encryption can include a password, digital signature, asym-
metric or symmetric keys, or a complex combination of all.
End station: Any terminate point in a network, usually a

desktop or workstation computer.
Enrollee: A member of a health plan or a member’s qualifying

dependent.
Enterprise business application: Generally, a business appli-

cation “shell” or suite that operates across an enterprise,
allowing access to key work tasks and applications. Such
applications are usually large, often configured to be corpo-
rate-specific, and can cross over into knowledge management.
Compare enterprisewide application integration.

Enterprise resource planning (ERP): The use of software tools
to automate tasks and track data generated by specific depart-
ments—primarily finance, inventory and human resources. ERP
is reaching further into supply chain management, and some
consider the two terms inseparable.
Enterprisewide application integration (EAI): This big-pic-

ture approach studies the separate applications in an enter-
prise and incorporates middleware tools and message brokers
to consolidate and/or synchronize disparate applications.
EAI’s hot potential is in linking legacy systems and dissimilar
platforms with current Web-enabled technology. Compare
enterprise business application.
Enterprisewide network: A system where all computers in a

healthcare system’s various buildings are connected to
exchange information.
EOB: See explanation of benefits.
Episode of care: Healthcare services provided for a specific

illness during a set time period.
ePPI: See Electronic Provider-Partner Interface.
ERISA: Employee Retirement Income Security Act of 1974. A

federal outline for regulating employee benefit plans, includ-
ing healthcare plans sponsored and/or insured by an employ-
er.
ERP: See enterprise resource planning.
Ethernet: A popular method for sending data through a local

area network using a single-channel cable and a special data
collision protocol to detect network availability. See packet
switching and compare fiber distributed data interface.

Event reporting: A summary of a computer network as it is
monitored for “events,” such as irregular operations, network
overload, unresponsive hardware, repeated denied-access mes-
sages and suspicious user activities.
Evidence-based medicine: Physician care based on best-prac-

tice guidelines developed from the scope of clinical literature.
Burgeoning electronic access to current practice guidelines and
specialty-specific literature is enhancing the development of
expert systems and helping physicians stay updated on treat-
ments.
Executive information system: A system that allows execu-

tives to analyze company data and reach management conclu-
sions through decision-making tools, much as a physician
might use a decision support system to narrow diagnosis
options.
Experience rating: A method of determining a company’s

health insurance premiums by estimating the future healthcare
risks of its employees. The risk level of the work environment
is considered as well as the age, gender and health history of
each employee.
Expert system: A topic-specific software program designed to

imitate human decision making using detailed knowledge of a
particular subject and rules for applying the facts to a sce-
nario. See artificial intelligence.
Explanation of benefits (EOB): After a provider sends a claim

to a payor, this billing summary is issued to the patient, detail-
ing the charges for services rendered, which portions are paid
by insurance and the amount the patient must pay.

eXtensible Markup Language (XML): A new version of
SGML being developed by the World Wide Web Consortium.
Instead of forcing the Web programmer to use proprietary
building blocks based on the specific browser, XML allows
customizable element tags and multiple destinations within a
single link. XML’s increased functionality may eventually
make it a formidable successor to HTML.
Extranet: Works like an intranet but allows access by out-

side individuals who have a valid password or encrypted
equivalent. By customizing various levels of content access,
an extranet can interact with outsiders while maintaining its
closed-circle nature. See virtual private network.
Failover, fail over: The act of moving an active command,

connection or process from a failed device to a working
device without interruption. A print job may fail over from a
disabled printer to a working printer without canceling the
print command, or an Internet connection to a faulty Web
server may be passed to a secondary server without breaking
the user’s connection.
Fast packet: See packet switching.
Fault tolerance: A description of a computer system’s ability

to maintain normal operations despite a failure of hardware
or applications. Common solutions include backup power
sources, disk mirroring, server duplication and specialized
software that reroutes processes around the failures.
FDDI: See fiber distributed data interface.
Fee for service: The most common U.S. healthcare payment

system. A physician declares his or her own rates and is paid
after each medical service is delivered, as opposed to a flat-rate
plan such as capitation. See fee schedule.

Fee schedule: A list of maximum fees, per service, a provider
will be reimbursed within a fee-for-service payment system.
FHSS: See Frequency-hopping Spread Spectrum.
Fiber distributed data interface (FDDI): A transmission stan-

dard that uses fiber-optic technology to exchange data at
speeds of 100 to 200 million bits per second, more than ten
times faster than Ethernet.
Fiber-optic network: A communication carrier system using

thread-like strands of glass or plastic-coated glass instead of
wire, allowing the transmission of data as pulses of light.
Fiber-optic systems can carry much more simultaneous infor-
mation than copper wire and with the help of repeaters can
carry over great distances without interference distortion.
Fibre channel: Transmission medium capable of 100 Mbps to

1 Gbps. Much faster than a SCSI interface, fibre channels are
a growing option for connecting servers, high-volume storage
systems and bandwidth-greedy peripherals.
Field emission display (FED): A new flat-panel technology

that combines the high resolution and full viewing angles of a
standard picture-tube monitor with a flat screen and relatively
low power consumption. There’s a limit to how small the
screen can be, making this form more suitable to workstation
monitors than handhelds.
File server: A computer dedicated to managing the flow of

information among networked computers and used as a stor-
age location for programs and files shared by network users.
See client/server.
File transfer protocol (FTP): A standard application governed

by TCP/IP for transferring files between computers or across
the Internet. These days, nearly every system can accept FTP
files.

Firewall: A security system situated between a private net-
work and outside networks. The firewall screens user names
and all information that attempts to enter or leave the private
network, allowing or denying access or exchange based on
preset access rules. See encryption and proxy server.
FireWire: Also called IEEE 1394, I-Link or Lynx. A bus alter-

native developed by Apple, Texas Instruments and Sony. With
stunning rates of 100 to 400 Mbps, it can allow rapid, real-
time transfer and archiving of high-resolution images and high-
bandwidth multimedia. Similar to a universal serial bus, it can
connect multiple peripherals (63) through one port.
Firmware: Software programs, stored in read-only memory,

that are retained even after the computer is turned off.
Firmware is easier to configure and update than hardware
and is more enduring than software.
Flash memory: Technology used on removable memory cards

to retain data after the power is turned off. Used in many
medical imaging devices, digital cameras and laptops.
Flat panel: Display technology that uses one of a variety of

substances sandwiched between two wired plates—i.e., liquid
crystal, electroluminescent, vacuum fluorescent, plasma, field
emission and organic light-emitting display methods. Once
mainly for laptops, flat panel screens are rapidly becoming
low-emission alternatives for desktop displays, large-screen
wall monitors and HDTV.
Format: The structure or layout of a document, application or

system.
Formulary: A list of pharmaceutical products and dosages

deemed by a healthcare organization to be the best, most eco-
nomical treatments. The list varies from one organization to
another, and in some healthcare systems, providers are expect-
ed to use the listed products.

Frame: See packet.
Frequency Division Multiple Access (FDMA): This transmis-

sion protocol, used by the Advanced Mobile Phone Service
cellular system, divides the designated frequency spectrum
into channels, allowing one user on a channel at a time.
Frequency response: A description of response to sound,

measured in cycles per second (Hz). The wider a system’s fre-
quency response parameters, the greater the range of sounds
it can detect.
Frequency-hopping Spread Spectrum (FHSS): A wireless

spread-spectrum method that “hops” its transmission across
multiple channels instead of remaining on one signal. By FCC
rules, transmissions using the 2.4 GHz ISM band must change
channels every 0.4 seconds, making them difficult to inter-
cept. Compare Direct Sequence Spread Spectrum.
Front end, back end: See back end, front end.
FTP: See file transfer protocol.
Fuzzy logic: Computer “thought” based on degrees of truth

rather than the restrictive parameters (true/false, and/or) of
Boolean logic. Because it can extrapolate a range of possible
relations based on a partial term (or a misspelled word), fuzzy
logic is built into many search engines and is a key in devel-
oping expert systems and other artificial intelligence.
Gap analysis: Traditionally, this is an assessment of what a

given population needs vs. the facilities, services and expertise
available to serve those needs. It now includes what’s accessi-
ble online, and a gap analysis can pick up where a clickstream
study leaves off, showing marketing departments what cus-
tomers and providers wish they could do on the Web site.

Gatekeeper: [managed care] A physician who manages a
patient’s various healthcare services, coordinates referrals and
helps control healthcare costs by screening out unnecessary
services. Many health plans insist on the gatekeeper’s prior
approval for special services or the claim will not be covered.
GB (gigabyte): About 1,000 megabytes (MB) of data.
Genomics: The study of the genome—an organism’s biologi-

cal blueprint of DNA, chromosomes and genes. Information
systems, databases and computerized research tools have
joined forces in the Human Genome Project, a worldwide
collaborative effort to identify and record the 80,000+ genes
and 3 billion DNA segments that define the human species.
See bioinformatics and biotechnology.
Gigabit Ethernet: A recent local area network platform with

transmission rates of 1 Gbps. Fiber optic is the preferred car-
rier medium, but new standards facilitate its use over copper
wires. See the 802.3 standard.
Global Positioning System (GPS): This geographic locator

system allows a transmitter to bounce signals off multiple
satellites to determine the transmitter’s location. GPS can
track lots of things besides aircraft, including new possibilities
for materials management. Some healthcare facilities are using
the technology to pinpoint the location of the closest portable
cardiac equipment or wheelchair.
GNOME: GNU Network Object Model Environment. An

open-system computer user interface developed by the GNU
Project (http://www.gnome.org). Used in Linux and other
open operating systems, the GNOME code is available for
users and developers under a free public license. Another
open-system interface is KDE.

Gopher: Before the World Wide Web, Gopher was the pri-
mary search tool for information on the Internet. Some
Gopher sites are still around (the site addresses begin with
gopher rather than http), but Web sites, browsers and Web
search engines are clearly today’s dominant way to seek
online information.
Graffiti: The trade name of a handwriting recognition soft-

ware program used on personal digital assistants and other
handhelds that lack a keyboard. Using an electronic stylus,
the user must write according to a predefined character set
consisting of a single stroke per letter.
Graphical user interface (GUI): An interface that allows a

person to operate a software program through visual images
(called icons), drop-down menu choices, and buttons or tool
bars instead of complex keystrokes. The most common
manipulating device is a mouse, and the GUI is what makes
“point and click” capabilities possible.
Gray scale: See bit depth.
Group model HMO: A form of health maintenance organiza-

tion where a partnership or company provides services and
pays for the facility and salaries. Compare independent prac-
tice association, network model HMO and staff model HMO.
Group Practice Without Walls (GPWW): A recent group

practice alternative somewhere between a private practice and
an HMO. The physician group owns the assets of the collec-
tive practices and shares some costs, but each physician con-
trols his or her patient appointments and staff. Since the
physicians are not necessarily in the same building, the group
is “without walls.”

Grouper: A software tool that collects the various service,
treatment and diagnosis codes for a care episode and groups
them under the relevant procedural codes for claims process-
ing. Not keeping the grouper updated to the latest coding
guidelines can affect the charge master and result in error-rid-
den or duplicate claims.
Groupware: Any technology that allows people to collaborate

electronically, including email, real-time networking, and con-
ference tools based on telephony, video or the Web. Workflow
automation, enterprise resource planning and even telemedi-
cine systems are all groupware at the root.
GSM: Global System for Mobile Communications. A digital

cellular standard that uses time division multiple access
(TDMA) to carry eight simultaneous calls on the same fre-
quency. This open standard is the primary wireless communi-
cation method in Europe and Asia but is encountering grow-
ing competition in North America from code division multiple
access (CDMA).
GUI: See graphical user interface.
Haptic interface: A user interface that allows a computer or

robotics-driven device to interpret the sensation of touch.
Haptic tools, already used in surgical rehearsal systems to
imitate the body’s reaction to touch, are being incorporated
into the latest minimally invasive procedures to give surgeons
a better “feel” for the tissue without invasive access.
HCFA: See Health Care Financing Administration.
HCFA 1450: See Uniform Billing form 92.

