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Agency for Healthcare Research and Quality — AHRQ
AHRQ's mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. The agency has focused its health IT activities on the following three goals: (1) to improve health care decision-making; (2) to support patient-centered care; and (3) to improve the quality and safety of medication management. To address the mission, AHRQ has invested over $300 million in contracts and grants to over 200 communities, hospitals, providers, and health care systems in 48 States to promote access to and encourage the adoption of health IT.
Alert fatigue
A commonly observed condition among physicians overwhelmed with large numbers of clinically insignificant alerts, thus causing them to "tune out" and potentially miss an important drug-drug or drug allergy alert.
Adverse drug event — ADE
An injury resulting from the use of a drug.


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Cause and effect diagram
A tool that can be used to graphically classify all potential root causes.
Clinical decision support — CDS
Computer tools or applications to assist physicians in clinical decisions by providing evidence-based knowledge in the context of patient-specific data. Typically a decision support system responds to "triggers" or "flags" — specific diagnoses, laboratory results, medication choices, or complex combinations of such parameters — and provides information or recommendations directly relevant to a specific patient encounter.
Computerized physician order entry — CPOE
A computer application that allows a physician’s orders for diagnostic and treatment services (such as medications, laboratory, and other tests) to be entered electronically, instead of being recorded on order sheets or prescription pads. The computer compares the order against standards for dosing, checks for allergies or interactions with other medications, and warns the physician about potential problems.


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Early adopter
An organization or individual who embraces new technology or administrative practices before others typically do.
Electronic health record — EHR
A real-time patient health record with access to evidence-based decision-support tools that can be used to aid clinicians in decision making. The EHR can automate and streamline a clinician's workflow, ensuring that all clinical information is communicated. It can also prevent delays in response that result in gaps in care. The EHR can also support the collection of data for uses other than clinical care, such as billing, quality management, outcome reporting, and public health disease surveillance and reporting. EHR is sometimes used interchangeably with EMR (electronic medical record).
E-prescribe — electronic prescribing — eRX
A type of computer technology whereby physicians use handheld or personal computer devices to review drug and formulary coverage and to transmit prescriptions to a printer or to a local pharmacy. E-prescribing software can be integrated into existing clinical information systems to allow physician access to patient-specific information to screen for drug interactions and allergies.


Failure modes and effects analysis — FMEA
A widely-used risk assessment technique for identifying, prioritizing and fixing potential system failures before an adverse event actually occurs. Because FMEA is prospective — rather than retrospective — it focuses on systems rather than events. A common process used to prospectively identify error risk within a particular process.
A set of capabilities associated with computer hardware, software or other electronic devices.


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Health information technology — HIT
The application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making. Applications of health IT include the electronic health record (EHR), the personal health record (PHR), computerized physician order entry (CPOE), and clinical decision support (CDS). In addition, health information exchanges (HIEs) are being developed to support sharing of information electronically among health care providers.
The Health Information Technology for Economic and Clinical Health Act, signed into law on February 17, 2009, as a part of the American Recovery and Reinvestment Act (ARRA), amended the Public Health Service Act to codify the Office of the National Coordinator for Health Information Technology (ONC), required the national coordinator to establish a governance mechanism for a nationwide health information network (NIHN), and required the national coordinator to establish a voluntary program to certify health IT. Through HITECH, Congress also amended the Social Security Act to pay incentive payments to hospitals and physicians to promote adoption and use of certified health IT technologies. It also reduces payments for those who are not meaningful EHR users, beginning in 2015.


Hardware or software that facilitates interaction between disparate components of a system.
Issues log
A tool for collecting information about problems related to EHR implementation that is useful in identifying emergent unintended consequences and in supporting corrective action.
Interactive socio-technical analysis — ISTA
A framework developed for understanding interactions among technology, physical behavior, and the work environment that lead to unintended consequences


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Legacy IT
An existing health IT application or system that is in place when new IT is installed and may represent a significant prior investment. Compatibility with legacy IT is a major issue when considering acquisition of new applications or software.


Meaningful use
Requirements for obtaining certification and incentives for EHR usage, specified by the Department of Health and Human Services under the HITECH Act of 2009. See information provided by CMS about the Federal EHR incentive program.
Medicare and Medicaid EHR incentive programs
As a part of the HITECH Act of 2009, Congress created programs within Medicare and Medicaid to pay incentive payments to hospitals and physicians to promote adoption and use of certified health IT. Beginning in 2015, this program reduces payments for those who are not meaningful EHR users.
Multiple causation
When a combination (or alternative combinations) of causes are responsible for an outcome.


Near miss
An event or situation that did not produce patient injury, but only because of chance. This good fortune might reflect robustness of the patient (e.g., a patient with penicillin allergy receives penicillin, but has no reaction) or a fortuitous, timely intervention (e.g., a nurse happens to realize that a physician wrote an order in the wrong chart).


Office of the National Coordinator for Health Information Technology — ONC
The principal Federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. The position of National Coordinator was created in 2004, through an Executive Order, and legislatively mandated in the HITECH Act of 2009.


Process mapping
A technique for making a graphic representation of work. It shows decisions, event sequences, and wait times or delays. A process map shows who is doing what, with whom, when, and for how long.


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Readiness assessment
A tool designed to help organizations assess whether they are ready to undertake organization-wide practice or culture changes.
Regional Extension Center — REC
The Office of the National Coordinator for Health Information Technology (ONC), under the HITECH Act, has funded regional extension centers to provide technical assistance, guidance, and information on best practices to support and accelerate health care providers' efforts to become meaningful users of electronic health records (EHRs). The regional centers will support at least 100,000 primary care providers, through participating non-profit organizations, in achieving meaningful use of EHRs and enabling nationwide health information exchange.
Remediation plan
Plan for addressing a specific unintended consequence of EHR implementation.
Root cause analysis — RCA
A structured method used to analyze serious adverse events. The goal of RCA is to identify both active errors (errors occurring at the point of interface between humans and a complex system) and latent errors (the hidden problems within health care systems that contribute to adverse events).


System error
An error attributable to a combination of causes rather than to a single point of failure or a single individual.


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Unintended consequence
Unanticipated and unwanted effect of health IT implementation.
Usage metric
Measure for tracking the frequency and manner in which an EHR is used.
User interface
The display of computer information and the processes required to view and input information. How users must interact with the computer program.


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An informal practice or temporary fix used by frontline heath care workers to deal with a perceived block or disruption to the normal work flow (for example, when personnel find ways of bypassing safety features of medical equipment).
Workflow analysis/workflow assessment
A process used to systematically analyze and evaluate how work tasks are accomplished.


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