From detailed guides to online courses – resources are available to provide you with the knowledge necessary to build and integrate EHR applications.

Appendix B: Terms & Concepts

The following key terms and concepts are used throughout this document:

Certificate: used for authentication, this is an electronic file in a format in accordance with ITU-T recommendation X.509, containing the public key of a registrant and related information, digitally signed with the private key of the Certificate Authority (CA) issuing it, and including the ID for the certificate policy. A certificate identifies its registrant, contains a public key corresponding to a private key under the control of the registrant, identifies its operational period, contains a certificate serial number, and is digitally signed by the Certificate Authority issuing it.

Conceptual information architecture (CIA): a complete high-level view of information constituting an individual’s EHR in the Ontario health system, and an outline of its structure

Consent and consent directive: consent is the explicit or implicit granting of access to specified information. A consent directive is defined as express instruction(s) from a health care client (or someone authorized to act on the client’s behalf) to his/her HIC, regarding the collection, use, or disclosure of the client’s PHI.

Data exchange: the process of taking data structured under a source schema or standard, and transforming it into a target schema or standard so that it is an accurate representation of the source data 

Data standard: a standard that enables functional interoperability by defining the required content and format in which particular types of data are to be exchanged 

Domain repositories: disciplines in the health sector are referred to as clinical domains. Domain repositories are applications that collect, store, and support the use of clinical data about health care clients for a domain, and also provide business services for accessing and managing data. Examples include lab, drugs, and diagnostic imaging domain repositories.

eHealth Ontario Health Information Access Layer (HIAL) segment: an instance of the HIAL architectural concept, owned by eHealth Ontario and used as the access point for provincially-owned, shared EHR resources

Electronic medical record (EMR): a partial health record under the custodianship of a health care provider(s) holding a portion of the relevant health information about a person over their lifetime. This is often described as a provider-centric or health organization-centric health record of a person. The EMR represents a point of service application used by providers in their practice management and patient care, for storage, retrieval and manipulation of (for example) patient health records, clinical encounter notes, medications, orders, test results and a cumulative patient profile.

Electronic health record (EHR): secure and private lifetime record of key health history and care within the Ontario health system. The record is available electronically to authorized health care providers and the individual anywhere, anytime in support of high quality care. 

Electronic health record (EHR) application: a system that provides health care client data from multiple domain repositories and registries in the EHR for specialized use. EHR applications are more function-rich than the domain repositories. An example would be Public Health.

Electronic health record solution (EHRS): Canada Health Infoway defines EHRS as “a combination of people, organizational entities, business processes, systems, technology and standards that interact and exchange clinical data to provide high quality and effective health care”.

Federation: an association whose trusted members have agreed to share information across organizational boundaries. Identity federation refers to an association whose trusted members have agreed to share user identity information. 

Freedom of Information and Protection of Privacy Act (FIPPA): Ontario legislation that applies to information that institutions collect, the rights of access to that information by individuals, and the protection of privacy of individuals with respect to their personal information (PI). eHealth Ontario must adhere to all regulations addressed in FIPPA.

Governance: seeks to establish clear chains of responsibility to empower oversight bodies in their decision making, set in place measurements to gauge effectiveness, establish policies to guide the organization and stakeholder community to meet its goals, and allow control mechanisms to ensure compliance, and communication to keep all required parties informed

Health care client: a person who is eligible to receive, has received, or is receiving health care services in Ontario

Health care provider: a person or organization providing health care or other health-related services or products

Health Information Access Layer (HIAL): a single logical interface for EHR interoperability, facilitating the exchange of information between point of service applications and shared information resources. The HIAL abstracts the interfaces, security mechanisms, internal technical specifics, and topology (locations and partitioning) of these systems, and provides common services.

HL7: Health Level Seven International, a not-for-profit, ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services

HL7 v2: an HL7 standard supporting hospital workflows. Originally created in 1987, it defines a series of electronic messages to support administrative, logistical, financial, and clinical processes. 

HL7 v3: an HL7 standard supporting health care workflows. Development of version 3 started around 1995, resulting in an initial standard publication in 2005. The HL7 v3 standard, as opposed to HL7 version 2, is based on a formal methodology (the HDF – HL7 Development Framework) and object-oriented principles. 

