Accountable Care Organization (ACO): A healthcare organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. (Wikipedia)
Analog: A continuous signal where the time varying variable is represented by another time varying quantity. It differs from a digital signal where a continuous quantity is represented by a discrete function that only takes on one of a finite number of values.
Application Service Provider (ASP): An ASP hosts a variety of applications on a central server. For a fee, customers can access the applications over secure Internet connections or a private network. This means that they do not need to purchase, install or maintain the software themselves; instead they rent the applications they need from the ASP. New releases, such as software upgrades, are generally included in the price.
Asynchronous: Term describing store and forward transmission of medical images and/or data because the data transfer takes place over a period of time, and typically in separate time frames. The transmission typically does not take place simultaneously. This is the opposite of synchronous (see below).
Asynchronous Transfer Mode (ATM): A telecommunications standard to support voice, video and data communications. The mode uses asynchronous time-division multiplexing and encodes data into small, fixed-sized cells rather than packets or frames.
Authentication: A method of verifying the identity of a person sending or receiving information using passwords, keys and other automated identifiers.
Bandwidth: A measure of the information carrying capacity of a communications channel; a practical limit to the size, cost, and capability of a telemedicine service.
Basic Rate Interface: An ISDN (see below) configuration that provides two bearer (B) channels at 64 kilobits/second (kbit/s) each and one data (D) channel at 16 kbit/s. B channels are for voice data and D channels for any combination of data, control/signaling, and X.25 packet networking. B channels can be aggregated to provide128 kbit/s.
Bits Per Second (bps): Number of electronic data bits conveyed or processed per unit of time.
Bluetooth Wireless: An industrial specification for wireless personal area networks (PANs) that provides the means to connect and exchange information between devices such as mobile phones, laptops, PCs, printers, digital cameras and video game consoles over a secure, globally unlicensed short-range radio frequency. The specifications are developed and licensed by the Bluetooth Special Interest Group (http://www.bluetooth.com/Pages/about-bluetooth-sig.aspx).
Bridge: Device for linking multiple videoconferencing sites in a single videoconference session. It is also often referred to as a multipoint control unit (MCU).
Broadband: Communications (e.g., broadcast television, microwave, and satellite) capable of carrying a wide range of frequencies; refers to transmission of signals in a frequency-modulated fashion over a segment of the total bandwidth available, thereby permitting simultaneous transmission of several messages.
Cascading: Means to accommodate more videoconference participants than using one MCU by joining another MCU into a session hosted by the primary MCU.
Certification Commission for Health Information Technology (CCHIT): Founded in 2004 with the public mission of accelerating the adoption of health IT, it certifies electronic health records (EHRs) using comprehensive, practical definitions of what capabilities were needed in these systems. (http://www.cchit.org/)
Circuit Switched Network: A federal agency within the United States Department of Health and Human Services (DHHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the State Children’s Health Insurance Program (SCHIP), and Health Insurance Portability and Accountability Act (HIPAA) standards. (Wikipedia)
Class of Service (CoS): A digital-interface device for connecting Data Terminal Equipment devices (DTE) (e.g., router) to a digital circuit (e.g., T1 line). CSU connects to the network and the DSU handles the DTE interface.
Clinical Decision Support System (CCDS): A method for implementing a telecommunications network where two nodes have a dedicated communications channel through the network for communication, guaranteeing full bandwidth for the session.
Clinical Information System: Used in data and voice protocols to differentiate payloads in the transmitted packets to help assign priorities to the data payload.
Cloud computing: Systems (usually electronically based and interactive) that provide clinicians, staff, patients, and other individuals with knowledge and person-specific information, intelligently filtered and presented at appropriate times, to enhance health and health care. (http://healthit.ahrq.gov/images/jun09cdsreview/09_0069_ef.html)
CODEC: Hospital-based information system designed to collect and organize data relating exclusively to information regarding the care of a patient rather than administrative data. .=
Compressed video: The use of computing resources (hardware and software) that are delivered as a service over a network (typically the Internet). The name comes from the use of a cloud-shaped symbol as an abstraction for the complex infrastructure it contains in system diagrams. Cloud computing entrusts remote services with a user’s data, software and computation. (Wikipedia)
Data Compression: Acronym for coder-decoder. This is the videoconferencing device that converts analog video and audio signals to digital video and audio code and vice versa. CODECs typically compress the digital code to conserve bandwidth on a telecommunications path.