HCFA Internet Security Policy (HISP): The security require-
ments issued by the Health Care Financing Administration for
sending or receiving HCFA-governed data over the Internet,
including firewalls, encryption during transmission and
sender/receiver authentication protocols. Prior to this 1998
policy, the Internet was not permitted as a communications
medium for HCFA-related data. See the document at
http://www.hcfa.gov /security/isecplcy.htm.
HCPCS: HCFA Common Procedural Coding System. An

expansion of billing codes (CPT codes) to account for addi-
tional services, such as ambulance transport, supplies and
equipment.
HDML (Handheld Devices Markup Language): See Wireless

Markup Language.
HDTV: [telemedicine] High-definition television. A video stan-

dard for high-resolution broadcast technology. It produces
resolutions about four times higher than standard television
as well as increased color and sound quality.
Health benefits package: See health plan.
Health Care Financing Administration (HCFA): The branch

of the U.S. Department of Health and Human Services that
administers Medicare and the federal portion of Medicaid
(http://www.hcfa.gov).
Health Information and Application Working Group (HIAWG):

As part of the U.S. Information Infrastructure Task Force, this
group makes federal recommendations on how the National
Information Infrastructure can be used to benefit healthcare
and encourages cooperation among healthcare application
designers.

Health Insurance Association of America (HIAA): The pri-
mary advocacy association for the health insurance industry
(http://www.hiaa.org). Its nearly 300 members include major
medical, long-term care, dental, disability and supplemental
insurers.
Health Insurance Portability and Accountability Act of 1996

(HIPAA): A complex law that protects a person’s credit for
previous healthcare insurance to cover preexisting conditions
when changing health plans and institutes new mandates con-
cerning electronic healthcare transactions and data. The law’s
Administrative Simplification section mandates national stan-
dards for many of healthcare’s processes (http://www.hcfa
.gov/HIPAA/HIPAAHM.htm). See the transactions and code
sets rule.
Health insurance purchasing cooperative (HIPC): An evolv-

ing method of insurance rate-setting and purchasing. In most
cases a HIPC will consider all people within a certain region
for the purpose of determining insurance rates. Using this risk
pool, the cooperative then gives equal purchasing power to
both large and small companies.
Health maintenance organization (HMO): A health plan that

offers a range of services to its members for a prepaid premium.
Members pay a fixed rate and usually must use the participating
physicians and facilities to qualify for coverage unless an outside
referral is approved. HMOs use various approaches to gather
their providers, including the staff model HMO, group model
HMO, independent practice association and network model
HMO.
Health plan: A person’s specific health benefits package or the

organization that provides such a package. Blue Cross Blue
Shield offers health plans (benefits packages), but a health
maintenance organization (a company) also is a health plan.

Healthcare informatics: The use of electronic tools, applica-
tions and communications to interact with and manage
health-related data. Although some equate the term with
medical informatics, most now view it as an overarching term
that also includes bioinformatics, nursing informatics, popula-
tion health management, and other health fields.
Healthcare Informatics Standards Board (HISB): A group

within the American National Standards Institute (ANSI) that
works on standards for computer-based patient records, cod-
ing, terminology, international data exchange and patient pri-
vacy. Members include medical organizations, corporations
and federal representatives.
HEDIS: Health Plan Employer Data and Information Set. Per-

formance standards for health plans that employers can use as
a guide to compare health plans and to understand what a
plan offers. Developed by the National Committee for Quali-
ty Assurance, HEDIS also is a way for health plans to see
what is expected of them. See satisfaction survey.
Heuristic: A descriptor for artificial intelligence “thought”

based on an analysis of accumulated data and yes/no decision
trees. Since heuristic processing “learns by experience,” its
success depends on the amount of data introduced to the sys-
tem up to that point.
HIPAA: See Health Insurance Portability and Accountability

Act.
HIPC: See health insurance purchasing cooperative.
HIS: Hospital information system. A system that provides the

information management features that hospitals need for
daily business. Typically includes patient tracking, billing and
administrative programs and also may include clinical fea-
tures.

HL7 (Health Level 7): 1. A standard interface for exchanging
and translating data between computer systems. 2. A non-
profit organization (http://www.hl7.org) accredited by the
American National Standards Institute (ANSI) that develops
standards for data transfer.
HMO: See health maintenance organization.
Home healthcare agency: An organization that arranges for

and provides necessary healthcare services in a patient’s home.
Home page: The first or “main” page of a Web site. This

page usually acts as a table of contents for the layers of pages
and additional hypertext links available within the site.
Hospital alliance: Hospital groups that agree to buy equipment

and services jointly rather than incurring the costs separately.
Host: A computer that acts as a source of information or

capabilities for multiple terminals, peripherals and/or users.
HTML: HyperText Markup Language. The basic programming

language for Web sites. This “skeleton” of codes surrounds
blocks of text and/or images and contains all the display com-
mands. A browser is required to translate HTML into a graph-
ical display. See DHTML and Wireless Markup Language.
http: HyperText Transfer Protocol. A language protocol used

when Web browsers and Web sites communicate. When http
appears as part of a site address (called a URL), it indicates to
a Web browser, “HTML spoken here.” Compare Gopher.
https: See SSL.
Hub: A network device that passes data between the main net-
work line and the end stations. Hubs can include modem capa-
bilities and/or provide access to local area networks. See star
topology.

Hypermedia: Hypermedia takes the linking concept of hyper-
text one step further by incorporating linked multimedia ele-
ments. Clicking on a word or icon can link to a photograph,
full-motion video or a sound clip.
Hypertext: A document containing words or phrases, usually

highlighted in a different color, that are electronically linked
to text elsewhere. Electronic dictionaries and other software
programs use hypertext as a convenient maneuvering tool—
users can click on a letter or subject and go directly to the
material they want without scrolling through the entire docu-
ment. Hypertext also is what makes the World Wide Web so
valuable; with one click of the mouse a user can access more
information from the same site or a site halfway around the
world.
Hypertext link: The clickable word, phrase or icon in a

hypertext or hypermedia document that corresponds to a
linked page or site. Clicking on the link instantly requests the
information available at the new location. Also called a
hotlink.
IBNR: Incurred but not reported. A healthcare accounting

term used when services have been delivered but the claim has
not been processed by the insurer yet. Payors often keep funds
in reserve to cover IBNR services temporarily.
IDS: See integrated delivery system.
IEEE: See Institute of Electrical and Electronics Engineers.
IEEE 1394: See FireWire.
Image management: A feature of some image storage sys-

tems that allows users to rearrange and alter image files after
they are stored.

Independent practice association (IPA): A type of health
maintenance organization that contracts with a group of asso-
ciated physicians for services to its members. Under this
model, physicians may keep their own private practices and
may work for other HMOs. Compare group model HMO,
network model HMO and staff model HMO.
Individually identifiable health information: Also called

patient identifiable information. Any piece of health informa-
tion that can be linked or traced to an individual or family.
The HIPAA-proposed patient privacy regulations forbid the
unauthorized circulation of protected health information
unless it has been stripped of 19 identifiable items, including
name, phone number, email, health plan number, relatives’
names and biometric ID patterns.
Information appliance: A hardware/software combination

that connects a networked user with specific information
sources. Designed as a cost-effective alternative to a complete
computer system, these appliances can perform specific infor-
mational access tasks with little setup and relatively low cost.
Inpatient care: Services delivered to a patient who needs

physician care for at least 24 hours, usually in a hospital.
Institute of Electrical and Electronics Engineers (IEEE): An

international professional society devoted to research, educa-
tion and innovation in electronics engineering and computer
science. The 300,000-strong organization (http://www.ieee.org)
routinely sponsors symposia and produces a quarter of the
research journals in these fields.
Institute of Medicine (IOM): An organization within the

National Academy of Sciences that acts as an advisor in
health and medicine and conducts policy studies relevant to
health issues. The IOM coined the term “computer-based
patient record” and emphasizes its importance for future
healthcare management and delivery.

Integrated delivery system (IDS): A unified healthcare sys-
tem that provides physician, hospital and ambulatory care
services for its members by contracting with several provider
sites and health plans. Participants sometimes are called inte-
grated providers.
Integrated provider: See integrated delivery system.
Integrated services digital network (ISDN): A digital communi-

cations route capable of transmitting text, graphics, video and
audio at about 128 Kbps. Although an ISDN line is slower than
a fiber distributed data interface, it’s faster than a standard tele-
phone line and is a popular way to connect local area networks.
Intelligent agent: Also called an Internet agent. Most com-

monly found on Web sites, this mini-program is designed to
retrieve specific information automatically. Agents rely on
cookies to keep track of the user’s preferences, store book-
marks and deliver news through push technology. Intelligent
agents can’t perform their duties if the user’s browser rejects
cookies, and some Web pages (especially online ordering sites)
will not function properly without the agent’s information.
Intelligent character recognition (ICR): Unlike older scan-

ning technology that could interpret only a few standard type-
faces, this advanced scanning system can translate a wide
variety of printed fonts and type styles from paper sources
into electronic text. Compare optical character reader.
Interactive EDI: See real-time EDI.
Interactive voice response (IVR): An automated call handler.

Most IVR systems can be configured to deliver appointment
reminders and lab results, provide information on demand via
menu choices and keep a log of callers. “Voice response”
refers to the systems’s ability to “speak” the menu choices
and data results to the caller. IVR is one form of computer
telephony integration.

Interface: The electronic connection where two parts of a sys-
tem are joined, such as where a software program meets a
hardware component or where hardware meets an input
device. Also used to describe software that joins two different
information systems. See graphical user interface.
Interface engine: Software that assumes the duties of a physi-

cal interface.
Intermediate care facility: A place that provides medical care

to patients who don’t need to be in a hospital.
International Classification of Diseases (ICD-9, ICD-10): A

list that assigns codes to types of illnesses or conditions.
Whereas CPT codes represent procedures and other services,
ICD codes represent diagnoses.
International Committee for Standardization (ISO): Based in

Geneva, this international group works toward global tech-
nology standards. The American National Standards Institute
(ANSI) is one of its many affiliates.
Internet: An international network of computers that operates

on a backbone system without a true central host computer.
Today’s Internet links thousands of universities, government
institutions and companies, but when it was created in the
1960s, the Internet linked just four computers. Technically, the
Internet and the World Wide Web are not interchangeable
terms; the Web is an integral child of the Internet whose ease of
use has made it much more popular than its less graphical par-
ent. See Defense Advanced Research Projects Agency.
Internet Grateful Med: An online collection of medical data-

bases maintained by the National Library of Medicine
(http://igm.nlm .nih.gov), including Histline, Medline,
ChemID and Toxline.
Internet protocol: See TCP/IP.