Integration: the process of linking computing systems and software applications physically or functionally, to work with each other

Integrating the healthcare enterprise (IHE): an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information. IHE promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs in support of optimal patient care. Systems developed in accordance with IHE communicate with one another better, are easier to implement, and enable care providers to use information more effectively. 

Interoperability: the ability of systems to connect to, accept services from, exchange data with, and process data from, other systems, and the extent to which information or instructions sent from one system can be understood by another

Longitudinal health record: health care client-centric electronic health information, from the earliest event to the most recent client encounter

Personal health information (PHI): information about an individual in oral or recorded form, if the information, (a) relates to the physical or mental health of the individual, including information that consists of the health history of the individual’s family, (b) relates to the providing of health care to the individual, including the identification of a person as a provider of health care to the individual, (c) is a plan of service within the meaning of the Home Care and Community Services Act, 1994 for the individual, (d) relates to payments or eligibility for health care, or eligibility for coverage for health care, in respect of the individual, (e) relates to the donation by the individual of any body part or bodily substance of the individual or is derived from the testing or examination of any such body part or bodily substance, (f) is the individual’s health number, or (g) identifies an individual’s substitute decision-maker. 

Personal information (PI): information about an identifiable individual

Personal Health Information Protection Act (PHIPA): an act to a) establish rules for the collection, use and disclosure of PHI about individuals that protect the confidentiality of that information and the privacy of individuals with respect to that information, while facilitating the effective provision of health care b) provide individuals with a right of access to PHI about themselves, subject to limited and specific exceptions set out in this act, c) provide individuals with a right to require the correction or amendment of PHI about themselves, subject to limited and specific exceptions set out in this act d) provide for independent review and resolution of complaints with respect to PHI e) provide effective remedies for contraventions of this act

Portal: a website providing a single point of access to online services for a target group of users, aggregating information from multiple sources and presenting it as a unified whole

Portlets: pluggable software components that can be configured and displayed in a portal (or multiple portals based on the same standard), to provide access to information sources or applications 

Point of service (POS) application or system: a system employing EHRs in a clinical setting (e.g. an EMR system in a health care provider’s office, a laboratory information system, or a hospital information system)

Privacy: an individual’s right to control the collection, use, and disclosure of his/her PHI and/or PI

Regional Health Information Access Layer segment: one instance of the HIAL architectural concept, owned by one of ConnectingGTA (cGTA), ConnectingSouthWestOntario (cSWO), or ConnectingNorthernandEasternOntario (cNEO) and used as the access point to that region’s EHR resources as well as provincially owned shared EHR resources

Regional hub: a set of integrated ehealth services and infrastructure for a defined region of Ontario, which includes a HIAL segment, a provider portal, clinical repositories, and applications for that region

Registry: the authoritative source of reference information for an ehealth entity (e.g. clients, providers, systems). It also provides services to allow authorized users to access applicable functionality (such as search, retrieve, add, update, and merge), while protecting the privacy of the entity. Registry information is often consolidated information from multiple authoritative sources. 

Security: the protection of the confidentiality, integrity, and availability of information Confidentiality seeks to prevent unauthorized access to data; integrity seeks to prevent unauthorized modification of data; availability seeks to provide information when needed

Service-oriented architecture (SOA): a business-driven IT architectural approach that supports integrating the business as linked, repeatable business tasks, or services. At a technical level, it is a component model interrelating functional units of an application, called services, through well-defined interfaces. The interface is standards-based and independent of the hardware platform, the operating system, and the programming language implemented for the service.

Simple Object Access Protocol (SOAP): a protocol specification for exchanging structured information in the implementation of web services in computer networks. SOAP uses XML technologies to define an extensible messaging framework providing a message construct to be exchanged over a variety of underlying protocols. The framework has been designed to be independent of any particular programming model and other implementation-specific semantics, and is specified by the W3C recommendation.

Standard(s): accepted rule or format used to establish uniformity or consistency, including documented agreements containing specifications, or other precise criteria to be used consistently as rules, guidelines, or definitions

Terminology standard: a standard that enables semantic interoperability by defining comprehensive clinical language terms and their relationships to other terms that health care providers can use to observe diagnose and treat clients

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