Digital: Video images that have been encoded using fewer bits of information than the original dataset (either lossless or lossy) to reduce the amount of bandwidth needed to capture the necessary information so that the information can be sent over a network.
Digital Camera (still images): An electronic form of individual patient information designed to provide access to complete and accurate patient data.
Digital Imaging and Communication in Medicine (DICOM): A method to reduce the volume of data using encoding that results in the data having fewer bits of information than the original dataset (either lossless or lossy) to reduce image processing, transmission times, bandwidth requirements, and storage requirements. Some compression techniques result in the loss of some information while others do not, which may or may not be clinically important.
Digital Signature: A piece of hardware or device not part of the central computer (e.g., digitizers, stethoscope, or camera) that can provide medical data input to or accept output from the computer.
Digital Subscriber Line (DSL): Data technology using discrete values as opposed to continuous or analog signals.
Disease Management: A camera that stores images digitally rather than recording them on film allowing data to be downloaded to a computer system, manipulated with a graphics program and printed or transmitted electronically. It is typically used to take still images of a patient for dermatology, ophthalmology, and wound care.
Distance Learning: The international standard for medical images and related information (ISO 12052). DICOM consists of a set of protocols describing how images are identified, formatted, transmitted and displayed that is vendor-independent. It was developed by the American College of Radiology and the National Electronic Manufacturers Association (http://medical.nema.org/).
Distant Site: A series of standard digital transmission rates or levels based on DS0, a transmission rate of 64 Kbps (i.e., bandwidth normally used for one telephone voice channel).
Document Camera: Mathematical scheme for authenticating digital messages or documents. Valid signatures give the recipient evidence that the message was created by a known sender and not altered in transit.
eHealth: Technologies providing internet access by transmitting digital data over local telephone networks. The data bit rate typically is 256 kbit/s to 40 Mbit/s in the direction to the customer (downstream) depending on technology, line conditions, and service-level implementation.
Electronic Data Interchange (EDI): A continuous coordinated health care process that seeks to manage and improve the health status of a carefully defined patient population over the entire course of a disease (e.g., Congestive Heart Failure, Diabetes Mellitus) The patient populations targeted are high-risk, high-cost patients with chronic conditions that depend on appropriate care for proper maintenance.
Electronic Health Record (EHR): The incorporation of video and audio technologies, allowing students to “attend” classes and training sessions that are being presented at a remote location. Distance learning systems are usually interactive and are a tool in the delivery of training and education to widely dispersed students, or in instances in which the instructor cannot travel to the student’s site.
Electronic Medical Record (EMR): Site at which the physician or other licensed practitioner delivering the service is located at the time the service is provided via telecommunications system. (http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Telemedicine.html) Other common names for this term include hub site, specialty site, provider/physician site and referral site. The site may also be referred to as the consulting site.
Electronic Patient Record (EPR): Visual presenters, visualizers, digital overheads, or docucams, are real-time image capture devices for displaying an object to a large audience. Like an opaque projector it is able to magnify and project images of three-dimensional objects as well as transparencies. It can display written or typed information (e.g., lab results), photographs, graphics (e.g., ECG strips) and in some cases x-rays.
Encryption: The use of electronic information and communication technology to provide and support comprehensive pharmacy services when distance separates the participants.
Firewall: Healthcare practice supported by electronic processes and communication.
Frame Rate: The sending and receiving of data directly between trading partners without paper or human intervention.
Full Common Intermediate Format (FCIF or CIF): A systematic collection of electronic health information about individual patients or populations that is recorded in digital format and capable of being shared across health care settings via network-connected enterprise-wide information systems and other information networks or exchanges. EHRs generally include patient demographics, medical history, medication, allergies, immunization status, laboratory test results, radiology and other medical images, vital signs, characteristics such as age and weight, and billing information.