Internet protocol suite (IPS): The dominant set of open-data
architecture and its protocols. It includes TCP/IP and file
transfer protocol for data transmissions across the Internet
and is expected to remain one of the bases of the growing
National Information Infrastructure.
Internet service provider (ISP): A company that provides

modem or network users with access to the Internet and the
World Wide Web. Some charge by the hour, but most offer
monthly or yearly flat rates. Recently, some telephone compa-
nies have become ISPs, offering Internet access combined with
local telephone service.
Internet telephony: Also called IP telephony. A combination

of hardware and software that allows the Internet to be used
as a telephone carrier. After the costs of initial setup and
access to an Internet service provider, long-distance voice calls
can be made via the Internet free of charge, but current quali-
ty isn’t always as good as direct telephone service.
Internet2 (I2): A collaborative project begun in 1996 to cre-

ate additional infrastructure for the Internet backbone capable
of super-high bandwidth. Internet2’s vision for extremely fast
speed, complex real-time multimedia capabilities and quality
of service guarantees could have a significant impact on the
future of telemedicine. More details on the I2 project, which
involves more than 150 universities, can be found at
http://www.internet2.edu.
Interoperability: The ability of hardware and software from

different vendors to understand each other and exchange data,
either within the same network or across dissimilar networks.
Intranet: A member-only network that looks and acts like the

World Wide Web. Intranets allow companies to take advan-
tage of Web-based technologies and create a private means of
exchanging images and text among networked users. See fire-
wall and compare extranet.

Intrusion detection: System tools designed to recognize unau-
thorized and malicious entry into a network or host, includ-
ing monitoring for suspicious packet traffic, tracking intruders
and identifying where the security hole is. Many intrusion
detection tools can also detect a variety of misuse originating
from inside the network.
IOM: See Institute of Medicine.
IPsec: Internet Protocol Security. An encryption protocol for

securing Internet packets at the network layer instead of the
application layer. Uses public key infrastructure. IPsec can
encode the packet data and the sender’s identity, or just the
packet data.
ISDN: See integrated services digital network.
ISM bands: Industrial, Scientific and Medical bands. In the

1980s the Federal Communications Commission assigned these
three radio frequency ranges—902-928 MHz, 2400-2483.5
MHz and 5752.5-5850 MHz—for spread spectrum transmis-
sions. Use of these bands does not require a license, but trans-
mission methods must conform to several FCC requirements.
ISO: See International Committee for Standardization.
IVR: See interactive voice response.
Java: A platform-independent, object-oriented programming

language developed by Sun Microsystems and modeled on
C++. Java applets, mini-applications designed to run within
another program, are popular features of Web sites. See
JavaBeans and compare ActiveX.
JavaBeans: A Java tool for creating reusable and shareable

programming blocks in object-oriented programming. On the
Web, they can perform small tasks or communicate with each
other without contacting the file server.

Joint Commission on Accreditation of Healthcare Organiza-
tions (JCAHO): An independent, non-profit group (http://www
.jcaho.org) that accredits healthcare organizations. Healthcare
network criteria in JCAHO’s accreditation manual include
heightened attention to patient education and management of
information.
JPEG: Joint Photographic Experts Group. An international

organization that sets standards for transferring photographs
into compressed computer files. A JPEG also refers to any
image stored under this compression standard; the filename
ends in .jpg.
Jukebox: A unit that contains several laser disks available for

data storage and archiving. Much like its musical relative, it has
an internal mechanism that loads and unloads different disks.
KB (kilobyte): About 1,000 bytes of data.
KDE: An open-system desktop user interface designed primari-

ly for Unix-based applications, including Linux. It is available
to users and developers under a variety of licenses, including a
free public license (http://www.kde.org). Another open-system
interface is GNOME.
Knowledge management: This still-evolving concept involves

harnessing enterprisewide data, proprietary or otherwise, for
comparative decision making, workflow automation, supply
chain management and/or competitive advantage. Far more
than information-aggregation, knowledge management seeks
to enhance business value and help employees work more
productively.
LAN: See local area network.
Laser digitizer: A scanner that uses a laser to translate the source

into machine-readable form. Such scanners have much higher
resolution and bit depth than other types of scanners (e.g., CCD).

Leased line: A communication line rented from a carrier for
dedicated use.
Legacy system: An older computer system, often centered

around a mainframe, that has been in place for a long time.
Owners of legacy systems often are faced with weighing the
cost of replacing a system that technically “still works” with a
faster, less bulky, fully integrated system.
Leveling: [telemedicine] In teleradiology, modifying a dis-

played image to enhance its depth and contrast. Usually level-
ing is needed when a monitor cannot provide the same bit
depth as the original image source.
Linux: An operating system based on Unix and available free for

all major platforms. Because of its open architecture, scalability
and reliability, Linux is growing in popularity as a server and
network operating system alternative. See X Window System.
Liquid crystal display (LCD): A common, inexpensive flat-

panel display that traps liquid crystals between two grooved
plates. LCDs, now available in color, are the current domi-
nant choice for laptops, handhelds and many other devices.
Active matrix LCDs, also called thin film transistors (TFT),
have faster refresh rates, better resolution and fewer ghosting
problems than the older passive matrix options but are more
expensive. Both matrix versions are susceptible to tempera-
ture, static and rough handling.
Listserv: A free electronic mailing list service on the Internet

that automatically delivers topic-specific newsletters to a sub-
scriber’s email address. Compare push technology.
Local area network (LAN): A network of computer and

peripherals in close proximity, usually in the same building. A
LAN can facilitate high-speed exchange of text, audio and
video data among hundreds of terminals. Compare metropoli-
tan area network and wide area network.

LOINC: Logical Observation Identifiers, Names and Codes. A
database protocol aimed at standardizing laboratory and clin-
ical codes for use in clinical care, outcomes management and
research. Developed by the Regenstrief Institute for Health
Care, LOINC is touted as a middleman solution to potential
translation problems between labs that use HL7 reporting and
recipient systems that may not be able to translate such data.
Longitudinal patient record: See computer-based patient

record.
Lossless compression: A compression algorithm that allows

a file to be condensed into a smaller, more efficient format for
transmission over a network or the Web and to be expanded
again on the receiving end without any loss of data or quality.
Unlike other types of file compression, the recipient’s file and
the sender’s file will be exactly the same, a vital feature for
read-quality digital radiology and telemedicine/telesurgery sys-
tems. Compare lossy compression.
Lossy compression: A compression format, often used for

transmitting image files, that excises all non-essential or dupli-
cate data to reduce the file size. The loss of information is
usually unnoticed by the user unless extreme image detail is
required. Compare lossless compression.
M: See MUMPS.
M-commerce: Mobile commerce. An emerging form of

e-commerce where transactions, goods or services are
exchanged using a wireless device, such as a smart phone.
Machine readable: The point at which an original source (a

picture, sound or text) is translated into computerized form.
Scanners, digital dictation and speech recognition systems cre-
ate machine-readable files without keyboard entry, and the
files can be stored, accessed by others or sent electronically to
a recipient.

Magnetic stripe: Found on most plastic credit and ID cards,
this electromagnetic surface is capable of holding a small
amount of information. Compare smart card.
Mailing list: A group of email addresses to which news or

topical information is delivered, usually on a scheduled basis.
In a business context, it also can refer to an email list of
clients or employees. See listserv.
Mainframe: A powerful computer capable of organizing and

executing multiple processing tasks at high speeds. A main-
frame often acts as the controlling agent in a centralized com-
puting system.
MAN: See metropolitan area network.
Managed care: A healthcare system and ideology based on

prepaid membership instead of fee-for-service payment each
time service is delivered. Main characteristics: 1. The system
usually includes a set group of providers and is associated
with a certain health plan. 2. Patients must be enrolled in the
relevant health plan and pay the set premium in advance. 3.
The health plan and the providers share financial responsibili-
ty for care delivery.
Management services organization (MSO): Provides practice

management services to physician groups and hospitals. An
MSO typically controls the business assets of the group it
serves.
Master patient index, master person index: A software

database program that collects a patient’s various hospital
identification numbers (e.g., from lab, radiology, admissions)
and keeps them under a single, enterprisewide identification
number.
MB (megabyte): About 1 million bytes or 1,000 KB.

Medical informatics: The use of electronic tools, applications
and communications to assist with core clinical functions,
decision support, physician-centric tasks and medical knowl-
edge-base compilation. Compare healthcare informatics.
Medical Information Bus (MIB): Part of the Institute of Elec-

trical and Electronics Engineers (IEEE) P1073 standard, the
MIB seeks to provide open integration standards for connect-
ing electronic patient monitoring devices with information
systems.
Medical savings account: A private equity fund, much like

an individual retirement account, set up to help cover future
healthcare expenses, forming medical financial security
regardless of workplace health plans. Medical savings
accounts have received new attention since the Health Insur-
ance Portability and Accountability Act went into effect.
Medicare Part A, Part B: Part A benefits cover inpatient

services and limited amounts of long-term care. Part B bene-
fits cover outpatient services and diagnostic tests or images
and usually require a 20 percent co-payment.
Medicare risk contract: Instead of paying the premium for

portions of Medicare, the patient pays a flat fee to the
Medicare risk contract, which then assumes responsibility for
delivering healthcare. Like an HMO, most risk contracts cover
only the services delivered by listed providers.
Metadata: A data set that defines the scope of a larger data

set or describes the rules by which the larger data set was cre-
ated or structured.
Metropolitan area network (MAN): A system of networked

computers covering the space of an average-sized city. Com-
pare local area network and wide area network.

Microcomputer: A computer that uses a microprocessor and
its own memory/storage space to perform applications. Also
called a personal computer because it usually doesn’t have the
power to operate other computers.
Middleware: A bridge between two applications, or the software

equivalent of an interface. Middleware can “translate” each side
of a data exchange, allowing users to execute programs on
remote servers and access databases through Web sites without
having to know the other server’s language protocols.
Midrange: A computer used at the core of small networks,

with the power and size somewhere between a microcomputer
and a mainframe. Also called a minicomputer.
MIME: Multipurpose Internet Mail Extension. A transmission

format that allows the inclusion of images, sounds and word
processor text in an email message. See S-MIME.
Minicomputer: See midrange.
Mini-PACS: See PACS.
Mirroring: Two identical files or databases created and updat-

ed simultaneously so an exact duplicate exists at all times.
Compare duplexing.
Mission critical: Data relating to essential business opera-

tions.
Modem: Short for Modulator /Demodulator. A device that

translates computerized data into analog signals for transmis-
sion over a telephone line and converts incoming analog data
into digital form. See CODEC and Z-modem.
Morbidity: A measurement of illness or accident risk, based on

categories of age, region, occupation and others. Morbidity
describes potential or expected rates rather than actual rates.

Mortality: Statistical death rates, usually broken down by age
or gender.
Moving Picture Experts Group (MPEG): The standard com-

pression ratios, data transmission rates and pixel counts for
video files.
MPEG: See Moving Picture Experts Group.
MPI: See master patient index, master person index.
MSO: See management services organization.
Multimedia: The combination of text, graphics, sound and/or

video.
Multiplexer: A hardware component used to split a transmis-

sion line into subchannels, either by band division or time-
sharing, so several transmissions can travel on the line simul-
taneously.
MUMPS, M: Massachusetts General Hospital Utility Multi-

Programming System. A programming language for database
management in systems where multiple users need to access
data simultaneously. Originally designed for medical records,
MUMPS is now used in a variety of non-healthcare industries,
where it is more commonly called M.
Narrowband network: A network whose transmissions are

served by a single channel. Compare wideband network.
National Committee for Quality Assurance (NCQA): A non-

profit organization (http://www.ncqa.org) that acts as a
watchdog for the quality of care delivered by managed care
plans and physician organizations. Its accreditation process
includes HEDIS and patient satisfaction surveys.

National Committee on Vital and Health Statistics
(NCVHS): NCVHS acts in an advisory role to government
agencies, especially the Department of Health and Human
Services (DHHS), on issues pertaining to national health data.
Of the 18 committee members, 16 are appointed by the
DHHS secretary and two are appointed by Congress. HIPAA
gave NVCHS the important responsibilities of researching
specific HIPAA issues and making recommendations for
national rules. All NCVHS meetings are public and available
online; see http://www.ncvhs.hhs.gov for details.
National Council for Prescription Drug Programs (NCPDP):

An association (http://www.ncpdp.org) that contributes to and
encourages electronic data exchange standards in the pharma-
cy industry. The HIPAA transaction standards adopted the
NCPDP Telecommunication Standard Format 5.1 as the
requirement for electronic pharmacy claims.
National Information Infrastructure (NII): Formal name for the

“information superhighway” and a main focus of the National
Institute for Standards and Technology. Once composed of
four computers in the first Internet, the NII system now
includes fiber-optic networks, videography, telecommunica-
tions, cable and satellites. Healthcare emphases are on comput-
er-based patient records, secure data access and telemedicine.
National Institute for Standards and Technology (NIST): A

branch of the U.S. Department of Commerce’s technology
administration. Its Advanced Technology Program awards
grants for development and commercialization of new tech-
nology ideas and products. Although it considers projects in
any technological area, it has several target categories, includ-
ing the Information Infrastructure for Healthcare.
National Institutes of Health (NIH): This federal research

agency (http://www.nih.gov) within the Department of Health
and Human Services includes the National Library of Medi-
cine and 24 specialty research institutes and centers.

National Library of Medicine (NLM): The world’s largest
medical library and a branch of the National Institutes of
Health. The NLM has more than 5 million materials, and
many of its databases are available to the public on the World
Wide Web. The NLM maintains several project groups—
including new research in telemedicine, biotechnology, applied
informatics and Next Generation Internet—and sponsors fel-
lowships and grants for healthcare IT training sites. See Uni-
fied Medical Language System and Internet Grateful Med.
National Provider Identifier (NPI): The intended replacement

for the Unique Physician Identifier Number system. Under
development by the Health Care Financing Administration,
the system will assign a unique ID to each provider who bills
services under Medicare or as stipulated by the Health Insur-
ance Portability and Accountability Act.
Natural language processing: The goal of creating computer

systems and applications that understand the sentence struc-
ture and complex contextual meanings within human lan-
guage. Far more than speech recognition, this form of artifi-
cial intelligence hopes to understand the context of language
beyond a predefined set of vocabulary, eventually allowing
computers to interpret meaning well enough to translate accu-
rately from one human language to another.
NCCLS: Formerly the National Committee for Clinical Labo-

ratory Standards. An international standards organization
(http://www.nccls.org) that focuses on all forms of medical
testing and related issues.
NCPDP: See National Council for Prescription Drug

Programs.
NCQA: See National Committee for Quality Assurance.
Net PC: See thin client.

Network: A general term for terminals, processors and devices
linked either by cable or wireless technology. Peripherals, pro-
grams and applications can be shared by the network users.
Network analyzer: Also called a protocol analyzer. A software

security product that runs in the background of a network,
examining and logging packet traffic. Analyzers can be con-
figured to watch for unusual Internet protocol addresses, time
stamps and data blocks, and most come with alarm features.
In combination with a firewall and other security measures, it
can be an invaluable early warning device against hackers.
Network computer: See thin client.
Network model HMO: A health maintenance organization

that contracts with multiple groups of physicians for care
delivery. Compare staff model HMO, independent practice
association and group model HMO.
Network-attached storage (NAS): Storage device(s) connect-

ed to a network and accessible by multiple computers. Allows
simultaneous file sharing but needs at least a 100Base-T net-
work speed for best operation. Compare direct-attached stor-
age and storage area network.
Neural network: A system that uses the human inference con-

cept of an expert system but widens the scope to include
many subjects. Several processors, each with its own “special-
ty,” form a problem-solving network. See artificial
intelligence.
Newsgroup: Similar to a public bulletin board in a library or

post office, only electronic. Postings are categorized by topic
and can be read by anyone who visits the newsgroup. Com-
pare listserv.

Next Generation Internet (NGI): A federal project to develop
the Internet’s networking and data mining potential to better
serve the needs of government agencies such as the National
Institutes of Health and the National Science Foundation. See
National Library of Medicine.
NIST: See National Institute for Standards and Technology.
Node: A connection point on a network. Each node has its

own address and can process and forward data to other
nodes.
Non-repudiation: Proof that an electronic transaction or com-

munication occurred, establishing accountability for both the
sender and the recipient.
Notice of Proposed Rulemaking (NPRM): A public notice,

published in the Federal Register, of policy-in-progress. Typi-
cally, an NPRM includes a drafted text, a defined public com-
ment period and a proposed finalization date. All Administra-
tive Simplification regulations under HIPAA follow the
NPRM process.
NPI: See National Provider Identifier.
N-tier: An application or architecture that can be configured

in any number, or “n” number, of layers. N-tier platforms can
include multiple servers, mobile clients, modules, middleware
and storage; all partitioned for individual management. See
tiered architecture.
Nursing informatics: The use of electronic tools, applications

and communications to assist with nurse-centric tasks—such
as triage, charting and other note-based functions—and case
management. Although sometimes viewed as a subset of med-
ical informatics, it is becoming recognized as a separate field
with distinctly different approaches and system tools. Com-
pare healthcare informatics.

Object Request Broker (ORB): The messenger at the heart of
the CORBA framework. ORBs act as relay stations for
requests between the client’s software and the server. Since
ORBs work across multiple platforms, the user doesn’t have
to know each server’s protocol before communicating.
Object-oriented technology: A program based on self-con-

tained objects—complete blocks of data packaged with
accompanying processing directions. Because they are inde-
pendent, objects are not affected by outside commands and
can operate within a variety of applications. This technology
forms the basis for Java and ActiveX.
ODBC: Open DataBase Connectivity. Developed by Microsoft,

this standard interface acts as a translator for queries to dis-
parate databases, provided both the querying application and
the database management system can accept ODBC commands.
Offline/Online: A device that is not connected or is turned off

is offline. One that is connected and ready to send or receive
data is online. These terms refer mainly to peripherals but
also can describe a computer’s connectivity to a network or
the Internet.
OLAP: See OnLine Analytical Processing.
OnLine Analytical Processing (OLAP): Software query tools

that allow users to analyze database information. Commonly
found in data marts and decision support systems, OLAP servers
interpret the user’s request and provide data from multiple data-
bases. The principle is similar to a relational database tool, but
OLAP can provide multiple search parameters at once.
OnLine Transaction Processing (OLTP): A real-time transac-

tion between a user and a database server. Found in many
server systems used for lab reporting, OLTP accepts a request
and returns an immediate answer across multiple platforms.
Compare batch.

Open panel: See network model HMO.
Open system: A system capable of integrating hardware and

peripherals of multiple vendors. Such systems usually are able to
interact with other open systems based on standard protocols.
Open-ended HMO: See point of service.
Operating system (OS): The program that provides the brain

power and basic functions to run all the other applications. The
OS manages input, output, the memory and the ordering of
tasks.
Optical character reader (OCR): A scanner that translates

text from a printed page into electronic text, eliminating key-
board input. The accuracy of the translation can depend on
the typeface on the paper original. Compare intelligent char-
acter recognition.
Optical disk: A flat, circular disk used to store data. Each of

the three basic kinds requires a specific type of disk drive: 1.
Read-only: a disk with preloaded, permanent data that can be
read many times such as a CD-ROM. 2. WORM (write once,
read many): a blank disk that can accept data once but can be
read repeatedly. 3. EO (erasable optical) or CD-RW: a blank
disk that can accept data, be erased like a magnetic disk, and
loaded again with new data.
Organic light-emitting display: Also called organic LED. An

emerging technology that hopes to counter three drawbacks to
flat-panel displays: battery consumption, resolution and delica-
cy. Promising methods include flexible, light-emitting polymers
that require almost no backlighting, and displays that arrange
pixels vertically instead of horizontally, tripling resolution.
Touted as an eventual replacement for liquid crystal displays,
organic LEDs should deliver bright, high-resolution color
images on low-power, modestly priced flat screens of virtually
unlimited size.

Organization for the Advancement of Structured Information
Standards (OASIS): An international non-profit consortium
(http://www.oasis-open.org) that promotes the development
and practical application of open standards for structured
information processing, such as XML and HTML.
Original equipment manufacturer (OEM): A business entity

that builds a new branded solution or system out of compo-
nents, primarily hardware, manufactured by other companies.
Some equate an OEM with a value-added reseller.
Outcomes: An assessment of a treatment’s effectiveness by

considering its success as a care solution as well as its cost,
side effects and risk. Outcomes data are a crucial component
of an organization’s performance measurements. Building out-
comes archives also can serve as a valuable resource for use in
decision support systems.
Outpatient care: See ambulatory care.
Outsourcing: Electronic processing capabilities that are not

inherent in the system and so are arranged through or given
over to a third-party administrator.
Packet: A “package” of information for transmission. Pack-

ets are of a uniform size and coded with the destination
address. See packet switching.
Packet switching: A routing method where data files are

broken down into small blocks called packets and sent simul-
taneously to multiple users on a network. Each packet has
ordering instructions so the receiving system can reassemble
the blocks in the proper order. Transmitting a series of small
packets usually is faster than sending a large file in its entirety
to each user. Also called fast packet.
PACS: See picture archiving and communications system.

Patient accounting system: Software that records charges to
patients, creates billing forms and maintains payment records.
Patient education: Health and wellness information available

to the patient in electronic, video or print forms. Although
patient education includes general health sources (e.g., a well-
ness Web site or a self-help booklet), the current emphasis is
on delivering patient-specific information, often directly from
the physician.
Patient informatics: Previously an all-encompassing term,

patient informatics now is more commonly broken into
consumer informatics and patient education.
Payor: A company or an agency that purchases health services.
PBM: See prescription benefits manager.
PBX, PABX: See private branch exchange (PBX), private auto-

matic branch exchange (PABX).
PCS: See personal communications service.
PDA: See personal digital assistant.
.pdf: See Portable Document Format.
Pen-based technology: A system that uses a special pen, con-

nected by wire or wireless, as a selection tool and/or an input
device.
Performance measurements: The collected results of a

healthcare organization’s actual performance over a specified
time. The Joint Commission on Accreditation of Healthcare
Organizations and the National Committee for Quality
Assurance have developed performance measurement stan-
dards, and performance data usually are a major factor in an
organization’s accreditation process. See HEDIS.

Per member, per month (PMPM): A unit of comparison
derived from a tally of the revenue, premium, cost, service uti-
lization or capitation payments for a health plan member per
month.
Personal communications service (PCS): A wireless commu-

nication service that can transmit voice, data and messaging.
Includes CDMA, GSM and TDMA systems.
Personal digital assistant (PDA): A handheld computer that

provides access to notes, phone lists, schedules and, with
additional connectivity, paging systems or the Internet. PDAs
have no hard drive and most lack keyboards. Using a scaled-
down operating system, input is predominantly pen-based,
although speech recognition may become more prevalent.
Physical security safeguards: Protection against physical intru-

sions that may endanger data security, integrity or availability,
including locks on doors and equipment, secure data storage
and disposal, audit trails and monitored access of personnel to
restricted areas. Part of the HIPAA-proposed security regula-
tions. Compare technical security safeguards and administra-
tive security safeguards. See security officer.
Physician hospital organization (PHO): A system where a

hospital and its physician groups jointly own the organiza-
tion. The PHO as an entity then assumes the responsibility of
arranging contracts with managed care plans and care facili-
ties.
Physician practice organization (PPO): See Preferred

provider organization.
Picture archiving and communications system (PACS): A

system that uses an image server to archive and exchange x-
rays, CT scans and other medical images over a network. A
mini-PACS specializes in one type of image, such as ultra-
sound.