Guideline: A computerized medical record generated in an organization that delivers health care, such as a hospital or physician’s office. EMRs are often part of a local stand-alone health information system that allow storage, retrieval and modification of records.
Gatekeeper: An electronic form of individual patient information that is designed to provide access to complete and accurate patient data, alerts, reminders, clinical decision support systems, links to medical knowledge, and other aids.
Gateway: A system of encoding electronic data where the information can only be retrieved and decoded by the person or computer system authorized to access it.
Graphics Interchange Format (GIF): The electronic generation, transmission and filling of a medical prescription, as opposed to traditional paper and faxed prescriptions. E-prescribing allows for qualified healthcare personnel to transmit a new prescription or renewal authorization to a community or mail-order pharmacy.
Health Information Exchange (HIE): Computer hardware and software that block unauthorized communications between an institution’s computer network and external networks.
HIPAA: Frequency (rate) at which imaging devices produces individual consecutive images or frames. It is most often expressed in frames per second (FPS) or with progressive scan monitors as hertz (Hz).
Home Health Care and Remote Monitoring Systems: Format first proposed in the H.261 standard used to standardize horizontal and vertical resolutions in pixels of YCbCr (color) sequences in video signals and.
Hub Site: A standard video signal that allows video to be shown at the distant end in smooth, uninterrupted images.
Informatics: A statement of policy or procedures to determine a course of action, or give guidance for setting standards (http://jtt.rsmjournals.com/content/8/2/63.abstract).
Integrated Services Digital Network (ISDN): Device for managing videoconferencing traffic typically in an IP-based (H.323) network that eliminates bottlenecks and simplifies addressing of videoconferencing endpoints.
Internet Protocol (IP): Device providing protocol translation between H.320 (ISDN) and H.323 (IP) networking environments that allows endpoints using ISDN to interconnect with those over IP.
Interoperability: Bitmap image format supporting up to 8 bits per pixel and allowing a single image to reference a palette of up to 256 colors.
ISDN Basic Rate Interface (BRI): the mobilization of healthcare information electronically across organizations within a region, community or hospital system. (Wikipedia)
ISDN Primary Rate Interface (PRI): Communication standard that guides the transmission of health-related information. HL7 allows the integration of various applications, such as bedside terminals, radiological imaging stations, hospital census, order entries, and patient accounting, into one system.
JCAHO: A video of higher resolution than what is standard. There is no specific definition or criterion for HD but video images with more than 480 horizontal lines (North America) or 570 lines (Europe) is HD. 720 scan lines is generally the minimum. Standard resolution images acquired at rates faster than normal (60 fps North America, 50 fps Europe) by a high-speed camera are often regarded as high-definition as are non-interlaced or progressive scan video.
JPEG (Joint Photographic Experts Group): Acronym for Health Information Portability and Accountability Act. The HIPAA Privacy Rule protects the privacy of individually identifiable health information, the HIPAA Security Rule sets national standards for the security of electronic protected health information, and the confidentiality provisions of the Patient Safety Rule protect identifiable information being used to analyze patient safety events and improve patient safety. (http://www.hhs.gov/ocr/privacy/index.html)
Kiosk: Care provided to individuals and families in their place of residence for promoting, maintaining, or restoring health or for minimizing the effects of disability and illness, including terminal illness. In the Medicare Current Beneficiary Survey and Medicare claims and enrollment data, home health care refers to home visits by professionals including nurses, physicians, social workers, therapists, and home health aides. Use of remote monitoring and interactive devices allows the patient to send in vital signs on a regular basis to a provider without the need for travel.
Latency: Location from which specialty or consultative services originate.
Licensure: The use of computer science and information technologies for the management and processing of data, information and knowledge. The field encompasses human-computer interaction, information science, information technology, algorithms, areas of mathematics, and social sciences.