Pixel: The smallest unit, or dot, of an image display. The size
of the pixel partially determines the display device’s resolution
quality. See bit depth.
PKI: See public key infrastructure.
Plasma display: Also called gas plasma. A flat-panel display

whose thin layer of ionized neon gas forms glowing pixels
trapped within a wire grid. The crisp monochrome display
can withstand rough handling and adverse environments but
is not as power-efficient as a liquid crystal display.
Plug-and-play: A peripheral or hardware component that has

built-in initializing capabilities. The operating system auto-
matically recognizes its presence and adds it to the system
configuration, simplifying the user’s setup.
Point of service: A healthcare maintenance organization plan

that encourages the use of participating providers but does
not require it. However, members usually are charged higher
deductibles and co-payments if they use providers who are
not on the list. Also called an open-ended HMO.
Point-of-sale (POS): The device that is the first point in a

financial transaction. POS devices have evolved from manual-
key registers to electronic systems and magnetic stripe readers,
including electronic funds transfer capabilities.
POP3: See Post Office Protocol 3.
Population health management: Also called community-

based healthcare. The coordination of care delivery across a
population to improve clinical and financial outcomes. True
population management will include all aspects of disease
management, case management and demand management.

Port: A connection point through which a computer sends or
receives data. It may connect a computer to a printer, a
modem or a vast network. See SCSI, universal serial bus and
FireWire.
Portable Document Format: This file format, ending in .pdf,

renders a document as a searchable, navigable image, retaining
the original appearance of all graphics, layout and design.
Developed by Adobe Systems, .pdf has become a popular way
to circulate large documents via email and to migrate printed
material to the Web, greatly because the Acrobat viewer is free.
Portal: A Web site that acts as a doorway to a variety of other

sites and services. Since healthcare portals can guide high vol-
umes of users to search engines, drug databases, consumer con-
tent, online prescription services, medical supplies, and physi-
cian continuing medical education, companies and health sys-
tems took quick notice of the advertising/investment potentials.
Positron emission tomography (PET): A nuclear medicine

diagnostic imaging technology for observing the functions of
organs and tissue rather than physical structure. PET scans
can differentiate between damaged and healthy tissue, or
show which parts of an organ are not functioning properly.
Post Office Protocol 3 (POP3): An email protocol based on

the client/server idea. POP3 allows email to be received,
stored and later forwarded to a different email address at the
request of the user.
PPO: See preferred provider organization.
Preferred provider organization (PPO): A managed care sys-

tem where insurance companies, employers and other health-
care buyers arrange lower fees with select doctors and facili-
ties. Patients who use a preferred provider pay less, so in the-
ory, a provider’s reduced fees are balanced by having more
patients.

Prescription benefits manager (PBM): A company that man-
ages provider and health plan prescription costs by negotiat-
ing with drug manufacturers and pharmacy service companies
for the best drug rates and reimbursements.
Pretty good privacy (PGP): A popular and low-cost encryp-

tion tool for sending, receiving and storing secure email,
including digital signatures. PGP uses a public/private key sys-
tem built on one of two main encryption algorithms (RSA or
Diffie-Hellman). See public key infrastructure.
Primary care network: A group of primary care physicians

who contract among themselves and/or with health plans.
Providers in the group usually share financial responsibilities
and risks.
Primary user interface device: The main device through which

a user activates and controls a system. The device may be a
mouse, keyboard, touch screen, electronic pen or voice, depend-
ing on the needs of the user and the capabilities of the system.
Privacy: The right to remain anonymous, to be kept from

public view or to be protected from intrusions from unautho-
rized others. In healthcare, privacy is intrinsically tied to
patient rights, including the right of a patient to know and
control how personal health data are being used, stored
and/or shared with others.
Private branch exchange (PBX), private automatic branch

exchange (PABX): A private telephone network within a sin-
gle enterprise, eliminating the need to wire separate telephone
lines to every office station. A PABX combines internal
switching lines, external lines and some degree of automated
call routing.
Private key cryptography: An encryption model that uses

the same key to encrypt and decrypt message content. See
symmetric key and compare public key infrastructure.

Process management: An evaluation and restructuring, if nec-
essary, of system functions to make sure processes are carried
out in the most efficient and economical way.
Profiling: See provider profile.
Prospective payment: A payment plan where reimbursements

are based on set rates for predefined groups of services.
Unlike the previous Medicare reimbursement system, prospec-
tive payment pays hospitals according to what a care episode
should cost regardless of the actual expenses, placing new
emphasis on materials management and the accuracy of diag-
nostic, evaluation and procedural coding. See capitation and
ambulatory payment classification.
Protected health information: Any individually identifiable

health information that is used or circulated by any entity
that falls under governance of the Health Insurance Portabili-
ty and Accountability Act (HIPAA). The privacy regulations
will mandate safeguards for protected health information, and
the responsibility for maintaining them also may be extended
to third-party business partners.
Protocol: A way of doing things that has become an agreed-

upon convention, or “rule.” In electronic communication, if
several systems use the same protocols, they operate in a simi-
lar way and can easily exchange data. Standard protocols
have evolved on a national and international basis for data
exchange, language translation and use of the Internet, to
name a few.
Provider profile: An examination of services provided, claims

filed and benefits allocated by healthcare facilities, physicians
and other providers to assess quality of care and cost manage-
ment.

Proxy server: A server that acts as a gateway between a com-
pany’s intranet and the outside Internet, used in combination
with, or as the next checkpoint after, a firewall. Proxy servers
also are useful as temporary storage devices, allowing quick
access to information that is used heavily for a short period of
time. For example, a medical image may sit on a proxy server
while it is in consultation and then be sent on to a long-term
archive elsewhere.
Public key infrastructure (PKI): An identity verification

model that uses digital certificates, trusted certificate authori-
ties and public/private encryption keys to authenticate com-
munications from a specific sender to a specific recipient. A
detailed description of how PKI works can be found on the
Web site of RSA, the developer of PKI’s primary algorithms,
at http://www.rsasecurity.com.
Push technology: The automatic delivery of Web news and

other information without a request from the user. Unlike
Web pages and most email where a user downloads or
“pulls” information each time in order to view it, push tech-
nology requires a user to register only once and sends the
news as it becomes available, without further prompting.
Compare listserv.
QoS: See quality of service.
Quality assurance: An assessment of the delivery portion of

healthcare plans to make sure patients are receiving high-
quality care when and where they need it. The National Com-
mittee for Quality Assurance is a key agency in evaluating the
performance of managed care plans.
Quality measurements: See performance measurements.

Quality of service (QoS): A guarantee of throughput, or data
delivery, on a network. Especially important for video/voice
transmissions and virtual private networks, QoS ensures that
a data packet will travel from its source to its destination
within a specified time frame.
Radio frequency (RF): Any frequency that corresponds to

radio signals, including those used by cellular telephones and
wireless networks.
RAID: Redundant Array of Independent Disks. A storage

medium that spreads data across multiple disks to increase
access performance and fault tolerance. RAID comes in at
least nine types, with varying combinations of error checking,
access speed and redundancy features.
RAS: Reliability, availability, serviceability. An evaluation

method that weighs a system’s performance and mainte-
nance/repair record. In short, it reveals whether or not the
productivity of the system is worth the cost to maintain it.
Raster graphics: Using a process called bitmapping, a digital

image file is created by saving each bit of an original image
instead of saving lines plotted between points. Raster files are
capable of high definition and color depth but are difficult to
manipulate without loss of quality. Scanners create raster
images. Compare vector graphics.
RBAC: See role-based access control.
Read Classification System (RCS): A vocabulary classifica-

tion system developed in the United Kingdom, now often used
as a complement to, or instead of, SNOMED. Diagnostic,
symptomatic and procedural data are stored under codes but
are translated from codes into text descriptions when
accessed.

Reader: In a broad sense, a device that can access data from a
machine readable storage source. Most often refers to the
device that reads magnetic stripe cards.
Real time: Computer communications or processes that are

so fast they seem instantaneous.
Real-time EDI: An interactive data exchange between two

computers, where one sends a request and the other responds
immediately, much like a conversation. The opposite of a
batch transmission, where a request is made and the data are
sent later.
Redundant backup, redundancy: Using storage components or

entire ancillary systems to create duplicate copies of data, avail-
able instantly if the primary system fails. See RAID and mirror-
ing.
Relational database: A database where all information is

arranged in tables containing predefined fields. Using Struc-
tured Query Language, reports and comparisons can be gen-
erated by selecting fields of interest from the original database
and creating new tables. Changing a field in one record auto-
matically changes the same record in all related databases,
allowing for easy global updating.
Remittance advice: A notice of payment due, either in paper

form or as a notice of an electronic data interchange financial
transaction. See explanation of benefits.
Remote computing: Using a network to contact someone

else’s computer system, usually through telephone lines, in
order to access software and other information. Through
remote computing agreements, healthcare organizations can
use their own networks to access resources from vendors or
consultants.

Retention: 1. The result when members remain on a health
plan from one year to the next. 2. The percentage of a premi-
um that a health plan keeps for internal costs or profit.
Return on investment (ROI): For information technology, it’s

the estimated profit or cost efficiency of one system or infra-
structure compared to that of another. ROI considerations
should include the total cost of ownership (hardware, soft-
ware, implementation, initial training, operations staff, main-
tenance staff and services, and connectivity fees) as well as
less tangible issues, such as care delivery speed and quality,
workload management and patient satisfaction.
Ring topology: A network layout where all segments are con-

nected to each other in one circle. Each segment is represented
by a node on the ring, and a data packet travels around the
ring until it finds a node with the matching address. The most
common type is a token ring. Compare bus topology and star
topology.
Risk analysis: [security] An assessment of an enterprise’s

security risks under currently installed control mechanisms,
usually coupled with an analysis of what additional technolo-
gies or mechanisms might lessen security risks cost-effectively.
Risk assessment: See morbidity.
Risk sharing: Common in a health maintenance organization

setting, this arrangement combines the risk of financial losses
for all care providers in a business entity such as a hospital or
physician group. One provider’s losses are shared by all, but
gains also are shared.

Robotics: A form of artificial intelligence, robotic systems are
used in healthcare in two main forms: they process sensory
input from haptic interfaces, and they allow surgeons to act
with more accuracy than the unassisted human hand. Robotic
systems with miniaturized cameras and precision laser surgical
instruments are now used to conduct minimally invasive sur-
gery right down to the cellular level.
ROI: See return on investment.
Role-based access control (RBAC): A security access protocol

that defines a user’s roles within the enterprise and establishes
what information the user is permitted to see, change or add
based on those roles. Instead of merely recognizing that physician
A is a valid user, this protocol allows multiple hierarchies of
access depending on physician A’s role at the time, such as pri-
mary care, referral care or emergency care. Compare context-
based access control and user-based access control.
Router: A device that sends data transmissions only to the

portion of a network meant to receive them, rather than to
every user. Instead of merely passing information like a
bridge, a router keeps tabs on the rest of the activity on the
network and changes traffic patterns if necessary to maintain
efficiency.
RSA: This encryption algorithm, named for developers Ron

Rivest, Adi Shamir, and Leonard Adleman, is a predominant
standard for secure Internet data transmission and sender
authentication. Based on public/private keys, RSA is an inte-
gral part of most current Web browsers. A detailed explana-
tion can be found on RSA Security’s Web site, http://www
.rsasecurity.com. See public key infrastructure and pretty good
privacy. Compare Advanced Encryption Standard.

Sanction policy: A set of disciplinary steps outlining how vio-
lations of health information security policies and procedures
will be handled, including the grounds for termination, con-
tract withdrawal, and civil or criminal penalties. The HIPAA-
proposed security regulations require the sanction policy to be
made available to all personnel and third-party agents/con-
tractors. See security officer.
Satisfaction survey: A survey sent to members of a health

plan to allow feedback on the organization’s service and qual-
ity. The current HEDIS standard requires such surveys as part
of performance measurements.
Scalable, scalability: The versatility of a computer’s architec-

ture or an application’s functionality. The ability of a system
or application to do any or all of the following, without los-
ing functionality: to be expanded or downsized in capacity
and user loads, to accept new modules or features, to adapt
to a more complex or alternate operating system or platform.
SCSI: Small Computer System Interface. Pronounced

“scuzzy,” this ANSI interface for connecting external devices
is standard on Macintosh computers, but PCs also have
adopted the technology. It works like a parallel port, only
much faster, and it can accept multiple devices through one
port. Available in various data rates: A Fast SCSI has rates of
10 Mbps, but a Wide Ultra2 can handle up to 80 Mbps.
Seamless integration: A system with the flexibility to accept

new devices and programs without disrupting other functions
or requiring extensive installation tasks.

Search engine: A tool for finding information quickly from a
variety of sources on the Internet or the World Wide Web.
Users can enter keywords or narrow their search using
boolean language, and the search engine will list as many rele-
vant sources as it can find. Not all engines are designed the
same way; some gather information by keyword registry, and
others use a “bot”—a robot program that wanders the Web
and scans the first few hundred words of each site it encoun-
ters.
Seat: See end station.
Secure Electronic Transaction (SET): An encryption/authen-

tication protocol designed for financial transactions over the
Internet. Using digital signatures and a digital certificate
among buyer, financial institution and seller, SET allows users
to make Internet purchases by credit card without letting the
merchant see the actual credit card number. This system runs
on SSL and S-HTTP and resembles public key infrastructure
in concept.
Secure HyperText Transfer Protocol (S-HTTP): An encrypted

version of HTTP for transmitting messages or data packets
securely over a standard Web site. This technique encrypts the
data but not the connection. Compare SSL.
Secure Sockets Layer (SSL): Developed by Netscape and

now used by many Web sites, SSL is an encryption protocol
(40-bit or 128-bit) that establishes a secure transmission con-
nection between a user and a host. E-commerce health sites
may offer an SSL site address, which begins with https://, for
the submission of credit card numbers, medical history or pre-
scription orders. Compare Secure HyperText Transfer Proto-
col.

Security officer: Responsible for supervising information
security policies and procedures; implementing administrative
security safeguards, physical security safeguards and technical
security safeguards to protect the integrity and confidentiality
of data; creating security contingency plans; training person-
nel on security mechanisms and procedures; maintaining a
sanction policy; and providing documentation of the func-
tions mentioned. The proposed HIPAA security regulations
require the appointment of a security officer.
Segmentation: Splitting a large or heavily used network into

smaller, interconnected portions to spread out the data traffic.
Self-insured: A company that creates and maintains its own

health plan for its employees instead of contracting with an
outside insurance provider. Also called self-funded.
Server: See file server.
Service bureau: An establishment that provides business and

electronic services for a fee. Photocopying, printing of com-
puter files and fax transmissions are standard in most service
bureaus, and many now offer walk-in World Wide Web
access.
SGML: See Standard Generalized Markup Language.
S-HTTP: See Secure HyperText Transfer Protocol.
Simple Network Management Protocol (SNMP): A standard

language for communication between devices on a network.
All SNMP-compatible devices respond to the same commands
to send, reject or accept data messages.
Skilled nursing facility: A place for patients who need the

scheduled medical care of a nurse but don’t need to stay in a
hospital.

Smart card: A portable, updatable card that can be used to
store personal identification, medical history and insurance
information. Because it has its own microprocessing chip, a
smart card can store thousands more bits of information than
a magnetic stripe card, although it requires a special card-
reading device.
Smart phone: A cellular telephone with additional capabili-

ties, such as functions associated with a personal digital assis-
tant and/or the ability to access the Internet. In the latter case,
an alternate term is Web phone. See Wireless Application Pro-
tocol.
S-MIME: Secure Multipurpose Internet Mail Extensions. A

protocol for encrypting email attachments, now included with
most Web browsers. Based on RSA public-key encryption.
Sniffer: See network analyzer.
SNMP: See Simple Network Management Protocol.
SNOMED: See Systematized Nomenclature of Medicine.
SOAP: A standard format for physician charting of patient

examinations on a problem-based patient record. SOAP com-
bines patient complaints and physician determinations: Sub-
jective (patient’s input), Objective (physician’s observations),
Assessment (physician’s conclusions), and Plan (medical
course of action). Originating in the paper-based world,
SOAP elements are now incorporated into many template-
based charting systems.
SONET: See Synchronous Optical Network.

Speech recognition: A computer’s ability, through software,
to accept spoken words as dictation or to follow voice com-
mands. Vocabulary limitations and recognition abilities can
vary greatly from system to system. Also called voice recogni-
tion or speech understanding. Compare continuous speech
recognition.
Spooling: The act of preparing a data file for printing, send-

ing or other processes while the system is occupied with other
tasks. Each job is placed in a waiting line, or queue, and
saved in a temporary storage space called a spool.
Spread spectrum: A wireless communication method that

spreads transmissions across a spectrum instead of transmit-
ting over a fixed radio frequency. The Federal Communica-
tions Commission has authorized the three ISM bands for
such transmissions. The two types of SS transmission, Direct
Sequence (DSSS) and Frequency-hopping (FHSS), deter eaves-
droppers because the signals are either encoded or are diffi-
cult to intercept. See CDMA.
SQL: See Structured Query Language.
SSL: See Secure Sockets Layer.
SSP: See storage service provider.
Staff model HMO: Also called a closed panel model. A health

maintenance organization variation where the staff physicians
work only for a single HMO and have no private practices.
Compare group model HMO, independent practice associa-
tion and network model HMO.
Standard: A process, format or transmission protocol that has

become convention by agreement of a group of users.

Standard Generalized Markup Language (SGML): An ISO
standard that establishes rules for identifying elements within
a text document. Once identified, or “tagged,” the elements
can be further interpreted by other markup languages, such as
HTML, XML and DHTML.
Standard industry code (SIC): Codes assigned to various

industries and jobs. Since workforce sectors carry different
levels of health risk, the SIC is used in calculating insurance
and health plan premiums.
Star topology: A local area network designed in the shape of

a star, where all end points are connected to one central
switching device, or hub. Star networks are easier to manage
than ring topology but are slower because every message must
pass through the central point. Compare bus topology.
Storage area network (SAN): A network of storage devices,

connected to the main computer network via a fibre channel
hub. As a separate and scalable place to consolidate stored
data, SANs can free up traffic and space on the main network
but don’t allow easy file sharing. Compare direct-attached
storage and network-attached storage.
Storage service provider (SSP): A business entity that acts as

an outsourced service for data storage as an alternative to in-
house hardware. For a fee, usually monthly, such companies
provide unlimited storage space, a variety of maintenance servic-
es and some sort of electronic access to the data.
Store-and-forward operation: A network delivery method that

does not use real-time communication. Text or image data are
received by the network and held for later delivery. “Later”
can be less than a minute or several hours, depending on the
type of communications and network delivery protocols.

Streaming, streaming media: A technology that allows large
audio, video or multimedia files to be sent from a server to a
user in a continuous download. The data are compressed by
the host server, sent over the Internet and decompressed on
the fly by a viewer or player program resident on the user’s
computer. Using a buffer, the player “feeds” the data to the
screen in a steady stream, resulting in what appears to be
“live” media. Most full-motion video clips and continuous-
play audio files use streaming technology.
Structured Query Language (SQL): A standard command lan-

guage used to interact with databases.
Subrogation: An agreement by which the primary insurer, usu-

ally a health insurance company, can collect funds from a
patient’s other benefits sources (e.g., auto insurance) as reim-
bursement for claim costs. Not legal in all states.
Supply chain management: A strategy for electronically link-

ing supply chains, inventories, human resources and the sales
force. Ideally, automating the entire supply chain—from per-
formance data analyses and supply ordering down to the end
user—can reduce inventory glitches, manage distribution and
anticipate future supply needs.
Switch: An input/output device with several ports. Like a

track-switching point in a railyard, the switch allows a user to
choose where data are to be sent—to the fax machine instead
of the printer or to the network instead of the fax.
Symbolic reasoning: The type of “thinking” employed by

artificial intelligence systems. Symbolic reasoning relies on
symbols rather than mathematical equations and more closely
resembles human thought and decision-making skills.
Symmetric key, symmetric cipher: A key used in private key

cryptography, where the same secret key is used for both
encryption and decryption. Compare asymmetric key.

Synchronous Digital Hierarchy: See Synchronous Optical
Network.
Synchronous Optical Network (SONET): An ANSI standard

for transmitting multiplexed data streams across fiber-optic
networks. Its carrier levels range from 51.84 Mbps to about
2.5 Gbps. SONET can be used as the base for broadband
ISDN or high-speed asynchronous transfer mode (ATM) net-
works and is compatible with its equivalent international
standard, synchronous digital hierarchy.
Systematized Nomenclature of Medicine (SNOMED): A stan-

dardized vocabulary system for medical databases. Used in
more than 37 countries, SNOMED has potential to become
the standard vocabulary for speech recognition systems and
computer-based patient records. See Read Classification Sys-
tem.
T1, T3, T4: Types of transmission lines in the T-carrier

telecommunications system. T1 lines can transmit about 1.5
Mbps of data. A T3 line contains 28 T1 lines and can trans-
mit about 45 times the data of a single T1, enough for full-
motion video. Six T3 lines make one T4 line, capable of
transmitting about 274 Mbps. European equivalents run from
E1 to E5. See backbone network.
TCP/IP: See Transmission Control Protocol/Internet Protocol.
TDMA: See Time Division Multiple Access.

Technical security safeguards: Software and/or hardware
tools that help ensure authorized and timely access to infor-
mation while protecting the computer system from security
breaches or improper use of data. The HIPAA-proposed secu-
rity regulations require audit trails and unique identification
of users based on at least one of the following methods: con-
text-based access control, role-based access control, and user-
based access control. Automatic logoff and a mechanism to
provide user access in an emergency are also required. Special
rules apply to information being passed over a network,
including an alarm mechanism and event reporting. The use
of encryption for network transactions is strongly suggested.
Compare administrative security safeguards and physical
security safeguards. See security officer.
Telecommunications: The electronic transmission of voice

signals and other data over telephone-based carrier systems,
including cellular. See Internet telephony.
Telehealth: A broad term describing the combined efforts of

health telecommunication, information technology and health
education to improve the efficiency and quality of healthcare.
Telemedicine: As a segment of telehealth, telemedicine focus-

es on the provider aspects of healthcare telecommunications,
especially medical imaging technology.
Teleradiology: Conducting radiology image exchange and/or

image interpretations electronically, usually via videoconfer-
encing or messaging.
Terabyte (TB): About 1 trillion bytes or 1,000 gigabytes (GB).

A system with a terabyte of storage could hold as much as 500
computers with 2 GB of space each.
TFT: Thin film transistor. See liquid crystal display.