Local Area Network (LAN): A common dial-up transmission path for videoconferencing. Since ISDN services are used on demand by dialing another ISDN based device, per minute charges accumulate at some contracted rate and then are billed to the site placing the call. It is analogous to using the dialing features associated with a long distance telephone call. The initiator of the call pays the bill. ISDN permits connections up to 128Kbps.
Lossless: Video conferencing technologies that allow for two-way, synchronous, interactive video and audio signals for the purpose of delivering telehealth, telemedicine or distant education services. It is often referred to by the acronyms ITV, IATV or VTC (video teleconference).
Lossy: Protocol by which data is sent from one computer to another over the Internet. Each computer has at least one address that uniquely identifies it from all other computers on the Internet. IP is a connectionless protocol, which means that there is no established connection between the end points that are communicating. The IP address of a videoconferencing system is its phone number.
Meaningful use: The ability of two or more systems (computers, communication devices, networks, software, and other information technology components) to interact with one another and exchange data according to a prescribed method in order to achieve predictable results (ISO ITC-215). There are three types of interoperability: human/operational, clinical, and technical.
Medical Codes: Interface that provides 128k of bandwidth for videoconferencing or simultaneous voice and data services. Multiple BRI lines can be linked together using a multiplexer to achieve higher bandwidth levels; for example, one can combine 3 BRI lines to provide 384k of bandwidth. BRI services are not available in some rural locations.
Megapixel (MP or Mpx): Interface standard that operates using 23, 64k channels and one 64k data channel. With the proper multiplexing equipment the ISDN PRI channels can be selected by the user for a video call; for example, for a videoconference at 384k of bandwidth the multiplexer can be set up to use channels 1 through 6 (6 x 64k = 384k). The fewer channels used to obtain a quality video signal, the less expensive the call.
Mobile Telehealth: Acronym for Joint Commission on Accreditation of Healthcare Organizations, an independent, not-for-profit organization that accredits and certifies health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards. (http://www.jointcommission.org/)
MPEG: Method of lossy compression for digital imaging. The degree of compression can be adjusted allowing for tradeoffs between storage size and image quality. JPEG typically achieves 10:1 compression with little perceptible loss in image quality.
Multiplexer (MUX): Specifically designed computer system for accessing specific programs or search sites that is typically part of a structure designed to prevent theft or tampering and withstand unattended public use and promote privacy and security during use.
Multiple Label Switching (MPLS): The perceptible delay between transmission and receipt of data across a connection, generally due to high network activity or a poor/slow connection.
National Health Information Infrastructure (NHII): a restricted practice requiring a license, which gives a “permission to practice.” Such licenses are usually issued in order to regulate some activity that is deemed to be dangerous or a threat to the person or the public or which involves a high level of specialized skill. (Wikipedia)
Network Integrators: Computer network within an organization, supporting devices, linking computers, printers, servers, etc. and supporting audio, video, and data exchange. It generally operates at 10, 100, or 1,000 Mbps.
Noise Cancellation: A form of data compression, typically of an order of less than 10:1, in which none of the original data information is lost when the image is reproduced.
Originating Site: A form of data compression using relatively high ratios that results in permanent loss of information upon reconstruction.
Packet Switched Network (PSN): Practice of medicine and public health supported by mobile communication devices, such as mobile phones, tablet computers and PDAs for health services and information.
Patient Exam Camera (video): the set of standards defined by the Centers for Medicare & Medicaid Services (CMS) Incentive Programs that governs the use of electronic health records and allows eligible providers and hospitals to earn incentive payments by meeting specific criteria. (healthit.gov)
Patient Protection and Affordable Care Act (PPACA): A process of describing medical diagnoses and procedures using specific universal medical code numbers. States may select from a variety of HCPCS codes (T1014 and Q3014), CPT codes and modifiers (GT, U1-UD) in order to identify, track and reimburse for telemedicine services. (http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Telemedicine.html)
Peripheral Devices: A centralized office that answers incoming telephone calls from patients, but may also respond to letters, faxes, e-mails and similar written correspondence. Usually staffed by nurses, call centers provide basic health information and instructions to callers but do not provide an official diagnosis of conditions or prescribe medicine. Call centers act as an initial triage point for patients.