Thin client: A”stripped down”personal computer designed
specifically to be a client in a client/server network. Thin
clients tend to cost less than fully equipped models—since a
thin client assumes the presence of a file server, it has no need
for full software or internal devices of its own. Microsoft and
Intel have jointly produced the “Net PC,” and Oracle/Sun
Microsystems have collaborated on the “Network Computer.”
Third-party administrator: A company independent of a

healthcare organization that handles claims and/or other busi-
ness. See outsourcing.
Tiered architecture: A client/server network whose structure

is divided into several levels. The system’s application respon-
sibilities are apportioned to different parts of the network,
relieving the main server of some of its duties. See n-tier.
Time Division Multiple Access (TDMA): A wireless communi-

cation method that divides the designated frequency into time
slots. Each frequency can carry multiple transmissions, with
each call taking a “turn” in a time slot. Mobile TDMA hand-
sets tend to have better sound quality than those using the
code division (CDMA) method but require more battery
power to remain on the designated frequency.
Token: A portable piece of hardware, such as a smart card or

radio frequency badge, that contains unique information to
identify its owner. A token is most often used as an additional
authentication mechanism in combination with a user name
and password but can be used with other tools, such as
biometrics or digital certificates.

Token ring: A message-passing method that controls traffic
within some ring topology networks. A set number of empty
“boxes,” called tokens, circulate around the ring, coded with
an availability signal. When a node wishes to send data, it
puts the addressed information in the nearest available token.
As in all ring networks, data travel around the ring until they
find a node with a matching address. Once data are delivered,
the empty token is returned to the ring.
Topology: The arrangement or layout of a network system

such as ring topology or star topology.
Total cost of ownership (TCO): See return on investment.
Transactions and code sets rule: The first HIPAA Adminis-

trative Simplification rule to be finalized. Published August
17, 2000, the “Standards For Electronic Transactions” rule
specifies the required formats, based on the ASC X12N stan-
dards, for eight types of electronic transactions: Claims and
encounters, payment and remittance advice, coordination of
benefits, claim status, enrollment/disenrollment, eligibility,
referrals and authorizations, and the payment of premiums.
Required code sets include the International Classification of
Diseases, the National Drug Codes, the Current Dental Ter-
minology, and HCPCS codes.
Transmission Control Protocol/Internet Protocol (TCP/IP):

The most common group of conventional rules for exchang-
ing packets of information among networks, including the
Internet. TCP/IP has been used on the Internet since the early
1980s and is considered an international standard.
Triage: Once used solely as a way to sort disaster victims into

categories of care urgency, this method also is used to guide
patients to proper services by using an intermediary person to
gather preliminary information and answer patients’ ques-
tions.

Trojan horse: An invasive computer program, usually hidden
in a downloadable file, designed to give a hacker remote con-
trol over the infected computer, including its access protocols.
Although it can be used to destroy data, its most malicious
role is in security hijacking, where a hacker gains access to a
private network by planting a password-stealing Trojan horse
on a valid user’s computer. Unlike a virus or worm, pure Tro-
jan horse programs do not copy themselves. Antivirus soft-
ware libraries usually include known Trojan horses.
Tunneling software: Software designed to permit restricted

access through a network’s firewall. The software, which
resides on either the remote user’s computer or on the host
server, requires a user name/password or an encrypted equiva-
lent to gain entry to the tunnel. See virtual private network.
Turnkey: A system that already contains all the components

and programs required for operation. The vendor takes care
of installation and configurations so all the user has to do is
“turn the key” to begin using the system.
UB 92: See Uniform Billing form 92.
Unified Medical Language System (UMLS): An ongoing

National Library of Medicine project to expand and coordi-
nate medical databases into “knowledge sources” that can be
easily accessed by multiple platforms. The current UMLS proj-
ect offers lexicon and semantic databases and medical resource
lists, including Internet Grateful Med. Under most circum-
stances, the licensed use of UMLS products is free.
Uniform billing code: The procedural rules on patient billing,

including what information should appear on the bill and
how it should be coded.
Uniform Billing form 92 (UB 92): A current HCFA billing

form used to bill Medicare and third-party payors for reim-
bursement. Also called HCFA 1450.

Unique Physician Identifier Number (UPIN): A database sys-
tem created in 1985 that gave a unique ID number to each
physician who billed his or her services under Medicare.
HCFA plans to replace this system with the National Provider
Identifier system.
Universal serial bus (USB): A relatively recent external bus

with transfer rates up to 12 Mbps. Since up to 127 peripher-
als can be connected through one port, the USB is expected to
replace serial and parallel ports eventually. Compare FireWire.
Unix: An operating system that has evolved since the 1970s

into a standard for mainframes, work stations and other com-
puters. Developed by Bell Laboratories and written in C+ pro-
gramming language, Unix became the first open system
because of its versatile, non-proprietary characteristics. See
Linux.
UPIN: See Unique Physician Identifier Number.
URL: Short for uniform resource locator. Much like a postal

system, every page on the World Wide Web has a unique
address, or URL. To visit a Web site, the user simply types the
address into the browser program. The URL also reveals
whether the site originates from an educational (.edu), corpo-
rate (.com), governmental (.gov) or other source. Most
international sites add a two-character country code. See
bookmark.
USB: See universal serial bus.
Usenet: An international network of electronic newsgroups

accessible through the Internet.
User-based access control: A security access protocol that

verifies legitimate users of the system based solely on the user
name. Compare context-based access control and role-based
access control.

Utilization management: A review process used to make sure
a patient’s hospital stay, surgery, tests or other treatment is
necessary.
UUENCODE: An Internet transfer protocol for data exchange

between dissimilar platforms, such as Windows and Macintosh.
The sending system translates files into 7-bit ASCII which the
receiving system decodes into its own platform. See the more
recent MIME and S-MIME encoding.
Vacuum fluorescent (VF): An established flat-panel display

technology used mainly for medical device and point-of-sale
screens. Its blue-green characters are exceptionally bright, but
the limited pixel count makes a VF display better suited to
text than graphics.
Value-added network (VAN): An information exchange net-

work between a healthcare site and its business operations,
such as billing and supply offices. A VAN merely transmits
information and does not attempt to verify it. Compare
clearinghouse.
Value-added reseller (VAR): A business entity that collects

existing components from other companies and customizes
them for a particular use or vertical industry, usually through
integrated packaging, application software or services. Some
equate a VAR with an original equipment manufacturer.
Vector graphics: Artistic and line drawings created on a com-

puter and saved as a series of connected points. Most “draw-
ing” programs, such as Adobe Illustrator, create vector files,
which are designed to be easily manipulated and take up far
less storage space than files created in raster graphics.
Vertical portal: See vortal.

Video on demand (VoD): A system that allows access to video
images in a stored database, a type of file server for video. Cost
can be a barrier with VoD systems, as can the enormous
amounts of bandwidth such systems require to operate effi-
ciently.
Virtual private network (VPN): A popular type of extranet.

By using public pathways, such as the Internet, a VPN can be
a cheaper alternative to a privately wired network, yet it can
be configured for controlled access to outside individuals via
tunneling software. One drawback: Internet VPNs are suscep-
tible to delays during peak usage, so a quality of service guar-
antee becomes an important issue.
Virtual Reality Modeling Language (VRML): A language speci-

fication for creating three-dimensional graphics on Web sites.
Some browsers may require an additional plug-in, such as
QuickTime VR, to view VRML files.
Virus: A malicious or invasive program that copies itself to

other programs or files on a computer. Some viruses render a
computer inoperable, and some corrupt or delete data or appli-
cations. Most often hidden in file attachments that are down-
loaded by unsuspecting recipients, viruses can take action
immediately or lie in wait for a predefined day or event.
Antivirus software can identify known viruses and “clean”
infected files, but only if the virus library is kept current. Com-
pare Trojan horse and worm.
Visual integration software: Technology that links multiven-

dor, stand-alone software applications under one visual
process, allowing easier switching from one application to
another, often using a single log-on. Leading methods, such as
those developed by the CCOW, can allow physicians to
access radiology reports, clinical lab data and history charts
for a single patient without logging on to each information
system separately.

Voice eXtensible Markup Language (VXML or VoxML): An
open interface originally developed by Motorola that makes
Web sites compatible with voice over IP and speech recogni-
tion tools. Leading corporations are promoting VXML as an
open-platform standard capable of melding the telephony,
speech recognition and Internet communications markets.
Voice over IP (VoIP): A form of telephony that delivers vocal

transmissions via Internet protocol (IP). In most cases, spoken
data are coded digitally and sent in electronic packets, either
over the public Internet or through an intranet/extranet. Qual-
ity and speed of delivery can be enhanced by using real-time
protocols and/or a specialized Internet service provider. See
Internet telephony.
Voice recognition: See speech recognition.
Vortal: Also called a vertical portal. A Web site that collects

or creates content and business tools pertaining to a particu-
lar industry or niche. Often offers B2B connectivity through
the site.
VRML: See Virtual Reality Modeling Language.
VXML or VoxML: See Voice eXtensible Markup Language.
W3C: See World Wide Web Consortium.
WAIS: See wide area information server.
WAN: See wide area network.
WAP: See Wireless Application Protocol.

Wavelet compression: A compression format that uses an
algorithm to covert a large file, such as a medical image, to a
mathematical equivalent that can be decoded by the receiver.
Wavelet-compressed files, which end in .wif, consume far less
file space than the JPEG format and can be transmitted elec-
tronically much faster.
Web phone: See smart phone.
Web ring: A group of Web sites on related topics linked with

each other in a loop, allowing the user to take a circular
“tour” within a specific subject area.
Web site: A group of related files, including text, graphics

and hypertext links on the World Wide Web. Accessed by typ-
ing its unique address, a site usually includes layers of sup-
porting pages as well as a home page. See URL and browser.
Web-enabled: Software programs that can be used directly

through the World Wide Web, including financial and
human resources applications. Web enabling extends the
client/server concept to the largest server in the world—the
Internet.
WEDi: See Workgroup for Electronic Data Interchange.
Wide area information server (WAIS): A network search tool

for databases on the Internet. WAIS uses keyword queries to
locate resource lists and full text. Since Web browsers can
access much of the same information, WAIS is falling out of
use, but some specialized medical databases are not yet part
of the World Wide Web.
Wide area network (WAN): A network that links computers

over a distance, sometimes across hundreds of miles, using
digital technology or telephony. Compare local area network
and metropolitan area network.

Wideband network: A transmission medium with greater
bandwidth capacity than standard voice lines but less capacity
than broadband channels. Compare narrowband network.
Wireless Application Protocol (WAP): An emerging standard

to assist the combination of cellular/wireless devices and
Internet access. Platform-independent and supported by most
wireless networks, WAP is leading the way to interoperability
among vendors of smart phones, Internet-enabled pagers, and
handheld devices. See Wireless Markup Language.
Wireless Markup Language (WML): An extension of HTML

that presents Web-based text content in a format accessible by
handheld devices, such as smart phones and personal digital
assistants (PDAs). WML, formerly called Handheld Devices
Markup Language (HDML), is a key part of the Wireless
Application Protocol.
Workflow: A process description of how tasks are done, by

whom, in what order and how quickly. Workflow can be used
in the context of electronic systems or people—i.e., an elec-
tronic workflow system can help automate a physician’s per-
sonal workflow.
Workflow automation: The combination of software, tools

and services to automate knowledge-based tasks, on an ad
hoc or production-based level. Technologies commonly incor-
porated in workflow automation include document imaging
and management, knowledge management and groupware.
Workflow management: Streamlining informational processes

to improve efficiency and accuracy as records, reports and
transactions move from one employee or department to
another within an enterprise. Many workflow management
software systems offer sophisticated routing features to priori-
tize work tasks, allow tracking of progress status and provide
audit trails/reporting across departments.

Workgroup for Electronic Data Interchange (WEDi): A stan-
dards group (http://www.wedi.org) whose goal is to improve
healthcare through widespread adoption of e-commerce pro-
tocols, technologies and tools.
World Wide Web: An international group of databases within

the Internet that uses hypertext technology to access text, pic-
tures and other multimedia with a click of a mouse. Sites on
the Web usually are created in a form of HTML, Java or
both. A browser program is needed to access multimedia
aspects. See URL.
World Wide Web Consortium (W3C): An international organ-

ization that develops programming and interoperability stan-
dards for the Web. Among its many projects, W3C is involved
in initiatives for digital signatures, XML and DHTML.
Worm: An invasive computer program designed to copy itself

from one computer to another. Far more virulent than a virus,
worms do not need to be passed physically by users in order
to spread themselves. Compare virus and Trojan horse.
X Window System, X1: Originally developed at the Massa-

chusetts Institute of Technology, this open system uses graphi-
cal windowing technology that can be interpreted by a variety
of operating systems. Both Unix and Linux use versions of the
X Window System, and user interfaces such as GNOME and
KDE have been developed based on the system. Standards
development is now hosted by X.org, an international consor-
tium that also distributes X Window licenses and free updates
to the system. Not to be confused with Microsoft Win-
dows™, a proprietary windowing program.

X.509: A pervasive standard for digital certificates. The
X.509 format includes a serial number, an encryption algo-
rithm, the certificate holder’s name and public key, the name
of the certificate authority or other issuer, and an expiration
date. Although the standard is used as a base by Netscape
and Microsoft Web browsers and many digital certificate
companies, variations exist in the certificates themselves and
in the process of authenticating them. Efforts continue to
make all X.509-based certificates interoperable.
X12N: See ASC X12N.
XML: See eXtensible Markup Language (XML).
Zero latency: The utopia of real-time access, where all enter-

prise information and transactions are available to all depart-
ments (and ultimately, all business partners) without any time
lags. Although still a goal in many respects, its promise is pos-
sible thanks to developments in middleware, enterprisewide
application integration, fiber-optic networks and XML.
Zip, unzip: The act of compressing or decompressing a file by

using a software archiving program. A zipped file ends in .zip.
Z-modem: An error-detection standard for communication

between two modems. As blocks of data are sent, the receiv-
ing modem checks for errors and requests a resend if neces-
sary.

APPENDIX
Acronyms for Healthcare Information Technology
Associations and Organizations
AAHAM: American Association of Healthcare Administrative
Management
http://www.agpam.org
AAHP: American Association of Health Plans

http://www.aahp.org
AAIHDS: American Association of Integrated Healthcare

Delivery Systems
http://www.aaihds.org
AAMA: American Academy of Medical Administrators

http://www.aameda.org
AAMCN: American Association of Managed Care Nurses

http://www.aamcn.org
ACHE: American College of Healthcare Executives

http://www.ache.org
ACMCM: American College of Managed Care Medicine

http://www.acmcm.org
ACPE: American College of Physician Executives

http://www.acpe.org
ADA: American Dental Association

http://www.ada.org
AHA: American Hospital Association

http://www.aha.org
AHIMA: American Health Information Management Association

http://www.ahima.org
Copyright © 2001 The McGraw-Hill Companies, Inc.

AHRA: American Healthcare Radiology Administrators
http://www.ahraonline.org
AHRQ: Agency for Healthcare Research and Quality (formerly

the Agency for Health Care Policy and Research)
http://www.ahrq.gov
AMA: American Medical Association

http://www.ama-assn.org
AMDIS: Association of Medical Directors of Information Sys-

tems
http://www.amdis.org
AMIA: American Medical Informatics Association

http://www.amia.org
AMIP: Alliance of Medical Internet Professionals

http://www.amip.org
ANA: American Nurses Association

http://www.ana.org
ANIA: American Nursing Informatics Association

http://www.ania.org
APAMI: Asia Pacific Association for Medical Informatics

http://www.apami.org
ASAP: American Society for Automation in Pharmacy

http://www.asapnet.org
ASFP: American Society of Family Practice
ASHP: American Society of Health-System Pharmacists

http://www.ashp.org
ASHRM: American Society for Healthcare Risk Management

http://www.ashrm.org

ASTM: American Society for Testing and Materials
http://www.astm.org
ATA: American Telemedicine Association

http://www.atmeda.org
ATSP: Association of Telehealth Service Providers

http://www.atsp.org
CARS: Computer Assisted Radiology Society
CCQE: Center for Clinical Quality Evaluation
CHIM: Center for Healthcare Information Management

http://www.chim.org
CHIME: College of Healthcare Information Management

Executives
http://www.cio-chime.org
CHITA: Community Health Information Technology Alliance

http://www.chita.org
CLMA: Clinical Laboratory Management Association

http://www.clma.org
CPRI-HOST: Computer-based Patient Record Institute and

Healthcare Open Systems & Trials
http://www.cpri.org
DMAA: Disease Management Association of America

http://www.dmaa.org
ECRI: Formerly Emergency Care Research Institute; since

broadening its focus, now goes by the acronym alone
http://www.ecri.org

EPIC: Electronic Privacy Information Center
http://www.epic.org
FAHS: Federation of American Hospitals

http://www.americashospitals.com
FHCQ: Foundation for Health Care Quality

http://www.qualityhealth.org
HCCA: Health Care Compliance Association

http://www.hcca-info.org
HEDIC: Healthcare EDI Coalition

http://www.hedic.org
HFMA: Healthcare Financial Management Association

http://www.hfma.org
HIAA: Health Insurance Association of America

http://www.hiaa.org
HIBCC: Healthcare Industry Business Communications Coun-

cil
http://www.hibcc.org
HIMSS: Healthcare Information and Management Systems

Society
http://www.himss.org
HISA: Health Informatics Society of Australia

http://www.hisavic.aus.net
HON: Health On the Net Foundation

http://www.hon.ch
HPP: Health Privacy Project

http://www.healthprivacy.org

HTAIS: Health Technology Assessment Information Service of
ECRI
http://www.ecri.org
IAHSS: International Association for Healthcare Security and

Safety
http://www.iahss.org
IAPAC: International Association of Physicians in AIDS Care

http://www.iapac.org
IHI: Institute for Healthcare Improvement

http://www.ihi.org
IHPS: Institute for Health Policy Solutions

http://www.ihps.org
IMIA: International Medical Informatics Association

http://www.imia.org
ISMP: Institute for Safe Medication Practices

http://www.ismp.org
JHITA: Joint Healthcare Information Technology Alliance

http://www.jhita.org
MCO: Managed Care Organization
MGMA: Medical Group Management Association

http://www.mgma.com
MoHCA: Mobile Healthcare Alliance

http://www.mohca.org
MRI: Medical Records Institute

http://www.medrecinst.com
MS-HUG: Microsoft Healthcare Users Group

http://www.mshug.org

MUSE: Medical Users Software Exchange
http://www.museweb.org
NAHDO: National Association of Health Data Organizations

http://www.nahdo.org
NAHQ: National Association for Healthcare Quality

http://www.nahq.org
NAMCP: National Association of Managed Care Physicians

http://www.namcp.com
National CPR: National Coalition for Patient Rights

http://www.nationalcpr.org
NCHC: National Coalition on Health Care

http://www.nchc.org
NCHICA: North Carolina Healthcare Information and Com-

munications Alliance
http://www.nchica.org
NDEDIC: National Dental EDI Council

http://www.ndedic.org
NHCAA: National Health Care Anti-Fraud Association

http://www.nhcaa.org
NMHCC: National Managed Health Care Congress

http://www.nmhcc.org
NPSF: National Patient Safety Foundation

http://www.npsf.org
NUCC: National Uniform Claim Committee

http://www.nucc.org
PCRM: Physicians Committee for Responsible Medicine

http://www.pcrm.org

PSI: Psychiatric Society for Informatics
http://www.psychinformatics.org
RSNA: Radiologic Society of North America

http://www.rsna.org
SHS: Society for Health Systems

http://www.iienet.org/shs/index.htm
SPM: Society of Prospective Medicine

http://www.spm.org
TIPAAA: IPA Association of America

http://www.tipaaa.org
URAC: American Accreditation HealthCare Commission

http://www.urac.org
WHO: World Health Organization

http://www.who.int
WIMC: Women in Managed Care

http://www.wimc.org
WLANA: Wireless LAN Association

http://www.wlana.org

Healthcare Informatics - The Latest Word 2001 A Glossary of Healthcare Technology Terms (2001)

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Healthcare Informatics - The Latest Word 2001 A Glossary of Healthcare Technology Terms (2001)

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From the Publishers of Healthcare Informatics

Health Care Financing Administration (HCFA): The

McGraw-Hill eBooks are available at special quantity discounts to use as

DOI (eBook only): 10.1036/026046045001311

Copyright © 2001 Healthcare Informatics

Welcome to “The Latest Word 2001: A Glossary of Health-

Copyright © 2001 Healthcare Informatics

AAPCC: Adjusted average per capita cost. The amount of

Access control: Procedures, policies and safeguards to keep

Accredited Standards Committee (ASC) X12: Established in

Copyright © 2001 Healthcare Informatics

ActiveX: An object-oriented programming language devel-

Administrative security safeguards: Policies, procedures and

Administrative Simplification: Section 262 of the HIPAA law. In

Admission-discharge-transfer system (ADT): A software sys-

ADT: See admission-discharge-transfer system.

Copyright © 2001 Healthcare Informatics

Advanced Mobile Phone Service (AMPS): An 800-MHz ana-

AFEHCT: See Association for Electronic Health Care Transac-

AI: See artificial intelligence.

Alpha site: An initial test site for a prototype system or prod-

Ambulatory care: Services for patients who do not need to

Ambulatory patient group (APG): Originally developed by

Copyright © 2001 Healthcare Informatics

American National Standards Institute (ANSI): The many

American Standard Code for Information Interchange

Analog transmission: A method of information transfer that

Ancillary services: Tests, procedures, imaging and support

ANSI: See American National Standards Institute.

Copyright © 2001 Healthcare Informatics

APC: See ambulatory payment classification.

APG: See ambulatory patient group.

API: See application program interface.

Applet: See Java.

Application program interface (API): A set of premade func-

Application server: Unlike a general file server, this server is

Application service provider (ASP): An entity that allows

Copyright © 2001 Healthcare Informatics

Artificial intelligence (AI): Both a system and a concept, this

ASC X12N: Electronic data exchange standards developed by

ASCII: See American Standard Code for Information Inter-

ASP: See application service provider.

Association for Electronic Health Care Transactions

Asymmetric key, asymmetric cipher: An encryption key used

Asynchronous transfer mode (ATM): A telecommunications

ATM: See asynchronous transfer mode.

Copyright © 2001 Healthcare Informatics

Audit trail: A software tracking system used for data security.

Authentication: A confirmation of a user’s identity, generally

Authorization: A confirmation of a user’s access levels within

B2B: Business-to-business. Electronic commerce or services

B2C: Business-to-consumer. Electronic commerce or services

Backbone network: The electronic spine that joins multiple

Copyright © 2001 Healthcare Informatics

Bandwidth: A measurement describing how much informa-

Baseband transmission: Unmodulated signals sent on a sin-

Batch: A non-interactive, one-way transmission of data used

Baud rate: An older term measuring bandwidth usage, now

Bayesian network: A form of artificial intelligence (named for

BBS: See bulletin board service.

Copyright © 2001 Healthcare Informatics

Benchmarking: A performance measurement test, either with-

Beta site: A place where a new product can be tested by peo-