Personal Health Record (PHR): One million pixels, referring to the number of pixels in an image, image sensor elements of digital cameras or the number of display elements of digital displays
Picture Archiving and Communications System (PACS): The provision of health care services with the assistance of a van, trailer, or other mobile unit in which the health care provider might provide patient services at a distance from a normal medical facility. Services may also be provided through mobile technologies attached to an existing health care facility.
Pixel (picture element): Family of standards used for coding audio-visual information (e.g., movies, video, music) in a digital compressed format producing files that are much smaller for the same quality.
Portable Network Graphics (PNG): A device that combines multiple inputs (ISDN PRI channels or ISDN BRI lines) into an aggregate signal to be transported via a single transmission path.
POTS: A device that can link multiple videoconferencing sites into a single videoconference. An MCU is also often referred to as a “bridge.”
Presenter (Patient Presenter): Interactive electronic communication between multiple users at two or more sites which facilitates voice, video, and/or data transmission systems: audio, graphics, computer and video systems. Multi-point teleconferencing requires a MCU or bridging device to link multiple sites into a single videoconference.
Protected Health Information (PHI): Method in high-performance telecommunications networks that directs data from one network node to next based on short path labels rather than network addresses. MPLS supports T1/E1, ATM, Frame Relay, and DSL.
Remote Monitoring: Initiative to improve effectiveness, efficiency and overall quality of health and health care in the US. (http://aspe.hhs.gov/sp/nhii/FAQ.html)
RHIO: Organizations specializing in the development of software and related services that allow devices and systems to share data and communicate to one another.
Router: Method for reducing unwanted sound during videoconferencing or other electronic audio transmission.
Rural Health Care Division (RHCD): Location of the Medicaid patient at the time the service being furnished via a telecommunications system occurs. Telepresenters may be needed to facilitate the delivery of this service. (http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Telemedicine.html). Other common names for this term include spoke site, patient site, remote site, and rural site.
Session Initiation Protocol (SIP): Digital communications network that groups transmitted data, irrespective of content, type, or structure, into suitably sized blocks, called packets. Packets are transmitted over a shared network that routes packets independently and allocates transmission resources as needed.
Spoke Site: Digital or analog camera used to examine patients during a real-time teleconsult or acquire images for a store-forward teleconsult. Types of cameras include those embedded with set-top videoconferencing units, handheld video cameras, gooseneck cameras, camcorders, etc.
Standard: United States federal statute signed into law by President Barack Obama on March 23, 2010, commonly called Obamacare (or the federal health care law).. Together with the Health Care and Education Reconciliation Act, it represents the most significant regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965. (Wikipedia)
Switch: Any device attached externally to a computer (e.g., scanners, mouse pointers, printers, keyboards, and clinical monitors such as pulse oximeters, weight scales).
Synchronous: Health record maintained by the patient to provide a complete and accurate summary of an individual’s medical history accessible online.
Systemized Nomenclature for Medicine: Combination of hardware and software dedicated to short and long term storage, retrieval, management, distribution and presentation of digital medical images.
Tagged Image File Format (TIFF): Feature of videoconferencing devices where one channel is displayed on the full screen at the same time as one or more other channels are displayed in inset windows. Sound is usually from the main program only.
Telecommunications Providers (Telco): Smallest addressable element in a display device.
Teleconferencing: Bitmapped image format employing lossless data compression (designed to replace GIF).
Teleconsultation: Acronym for Plain Old Telephone Service.
Telehealth and Telemedicine: An individual with a clinical background (e.g., LPN, RN, etc) trained in the use of telehealth equipment who must be available at the originating site to “present” the patient, manage the cameras and perform any “hands-on” activities to complete the tele-exam successfully. In certain cases, a licensed practitioner such as an RN or LPN might not be necessary, and a non-licensed provider such as support staff, could provide tele-presenting functions. Requirements (legal) for presenter qualifications differ by location and should be followed.
TeleICU: Part of the HIPAA Privacy Rule that protects all “individually identifiable health information” held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. The Privacy Rule calls this information “protected health information (PHI).” Individually identifiable health information” is information, including demographic data, that relates to the individual’s past, present or future physical or mental health or condition, the provision of health care to the individual, or the past, present, or future payment for the provision of health care to the individual, and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual. Individually identifiable health information includes many common identifiers (e.g., name, address, birth date, Social Security Number).The Privacy Rule excludes from protected health information employment records that a covered entity maintains in its capacity as an employer and education and certain other records subject to, or defined in, the Family Educational Rights and Privacy Act, 20 U.S.C. §1232g.
Telematics: Type of ambulatory healthcare where patients use mobile medical devices to perform a routine test and send the test data to a healthcare professional in real-time. Remote monitoring includes devices such as glucose meters for patients with diabetes and heart or blood pressure monitors for patients receiving cardiac care.
Telementoring: The terms Regional Health Information Organization (RHIO) and Health Information Exchange (HIE) are often used interchangeably. RHIO is a group of organizations with a business stake in improving the quality, safety, and efficiency of healthcare delivery. RHIOs are the building blocks of the proposed National Health Information Network (NHIN) initiative at the Office of the National Coordinator for Health Information Technology (ONCHIT).
Telemetry: device that provides an interface between two or more networks or connects sub-networks within a single organization. The router directs network traffic between multiple locations and it can find the best route between sites. For example, PCs or H.323 videoconferencing devices tell the routers where the destination device is located and the routers find the best way to get the information to that distant point.
Telemonitoring: Component of the Universal Service Administrative Company (USAC) that manages a support mechanism to provide reduced rates to rural healthcare providers for telecommunications and Internet services necessary for the provision of healthcare.
Telepresence: An IETF-defined (Internet Engineering Task Force) signaling protocol used for controlling voice and video communication sessions such as calls over Internet Protocol (IP). It can be used for creating, modifying and terminating two-party (unicast) or multiparty (multicast) sessions. The sessions can consist of one or several media streams. Other common applications include video conferencing, streaming multimedia distribution, instant messaging, presence information, and file transfer. It is an Application Layer protocol designed to be independent of the Transport Layer. It can run on Transmission Control Protocol (TCP), User Datagram Protocol (UDP), or Stream Control Transmission Protocol (SCTP). It is text-based and incorporates Hypertext Transfer Protocol (HTTP) and the Simple Mail Transfer Protocol (SMT) elements.
Teleradiology and Picture Archiving and Communications Systems (PACs): Remote site where the patient is presented during telemedicine encounter or where the professional requesting consultation with a specialist is located.
Throughput: A statement established by consensus or authority that provides a benchmark for measuring quality and that is aimed at achieving optimal results.
Transmission Rate: Type of telehealth encounter or consult that uses still digital images of patient data for rendering a medical opinion or diagnosis. Common services include radiology, pathology, dermatology, ophthalmology, and wound care. Store and forward includes the asynchronous transmission of clinical data from one site to another.
Unified Medical Language System (UMLS): An electrical device that selects the path of a video transmission.
Universal Service Administrative Company (USAC): Interactive video connections that transmit information in both directions during the same time period.
Videoconferencing: The use of software that allows devices and systems to share data and communicate with one another.
Virtual Private Network (VPN): Clinical Terms (SNOMED CT): Provides core general terminology for EHRs and contains more than 311,000 active concepts with unique meanings and formal logic-based definitions organized into hierarchies. When implemented in software it can be used to represent clinically relevant information consistently, reliably and comprehensively as an integral part of producing electronic health records. (http://www.ihtsdo.org/snomed-ct/)
Wide Area Network (WAN): File format for digital images that are generally uncompressed, often used for document imagery (e.g., fax and scanner applications).
WiFi: The underlying communications rules and protocols that allow computers to interact with each other and exchange data on the Internet.
2019 State of the States Report
This comprehensive, state-by-state analysis includes a review of how patient settings, different technologies, and provider types are treated across the country, as well as detailed information on the unique policies dictating reimbursement and coverage of telehealth services in the U.S.